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1.
Lancet Diabetes Endocrinol ; 9(3): 165-173, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33549162

RESUMEN

BACKGROUND: The prevalence of diabetes has increased in the UK and other high-income countries alongside a substantial decline in cardiovascular mortality. Yet data are scarce on how these trends have changed the causes of death in people with diabetes who have traditionally died primarily of vascular causes. We estimated how all-cause mortality and cause-specific mortality in people with diabetes have changed over time, how the composition of the mortality burden has changed, and how this composition compared with that of the non-diabetes population. METHODS: In this epidemiological analysis of primary care records, we identified 313 907 individuals with diabetes in the Clinical Practice Research Datalink, a well described primary care database, between 2001 to 2018, and linked these data to UK Office for National Statistics mortality data. We assembled serial cross sections with longitudinal follow-up to generate a mixed prevalence and incidence study population of patients with diabetes. We used discretised Poisson regression models to estimate annual death rates for deaths from all causes and 12 specific causes for men and women with diabetes. We also identified age-matched and sex matched (1:1) individuals without diabetes from the same dataset and estimated mortality rates in this group. FINDINGS: Between Jan 1, 2001, and Oct 31, 2018, total mortality declined by 32% in men and 31% in women with diagnosed diabetes. Death rates declined from 40·7 deaths per 1000 person-years to 27·8 deaths per 1000 person-years in men and from 42·7 deaths per 1000 person-years to 29·5 deaths per 1000 person-years in women with diagnosed diabetes. We found similar declines in individuals without diabetes, hence the gap in mortality between those with and without diabetes was maintained over the study period. Cause-specific death rates declined in ten of the 12 cause groups, with exceptions in dementia and liver disease, which increased in both populations. The large decline in vascular disease death rates led to a transition from vascular causes to cancers as the leading contributor to death rates in individuals with diagnosed diabetes and to the gap in death rates between those with and without diabetes. INTERPRETATION: The decline in vascular death rates has been accompanied by a diversification of causes in individuals with diagnosed diabetes and a transition from vascular diseases to cancers as the leading contributor to diabetes-related death. Clinical and preventative approaches must reflect this trend to reduce the excess mortality risk in individuals with diabetes. FUNDING: Wellcome Trust.


Asunto(s)
Causas de Muerte/tendencias , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/mortalidad , Mortalidad/tendencias , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Causalidad , Diabetes Mellitus/epidemiología , Inglaterra/epidemiología , Femenino , Humanos , Masculino , Registro Médico Coordinado , Persona de Mediana Edad
2.
J Prim Care Community Health ; 12: 2150132721994018, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33567941

RESUMEN

OBJECTIVE: To examine the reasons contributing to the physician shortage in the country's medically underserved areas using the state of Delaware as a focus state. METHOD: A literature review regarding the shortage of physicians with data compilation from Delaware Department of Public Health (DPH) and Delaware Health and Social services (DHSS) was performed. A review of the "Conrad 30 J1 VISA waiver program," the most important and primary supplier of physicians to underserved areas of the state was performed. A survey interviewing the physicians recruited through this program to identify any challenges faced by them was designed and conducted. RESULTS: The number of primary care physicians providing direct patient care in Delaware in 2018 had declined about 6% from 2013. The average wait time to see a PCP was 8.2 days in 1998 as compared to 23.5 days in 2018. Forty-six percent of physicians serving in HPSAs in Delaware are IMGs recruited through the J1 VISA waiver program. Eighty percent of these IMGs are actively considering leaving the United States due to anxieties around physician immigration policies, mainly "Immigration backlog." CONCLUSION: The existing programs to recruit physicians to underserved areas seem to be inadequate. The state and the hospital systems should be able to utilize the J1 program to its full potential and focus on retaining these physicians after their assigned services. As the challenges of IMGs continue to worsen every day; the medical societies, hospitals, the state and federal government should advocate for policies that resolve these challenges.


Asunto(s)
Área sin Atención Médica , Médicos/provisión & distribución , Atención Primaria de Salud/estadística & datos numéricos , Servicios de Salud Rural/estadística & datos numéricos , Delaware , Humanos
3.
CMAJ ; 193(6): E200-E210, 2021 02 08.
Artículo en Inglés | MEDLINE | ID: mdl-33558406

RESUMEN

BACKGROUND: Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada. METHODS: This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period. RESULTS: Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%). INTERPRETATION: Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.


