MACCABI-RED, community emergency care at the press of a button: a descriptive study.

BACKGROUND: Maccabi-RED is a new service developed in Israel that allows primary care staff to direct urgent cases to specialists in the community for evaluation in their local clinics on the same day as an alternative to an emergency department (ED) visit. A primary care physician or a nurse can activate the service, and all nearby specialists receive "a call" and can decide if they are willing to accept it, thus allowing the patient to avoid an unnecessary visit to the ED. AIM: To quantify and characterize the medical care provided by this service in a large national healthcare system. DESIGN AND SETTING: Multicenter, community-based, retrospective cohort study. METHODS: All Maccabi-RED visits recorded between September 2021 and August 2022 were included. Patient characteristics were compared to national demographics. Descriptive statistics were used to present data regarding recorded diagnoses, treating physicians, treatments or referrals provided, and subsequent emergency department admissions or hospitalizations. RESULTS: 31831 visits were recorded. Most frequent diagnoses were musculoskeletal pain (12.1%), otitis or otalgia (7.8%), contusions (7.6%), fractures (7.1%), foreign body (6.7%), pregnancy-related symptoms (6.3%), and upper-respiratory or unspecified viral infection (6.3%). The most common treatments reported were foreign body removal (5%) and cast application (3.5%). Only 7.8% of visits resulted in emergency department admission within seven days (any cause). The average time from patient request to physician treatment was 91 min. CONCLUSIONS: Maccabi-RED is being widely used by patients nationwide. Additional studies are needed to investigate whether Maccabi-RED reduces emergency department visits and costs.

The use of medical health applications by primary care physicians in Israel: a cross-sectional study.

BACKGROUND: The use of medical health applications (mHealth apps) by patients, caregivers, and physicians is widespread. mHealth apps are often employed by physicians to quickly access professional knowledge, guide treatment, easily retrieve medical records, and monitor and manage patients. This study sought to characterize the use of mHealth apps among primary care physicians (PCPs) in Israel. The reasons for using apps and barriers to their use were also investigated. METHODS: From all MHS' PCPs, we randomly selected 700 PCPs and invited them to complete a questionnaire regarding the use of mHealth apps and attitudes toward them. RESULTS: From August 2020 to December 2020, 191 physicians completed the questionnaire (response rate 27.3%). 68.0% of PCPs reported using mHealth apps. Telemedicine service apps were the most frequently used. Medical calculators (used for clinical scoring) and differential diagnosis apps were the least frequently used. The most common reason for mHealth app use was accessibility, followed by time saved and a sense of information reliability. Among infrequent users of apps, the most common barriers reported were unfamiliarity with relevant apps and preference for using a computer. Concerns regarding information reliability were rarely reported by PCPs. Physician gender and seniority were not related to mHealth app use. Physician age was related to the use of mHealth apps. CONCLUSIONS: mHealth apps are widely used by PCPs in this study, regardless of physician gender or seniority. Information from mHealth apps is considered reliable by PCPs. The main barrier to app use is unfamiliarity with relevant apps and preference for computer use.

Risk Stratification Model for Severe COVID-19 Disease: A Retrospective Cohort Study.

BACKGROUND: Risk stratification models have been developed to identify patients that are at a higher risk of COVID-19 infection and severe illness. Objectives To develop and implement a scoring tool to identify COVID-19 patients that are at risk for severe illness during the Omicron wave. METHODS: This is a retrospective cohort study that was conducted in Israel's second-largest healthcare maintenance organization. All patients with a new episode of COVID-19 between 26 November 2021 and 18 January 2022 were included. A model was developed to predict severe illness (COVID-19-related hospitalization or death) based on one-third of the study population (the train group). The model was then applied to the remaining two-thirds of the study population (the test group). Risk score sensitivity, specificity, and positive predictive value rates, and receiver operating characteristics (ROC) were calculated to describe the performance of the model. RESULTS: A total of 409,693 patients were diagnosed with COVID-19 over the two-month study period, of which 0.4% had severe illness. Factors that were associated with severe disease were age (age > 75, OR-70.4, 95% confidence interval [CI] 42.8-115.9), immunosuppression (OR-4.8, 95% CI 3.4-6.7), and pregnancy (5 months or more, OR-82.9, 95% CI 53-129.6). Factors that were associated with a reduced risk for severe disease were vaccination status (patients vaccinated in the previous six months OR-0.6, 95% CI 0.4-0.8) and a prior episode of COVID-19 (OR-0.3, 95% CI 0.2-0.5). According to the model, patients who were in the 10th percentile of the risk severity score were considered at an increased risk for severe disease. The model accuracy was 88.7%. CONCLUSIONS: This model has allowed us to prioritize patients requiring closer follow-up by their physicians and outreach services, as well as identify those that are most likely to benefit from anti-viral treatment during the fifth wave of infection in Israel, dominated by the Omicron variant.

Treatment outcomes of acute streptococcal tonsillitis according to antibiotic treatment. A retrospective analysis of 242,366 cases treated in the community.

BACKGROUND: Acute upper respiratory infections are the most common reason for primary physician visits in the community. This study investigated whether the type of antibiotic used to treat streptococcal tonsillitis can reduce the burden by affecting the number of additional visits. OBJECTIVES: To assess the effect of different antibiotic treatments for tonsillitis on the number of additional primary physician visits and the development of infectious or inflammatory sequels. METHODS: This retrospective study included first cases of culture-confirmed streptococcal tonsillitis (n = 242,366, 55.3% females, 57.6% aged 3-15 years) treated in primary clinics throughout Israel between the years 2010 and 2019. Primary outcomes were the number of additional primary physician visits, due to any cause or due to specific upper airway infections. Secondary outcomes were the number of developed complications, such as peritonsillar abscess, post-streptococcal glomerulonephritis, rheumatic fever, post-streptococcal arthritis, chorea and death. RESULTS: Compared to penicillin-V, adjusted incidence rate ratios (IRR) for additional primary physician visits at 30-days were highest for IM benzathine-benzylpenicillin (IRR = 1.46, CI 1.33-1.60, p < .001) and cephalosporin treatment (IRR = 1.27, CI 1.24-1.30, p < .001). Similar results were noted for visits due to specific diagnoses such as recurrent tonsillitis, otitis media and unspecified upper respiratory tract infection. Amoxicillin showed decreased adjusted odds ratio (aOR) of developing complications (aOR = 0.68, CI 0.52-0.89, p < .01 for any complication. aOR = 0.75, CI 0.55-1.02, p = .07 for peritonsillar or retropharyngeal abscess). CONCLUSION: Penicillin-V treatment is associated with fewer additional primary physician visits compared to other antibiotic treatments. Amoxicillin and penicillin-V are associated with fewer complications. These findings are limited by the retrospective nature of the study and lack of adjustment for illness severity. Further prospective studies may be warranted to validate results.