Extended access to general practice services during weekends in the first wave of the COVID-19 pandemic.

OBJECTIVE: The incidence, symptoms, and trajectories of COVID-19 in the community were unknown in the early phase of the pandemic. Consequently, organizing a primary health care response was challenging. The aim of this study was to investigate whether reorganizing general practice services with extended weekend access for patients was feasible, and to assess the extent to which patients used this service. DESIGN: Observational study with registration after a simple intervention. SETTING: General practice services in the second half of March 2020 when the first wave of the COVID-19 pandemic hit Bergen, the second largest city in Norway. SUBJECTS: All general practices in Bergen were asked to be available during weekends for their patients with respiratory tract infections (RTIs), by telephone, video-, or e-consultation. MAIN OUTCOME MEASURES: Number of practices participating, patients connected to these practices, and consultations for RTIs and suspected COVID-19. RESULTS: During the first weekend, 33 of 71 practices (45%) covering 51% of the population participated. The following weekend this increased to 39 practices (53%) covering 64% of the population. The first weekend 25 practices reported a total of 336 consultations for RTIs, eight of which were for confirmed and 113 were for suspected COVID-19. The corresponding numbers reported from 23 practices the second weekend were 158 RTI consultations, four for confirmed and 41 for suspected COVID-19. CONCLUSIONS: On short notice about half the practices in Bergen were made accessible during weekends for their patients with RTIs. The number of consultations per practice was small, but combined this amounted to a substantial improvement in the emergency services.

Primary care utilization among patients with influenza during the 2009 pandemic. Does risk for severe influenza disease or prior contact with the general practitioner have any influence?

BACKGROUND: Little is known about how patients belonging to risk groups for influenza used the primary care system during the influenza pandemic. AIMS: To investigate the use of general practice and out-of-hours (OOH) services in patients with influenza-like illness (ILI) according to (i) risk for severe influenza disease and (ii) the number of regular general practitioner (GP) visits before the pandemic. METHOD: Observational study of all ILI patients during the 2009 pandemic. Data were recorded prospectively and collected after the pandemic. Patients at risk were identified during an 18-month period by diagnoses from GPs' billing claims. Associations between risk factors for severe influenza disease and utilization of primary care were analysed using bivariate and multivariate regression analyses. Similar analyses were used for the association between number of GP visits before the pandemic and the primary care utilization during the pandemic. RESULTS: ILI patients who were pregnant [odds ratio (OR) 1.70; 95% confidence interval (CI) 1.52, 1.89], had diabetes (OR 1.68; 95% CI 1.49, 1.89) or chronic lung disease (OR 1.44; 95 CI 1.34, 1.55) had increased risk of attending OOH services compared with patients with no risk factor. ILI patients with at least one GP visit prior to the pandemic used OOH services less during the pandemic compared with those with no GP visit. CONCLUSION: An increased use of OOH services was found in ILI patients who were pregnant, with diabetes or with chronic lung disease. Having visited the GP before the pandemic was associated with less use of OOH services among ILI patients.

Capacity and adaptations of general practice during an influenza pandemic.

BACKGROUND: GPs play a major role in influenza epidemics, and most patients with influenza-like-illness (ILI) are treated in general practice or by primary care doctors on duty in out-of-hours services (OOH). Little is known about the surge capacity in primary care services during an influenza pandemic, and how the relationship between them changes. AIM: To investigate how general practice and OOH services were used by patients during the 2009 pandemic in Norway and the impact of the pandemic on primary care services in comparison to a normal influenza season. MATERIALS: Data from electronic remuneration claims from all OOH doctors and regular GPs for 2009. METHODS: We conducted a registry-based study of all ILI consultations in the 2009 pandemic with the 2008/09 influenza season (normal season) as baseline for comparison. RESULTS: The majority (82.2%) of ILI consultations during the 2009 pandemic took place in general practice. The corresponding number in the 2008/09 season was 89.3%. Compared with general practice, the adjusted odds ratio for ILI with all other diagnoses as reference in OOH services was 1.23 (95% CI, 1.18, 1.27) for the 2008/2009 season and 1.87 (95% CI, 1.84, 1.91) for the pandemic influenza season. In total there was a 3.3-fold increase in ILI consultations during the pandemic compared to the 2008/09 season. A 5.5-fold increase of ILI consultations were observed in OOH services in comparison to the 2008/09 season. Children and young adults with ILI were the most frequent users of OOH services during influenza periods. CONCLUSIONS: The autumn pandemic wave resulted in a significantly increased demand on primary care services. However, GPs in primary care services in Norway showed the ability to increase capacity in a situation with increased patient demand.

