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Rachamin Y, Senn O, Streit S, Dubois J, Deml MJ, Jungo KT. Impact of the COVID-19 pandemic on the intensity of health services use in general practice. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The COVID-19 pandemic affects non-COVID-19-related health services use due to shutdown measures and fears of potential coronavirus infection or fears of overwhelmed health systems. We aimed to explore the impact of the shutdown in spring 2020 on the intensity of health services use (consultation counts, chronic disease measurement counts) in Swiss general practice.
Methods
Based on electronic medical records from 278 general practitioners in Switzerland, we built two patient cohorts: (1) Jan-Jun 2019 (173,523 patients); (2) Jan-Jun 2020 (179,086 patients). We used linear regression analysis to model weekly consultation counts, as well as weekly blood pressure (BP) and glycated hemoglobin (HbA1c) measurement counts, per 100 patients. We calculated expected values in absence of a shutdown and compared them to actual observed values in 2020. The analyses were repeated for selected at-risk groups (patients with hypertension, diabetes, or cardiovascular disease) and different age groups (<60 years, 60-80 years, and >80 years).
Results
During the shutdown period (calendar weeks 13-19 in 2020), weekly consultation counts were lower than non-shutdown models predicted. Consultation rates reduced by 17.2% for the total population, 16.5% for patients with hypertension, 17.5% for patients with diabetes, and 17.6% for patients with cardiovascular disease. Between different age groups, consultation counts reduced by 15.7% for patients aged <60 years, 20.4% for patients aged 60-80 years, and 14.5% for patients aged >80 years. Weekly BP counts reduced by 35.3% in the total population and by 35.0% for patients with hypertension. Weekly HbA1c counts reduced by 33.2% in the total population and by 29.8% for patients with diabetes. P-values were <0.001 for all reported estimates.
Conclusions
We found a significant decrease in the intensity of health services use in Swiss general practice during the shutdown in spring 2020.
Key messages
We demonstrate that the intensity of health services use in general practice decreased during the first Swiss shutdown in spring 2020, overall and among patients with chronic conditions. It is crucial that health systems remain able to meet the non-COVID-19-related health care needs of patients during shutdowns, especially for patients with chronic conditions who require regular care.
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Affiliation(s)
- Y Rachamin
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - O Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - S Streit
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - J Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - MJ Deml
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | - KT Jungo
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
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Deml M, Jungo K, Rachamin Y, Gicquel F, Dubois M, Bertato S, Dubois J, Senn O, Streit S. Continuity of care during the COVID-19 pandemic: Qualitative results from a mixed-methods study. Eur J Public Health 2021. [PMCID: PMC8574681 DOI: 10.1093/eurpub/ckab164.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Decreases in health service use were observed globally during the COVID-19 pandemic. In the quantitative part of this mixed-methods study, we documented similar trends in Switzerland, with a retrospective cohort study showing a 15-20% decrease in general practitioner (GP) consultations/chronic disease monitoring in spring 2020. These changes need to be understood, particularly for individuals at risk of COVID-19 complications, as many have conditions requiring regular monitoring. Methods With a mixed-methods design, we examine continuity of care for at-risk groups (people: ≥65-years-old, with cancer, diabetes, respiratory disease, etc.) between Mar-2020 and Apr-2021. Following quantitative analyses, we qualitatively studied changes in GP/patient practices thru semi-structured interviews with 23 GPs and 36 at-risk patients. We here focus on thematically analyzed qualitative results. Results Qualitative data helped explain observed reductions in consultations/monitoring: 1) some patients were discouraged to seek care by official recommendations and/or GPs during the first semi-shutdown; 2) some patients perceived GP offices as closed/overburdened; 3) some patients feared contracting coronavirus; 4) some patients sought alternatives to traditional primary care consultations (e.g., tele-consultations, consulting pharmacists/other professionals, self-reliance). Many patients did not feel that there was discontinuity of their cares. GPs commonly described feeling like an underutilized resource during the pandemic and explained how they could have been mobilized for population needs. Conclusions During the first wave, there was a mismatch between 1) GPs' reported availability/preparedness to adequately care for at-risk patients, and 2) some GPs discouraging at-risk patients to come for consultations, at-risk patients' perceptions that their care was not “urgent” in a pandemic setting, and patient perceptions that GPs were otherwise unavailable/overburdened. Key messages Qualitative data offer explanations for health service use reductions during the COVID-19 pandemic. Results provide potential paths forward and highlight GP views of being an underutilized resource.