Asunto(s)
Visita a Consultorio Médico/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Consulta Remota/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Pandemias , Atención Primaria de Salud/tendencias , Estudios Retrospectivos , Adulto Joven
4.
BMC Fam Pract ; 22(1): 31, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33535973

RESUMEN

BACKGROUND: Interprofessional primary care (IPC) teams provide comprehensive and coordinated care and are ideally equipped to support those populations most at risk of adverse health outcomes during the COVID-19 pandemic, including older adults, and patients with chronic physical and mental health conditions. There has been little focus on the experiences of healthcare teams and no studies have examined IPC practice during the early phase of the COVID-19 pandemic. The objective of the study was to describe the state of interprofessional health provider practice within IPC teams during the COVID-19 pandemic. METHODS: Observational cross-sectional design. A web-based survey was deployed to IPC providers working in team-based primary care clinics in the province of Ontario, Canada. The survey included 26 close-ended and six open-ended questions. Close-ended questions were analyzed using descriptive statistics. Content analysis was used to analyze the open-ended questions. RESULTS: 445 surveys were included in the final analysis. Service delivery shifted from in-person care (77% pre-COVID-19) to telephone (76.5% during the COVID-19 pandemic). Less than half of the respondents (40%) reported receiving any training for virtual delivery. Wait times to access team members were reported to have decreased. There has also been a shift in what IPC providers report as the most commonly seen conditions, with increases in visits related to mental health concerns, acute infections (including COVID-19), social isolation, and resource navigation. Respondents also reported a reduction in healthcare provision for multiple chronic conditions including diabetes, cardiovascular disease, and chronic pain. CONCLUSIONS: IPC teams are rapidly shifting their practice to supporting their patients during the pandemic. A surge in mental health issues has been seen and is expected to continue to increase in response to COVID-19. Understanding early experiences can help plan for future pandemic waves.


Asunto(s)
/epidemiología , Relaciones Interprofesionales , Atención Primaria de Salud/métodos , Estudios Transversales , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Ontario/epidemiología , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Encuestas y Cuestionarios
5.
Medicine (Baltimore) ; 100(4): e24422, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33530241

RESUMEN

ABSTRACT: Hypertensive patients commonly co-exist persistent depressive symptoms. However, these issues are not always identified, especially in primary health care, which may worsen the prognosis of hypertension. Therefore, the aim of this study was to determine the prevalence and risk factor of depression, and to develop risk nomogram of depression in hypertensive patients from primary health care Northwest China.We used a stratified multistage random sampling method to obtain 1856 hypertensives subjects aged ≥18 years in Xinjiang between April and October 2019. The subjects were randomly divided into a training set (n = 1299) and a validation set (n = 557). Depression was evaluated by Hospital Anxiety and Depression Scale (HADS), with a cut-off score ≥8. Using the least absolute shrinkage and selection operator (LASSO) regression model, we identified optimized risk factors of depression in the training set, followed by the establishment of prediction nomogram. The discriminative ability, calibration, and clinical usefulness of nomogram were assessed. The results were verified by internal validation in validation set.13.7% hypertensive subjects displayed depression. Seven independent risk factors of depression were identified and entered into the nomogram including age, region, ethnicity, marital status, physical activity, sleep quality, and control of hypertension. The nomogram displayed robust discrimination with an AUC of 0.760 [95% confidence interval (CI): 0.724-0.797)] and 0.761 (95%CI: 0.702-0.819), and good calibration in training set and validation set, respectively. The decision curve analysis and clinical impact curve demonstrated clinical usefulness of predictive nomogram.There is a considerable prevalence of depression in patients with hypertension from primary care of Xinjiang, Northwest China. Our nomogram may help primary care providers assess the risk of depression in patients with hypertension.


Asunto(s)
Depresión/epidemiología , Depresión/etiología , Hipertensión/psicología , Nomogramas , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Adulto , Calibración , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , Escalas de Valoración Psiquiátrica , Análisis de Regresión , Factores de Riesgo , Adulto Joven
6.
Lancet Public Health ; 6(2): e124-e135, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33444560

RESUMEN

BACKGROUND: The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK. METHODS: We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019-September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles. FINDINGS: We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3-47·4), anxiety disorders by 47·8% (44·3-51·2), and first antidepressant prescribing by 36·4% (33·9-38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18-44 and 45-64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8-40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0-76·4]). INTERPRETATION: Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised. FUNDING: National Institute for Health Research and Medical Research Council.