Influenza-like illness in Norway: clinical course, attitudes towards vaccination and preventive measures during the 2009 pandemic.

OBJECTIVES: To document clinical characteristics of influenza-like illness, reported use of health preventive measures and attitudes towards vaccination among patients with influenza-like illness in general practice during the influenza pandemic in 2009. METHODS: Cross-sectional survey in general practice. Patients, who were identified as having influenza-like illness during the peak of the influenza pandemic activity in Norway, were eligible for inclusion in the study. A questionnaire was sent 2-4 weeks after the patients visit to the GP with influenza-like illness diagnosis during October to December 2009, from general practices in Norway. A sample of responders >18 years also had a blood test to check for serological response to the pandemic H1N1 virus. RESULTS: Questionnaires were sent to 1324 patients, and 357 (27%) were returned. Fever (91% versus 49%, P < 0.01), cough (85% versus 73%, P = 0.016) and gastrointestinal symptoms (58% versus 38%, P < 0.01) were more frequent in the age group <18 years compared to older patients. Serological H1N1 responses were analysed in 72 patients; 34 (47%) were positive (haemagglutination inhibition assay titres ≥ 40). There were no statistically significant differences in symptoms between seropositive and seronegative patients. Women reported better adherence to personal protective measures, such as hand washing and cough etiquette than men. Women were also more concerned about possible adverse effects of the pandemic influenza vaccine than men. CONCLUSIONS: Discrimination between influenza and other viral upper respiratory tract infections is difficult in daily clinical practice, even during an influenza pandemic. A gender difference was found in reported precautions to prevent influenza.

[The influenza pandemic in a Norwegian municipality autumn 2009]. / Influensapandemien hausten 2009 i ein vestlandskommune.

BACKGROUND: In April 2009 the World Health Organization (WHO) declared that spreading of a new influenza A(H1N1) virus had reached epidemic proportions, and on June 11, 2009 they declared that the world was in fact facing a pandemic. In Norway the influenza pandemic was the cause of much activity from health authorities and all levels of the health services. This report concerns pandemic-related work within clinical and community medicine in a municipality in western Norway. MATERIAL AND METHODS: All contacts between the general practitioners (GPs) and patients with influenza-like disease in Austevoll municipality were recorded for the second half of 2009. The lead public health nurse recorded vaccination activity systematically. Absence from secondary school in the municipality was recorded and the Medical Health Officer recorded all pandemic-related activities. RESULTS: 141 patients living in the municipality (3.2 % of the population) contacted the GP for influenza-like disease. Most cases occurred during weeks 43-47. A large majority of the encounters with the GP during these weeks were with patients below 20 years of age, whereas the age distribution was much more diverse at other points in time. Absence from secondary school was also highest in weeks 43-47. 54 % of the municipality's inhabitants were vaccinated. At the end of the main wave of the epidemic, vaccination coverage had reached 28 %. The Medical Health Officer had a large workload, especially during the main wave. INTERPRETATION: The influenza epidemic in 2009 hit Austevoll municipality in weeks 43-47. Mass vaccination was started too late to have a major influence on the epidemic. Systematic mapping of the epidemic on a municipal level is a useful supplement to the national surveillance.