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Affiliation(s)
- M Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
| | - K Jungo
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Y Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - F Gicquel
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
| | - M Dubois
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
| | - S Bertato
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - J Dubois
- Institute of Family Medicine, University of Fribourg, Fribourg, Switzerland
| | - O Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - S Streit
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
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Jungo KT, Cheval B, Sieber S, van der Linden BWA, Ihle A, Carmeli C, Chiolero A, Streit S, Cullati S. Life course socioeconomic conditions, multimorbidity and polypharmacy in older adults. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.1133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Many older adults have multiple chronic conditions (multimorbidity). With multimorbidity often comes the concurrent intake of multiple medications (polypharmacy). Our aims were to assess if childhood socioeconomic conditions (CSC) are associated with multimorbidity and polypharmacy in older adults, and how these associations change when adjusting for adulthood socioeconomic conditions (ASC).
We used data from the European longitudinal Survey of Health, Ageing, and Retirement (SHARE), which follows individuals aged 50 years and over in 27 countries since 2004. We analysed data from 35,229 individuals with multimorbidity (mean age: women=64.1, men=65.4) and 20,757 individuals with polypharmacy (mean age: women=69.2, men=70.2). Multimorbidity was defined as 2 or more self-reported chronic conditions and polypharmacy as the intake of 5 or more medications. Confounder-adjusted multilevel logistic regression models were used to analyse associations of CSC (5 categories: most disadvantaged-most advantaged) and ASC with multimorbidity and polypharmacy. All analyses were adjusted for country, age, weight, alcohol consumption, smoking status and physical exercise. In addition, we adjusted the polypharmacy model with the number of chronic conditions, mental health, activities of daily living and living situation. We stratified the analyses by sex.
34% of women had multimorbidity and 26% received polypharmacy. In men, these percentages were 34% and 28%. All categories of CSC (except for disadvantaged CSC in men) were associated with multimorbidity. In both sexes, a higher advantage was associated with lower odds of multimorbidity. In women, advantaged and most advantaged CSC were associated with lower odds of polypharmacy (OR = 0.53, 95% CI 0.31-0.89; OR = 0.48, 95% CI 0.24-0.94). In men, CSC were not associated with polypharmacy. ASC attenuated the association of CSC with multimorbidity among women, but CSC remained associated. In men, CSC were attenuated after adjusting for ASC.
Key messages
Lower childhood socioeconomic conditions increase the odds of having multiple chronic conditions in older adults. In women, the odds of polypharmacy are marginally linked with CSC. Less disadvantaged socioeconomic conditions in adulthood may allow for compensating a more disadvantaged start in life, particularly in men.
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Affiliation(s)
- K T Jungo
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - B Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - S Sieber
- Swiss NCCR, University of Geneva, Geneva, Switzerland
- Institute of Demography and Socioeconomics, University of Geneva, Geneva, Switzerland
| | - B W A van der Linden
- CIGEV, University of Geneva, Geneva, Switzerland
- Population Aging Research Center, University of Pennsylvania, Philadelphia, USA
| | - A Ihle
- Swiss NCCR, University of Geneva, Geneva, Switzerland
- CIGEV, University of Geneva, Geneva, Switzerland
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - C Carmeli
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
| | - A Chiolero
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - S Streit
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - S Cullati
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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Jungo KT, Mantelli S, Rozsnyai Z, Reeve E, Poortvliet RKE, Gussekloo J, Rodondi N, Streit S. Are general practitioners willing to deprescribe in oldest-old patients with polypharmacy? Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz186.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Managing the growing number of oldest-old patients with multimorbidity and polypharmacy in primary health care poses an increasing public health challenge. Since inappropriate polypharmacy can harm patients’ health, general practitioners (GPs) should regularly review patients’ medications and, if necessary, deprescribe. This case vignette study evaluates the deprescribing decisions of GPs from 31 countries and compares the factors influencing GPs’ deprescribing decisions.