Asunto(s)
/psicología , Trastornos Mentales/terapia , Atención Primaria de Salud/estadística & datos numéricos , Conducta Autodestructiva/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Incidencia , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Conducta Autodestructiva/epidemiología , Reino Unido/epidemiología , Adulto Joven
8.
Am J Manag Care ; 27(1): 21-26, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33471458

RESUMEN

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic forced health systems to offer video and telephone visits as in-person visit alternatives. Although video visits offer some benefits compared with telephone visits, they require complex setup, which may disadvantage some patients due to the "digital divide." Our objective was to determine patient and neighborhood characteristics associated with visit modality. STUDY DESIGN: This was a cross-sectional study across 1652 primary care and specialty care practices of adult patients at an integrated health system from April 23 to June 1, 2020. METHODS: We used electronic health record and administrative data. Our primary outcome was visit modality (in-person, video, or telephone), which was captured using billing codes. We assessed predictors of using video vs telephone using multivariable logistic regression. We used hierarchical logistic regression to determine the contribution of patient-, physician-, and practice-level components of variance in the choice of video or telephone visits. RESULTS: We analyzed 231,596 visits by 162,102 patients. Sixty-five percent of the visits were virtual (31.7% telephone, 33.5% video). Patients who were older than 65 years (adjusted odds ratio [AOR], 0.41; 95% CI, 0.40-0.43), Black (AOR, 0.60; 95% CI, 0.57-0.63), Hispanic (AOR, 0.76; 95% CI, 0.73-0.80), Spanish-speaking (AOR, 0.57; 95% CI, 0.52-0.61), and from areas with low broadband access (AOR, 0.93; 95% CI, 0.88-0.98) were less likely to use video visits. Practices (38%) and clinicians (26%) drove more of the variation in video visit use than patients (9%). CONCLUSIONS: Telemedicine access differences may compound disparities in chronic disease and COVID-19 outcomes. Institutions should monitor video visit use across demographics and equip patients, clinicians, and practices to promote telemedicine equity.


Asunto(s)
/epidemiología , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Actitud del Personal de Salud , Estudios Transversales , Registros Electrónicos de Salud/estadística & datos numéricos , Humanos , Modelos Logísticos , Programas Controlados de Atención en Salud/organización & administración , Derivación y Consulta/estadística & datos numéricos
9.
Am J Manag Care ; 27(1): e4-e6, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33471462

RESUMEN

OBJECTIVES: Prior to the coronavirus disease 2019 (COVID-19) pandemic, introductions between primary care physicians (PCPs) and specialists were conducted in person. These important meetings were integral to patient care, facilitated care coordination, and improved the managed care of the patient. During COVID-19 and beyond, these important relationships should be fostered via digital means. We aimed to identify opportunities of digital health integration for the optimization of physician integration. STUDY DESIGN: Cross-sectional study. METHODS: Prior to COVID-19, we conducted a survey of PCPs at a large multidisciplinary group with more than 1500 physicians that staffs multiple hospitals within a health system. The survey was sent via email with only 1 reminder. RESULTS: Thirty-six PCPs responded to the survey; 25% (9/36) were very satisfied and 19.4% (7/36) were moderately satisfied with the current in-person introductions. The PCPs found introductions to specialists helpful; 83.7% (31/37) wanted to "put a name to the face," and 64.9% (24/37) wanted to "understand the range of service provided by the specialist." Fifty-one percent (19/37) and 54% (20/37) said "I can better manage patient care and know when to refer to a specialist" and "I learn more about a particular specialist," respectively, with specialist introductions. If made easy, 67.6% (25/37) of PCPs would be interested in TeleConnect to facilitate introductions to specialists. CONCLUSIONS: Referrals between PCPs and specialists have been an integral aspect of medical care within managed care organizations. With the advent of technology during COVID-19, and along with this brief survey, the need for digital means to introduce PCPs and specialists is underscored.


Asunto(s)
/epidemiología , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Actitud del Personal de Salud , Estudios Transversales , Femenino , Humanos , Masculino , Programas Controlados de Atención en Salud/organización & administración , Derivación y Consulta/estadística & datos numéricos
11.
Hypertension ; 77(3): 846-855, 2021 03 03.
Artículo en Inglés | MEDLINE | ID: mdl-33325240