We invited GPs to participate in an online survey, containing a) three cases of increasingly dependent oldest-old multimorbid patients with potentially inappropriate polypharmacy and b) Likert-scale questions assessing the importance of factors influencing deprescribing. We presented each case with and without history of cardiovascular disease (CVD). For each case, we asked whether GPs would deprescribe any medication and, if so, which one(s). We calculated percentages of GPs deprescribing at least one medication in each case, compared cases with/without CVD history and different levels of dependency in activities of daily living, and calculated the percentage of factors rated as important or very important.
Of 3175 invited GPs from 31 countries, 53% responded (N = 1’706) with a mean age of 50 years and 60% females. Results are preliminary, but despite some differences across GP characteristics (male/female, age) and across countries, GPs generally showed a high willingness to deprescribe in oldest-old patients (>80 years) with polypharmacy. GPs were more likely to deprescribe in patients with a higher level of dependency, in the absence of history of CVD, and when patients are on statins, proton-pump inhibitors or potentially inappropriate pain medication. Factors GPs rated as important or very important for the deprescribing decision were patients’ quality of life, risks and benefits of medications, patients’ life expectancy, and potential negative health outcomes resulting from deprescribing.
Key messages
Despite international differences, most GPs report they would deprescribe in older multimorbid patients with polypharmacy. The results will facilitate the development of interventions supporting general practitioners to deprescribe.
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Affiliation(s)
- K T Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - S Mantelli
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Z Rozsnyai
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - E Reeve
- School of Pharmacy and Medical Sciences, Division of Health Sciences, University of South Australia, Adelaide, Australia
- Canada College of Pharmacy, Faculty of Health, Dalhousie University, Halifax, Canada
| | - R K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - J Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands
| | - N Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Kronenberg O, Jungo K, Minder TL, Stassinakis A, Lussi A, Hotz P. [Dental knowledge and evaluation of school dental care by school graduates in Berne canton]. Schweiz Monatsschr Zahnmed 2001; 111:948-56. [PMID: 11590707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
In 1996, a letter was written to 401 High-School level graduates of 20 randomly selected schools in the canton of Berne, Switzerland. Out of these 401, 343 individuals could be interviewed and subsequently be given a clinical examination comprising a plaque revealing test. The average plaque index was 70%. The assessment of the questionnaires showed a comprehensive basic dental knowledge of the students so that reasonable care of their teeth could be expected. Whereas almost everyone used a toothbrush regularly, flossing fell short in the majority of the cases. Outside the class-rooms, concentrated F-preparations were hardly used systematically. Besides parents and the family, dentists and specifically trained auxiliaries (school dental health assistants, SDHA) were found to play a central role in the mediation of theoretical knowledge and in the practical instruction of oral hygiene procedures. They received mostly good grades by the students for their work. The regular teaching staff, however, fell clearly behind the SDHAs. In spite of the obviously big influence on the youth, the dentists play only an insignificant role in some places. Overall, the students consider dental health education as relatively important placing it on the same level as sex education. Since SDHAs do not visit the classes during the last five years any longer, teaching of dental prophylaxis has been reduced in many communities to fluoridation with concentrated F-preparations. Negative consequences such as uncertainty regarding tooth brushing techniques, handling dental floss and questions as to oral hygiene behavior after leaving school have already been registered. With the academic year 2000/01 one visit by an SDHA to the upper level classes (last five years) was reintroduced. This tepid reaction by the Bernese education authority to a massive weakening of public dental health promotion will hardly suffice to keep up the remarkable level of dental prevention reached over the past decades, let alone to warrant substantial progress. The study has also demonstrated that the acquisition of knowledge is based on repetitive efforts. This is the fundamental reason for systematic monitoring and re-instruction of dental hygiene procedures also during the last five classes of mandatory scholarity.
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Affiliation(s)
- O Kronenberg
- Universität Bern, Klinik für Zahnerhaltung, Präventiv- und Kinderzahnmedizin, Freiburgstr. 7, 3010 Bern.
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