RESUMEN

Hypertension has been identified as a risk factor for coronavirus disease 2019 (COVID-19) and associated adverse outcomes. This study examined the association between preinfection blood pressure (BP) control and COVID-19 outcomes using data from 460 general practices in England. Eligible patients were adults with hypertension who were tested or diagnosed with COVID-19. BP control was defined by the most recent BP reading within 24 months of the index date (January 1, 2020). BP was defined as controlled (<130/80 mm Hg), raised (130/80-139/89 mm Hg), stage 1 uncontrolled (140/90-159/99 mm Hg), or stage 2 uncontrolled (≥160/100 mm Hg). The primary outcome was death within 28 days of COVID-19 diagnosis. Secondary outcomes were COVID-19 diagnosis and COVID-19-related hospital admission. Multivariable logistic regression was used to examine the association between BP control and outcomes. Of the 45 418 patients (mean age, 67 years; 44.7% male) included, 11 950 (26.3%) had controlled BP. These patients were older, had more comorbidities, and had been diagnosed with hypertension for longer. A total of 4277 patients (9.4%) were diagnosed with COVID-19 and 877 died within 28 days. Individuals with stage 1 uncontrolled BP had lower odds of COVID-19 death (odds ratio, 0.76 [95% CI, 0.62-0.92]) compared with patients with well-controlled BP. There was no association between BP control and COVID-19 diagnosis or hospitalization. These findings suggest BP control may be associated with worse COVID-19 outcomes, possibly due to these patients having more advanced atherosclerosis and target organ damage. Such patients may need to consider adhering to stricter social distancing, to limit the impact of COVID-19 as future waves of the pandemic occur.


Asunto(s)
Presión Sanguínea/efectos de los fármacos , Hipertensión/epidemiología , Pandemias , Adulto , Anciano , Anciano de 80 o más Años , Antihipertensivos/uso terapéutico , Aterosclerosis/epidemiología , Comorbilidad , Inglaterra/epidemiología , Grupos Étnicos/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Hipertensión/tratamiento farmacológico , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Análisis de Supervivencia , Resultado del Tratamiento
12.
Sports Health ; 13(1): 91-94, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32662740

RESUMEN

BACKGROUND: The preparticipation physical evaluation (PPE) is a requirement for high school sport participation in most states, but its location and role in preventive health care for adolescents is often questioned. HYPOTHESIS: Athletes who had their PPE performed in an office setting, in particular) by their primary care physician (PCP), will have higher human papillomavirus (HPV) immunization rates than those who had their PPE done in a group setting at a mass-participation PPE. STUDY DESIGN: Retrospective cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: The PPE forms and immunization records for athletes at a single high school were reviewed to determine the location of PPE, the signing practitioner, and HPV immunization status. RESULTS: A total of 488 athletes (286 males, 202 females) were included; 51% had received at least 1 dose of the HPV vaccine while 39% had completed the series. There was no significant difference in vaccination rates between examination in an office setting versus a group setting. Athletes receiving their PPE at an urgent care facility had significantly lower rates of HPV series completion than all other settings (29% vs 43%; P = 0.004). PPE completion by the athlete's PCP was associated with higher rates of vaccine series completion (46% vs 34%; P = 0.014). CONCLUSION: Athletes who completed their PPE in mass event and office-based settings had similar rates of HPV vaccine series initiation and completion. PPEs done at urgent care facilities were associated with low rates of vaccine series completion, while those done by a PCP were associated with higher rates. CLINICAL RELEVANCE: HPV immunization rates in athletes are low, and the PPE represents a potential opportunity to improve immunization rates.


Asunto(s)
Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Examen Físico , Atención Primaria de Salud/estadística & datos numéricos , Deportes , Vacunación/estadística & datos numéricos , Adolescente , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Humanos , Masculino , Michigan , Estudios Retrospectivos , Instituciones Académicas
13.
N Z Med J ; 133(1527): 51-70, 2020 12 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332328

RESUMEN

AIM: To update data previously published on the health profile of the refugees resettling in New Zealand, and to draw attention to the change in health profile over time, with a decline of infectious disease/deficiencies, and a rise of non-communicable diseases, a worldwide phenomenon. METHOD: Comparative data was extracted from (1) written annual reports prepared by medical officers at the Mangere Refugee Resettlement Centre (1978-1991), (2) a Microsoft ACCESS patient management system between 1995 and 1999 and (3) a MEDTECH patient management system between 2010 and 2014. RESULTS: Over the period 1979-2014, the rate of infectious diseases has declined markedly in resettling refugees, and the rate of non-communicable diseases has increased. For example, the incidence of tuberculosis has decreased from 4% to 0.2%, gut parasites from more than 40% to, in some intakes, 15% and iron deficiency from 22% to 10%, while the diabetes rate has gone from 0.1% to 2.7%. CONCLUSION: While management of unfamiliar infectious diseases and deficiencies (especially vitamin D) still remains an important part of the management of refugee health, their management usually involves limited time and expense, and their burden is much less than before. However, refugees now resettling in New Zealand and the rest of the world often present with familiar non-communicable diseases that require long-term management.


Asunto(s)
Estado de Salud , Estilo de Vida/etnología , Atención Primaria de Salud/estadística & datos numéricos , Refugiados/estadística & datos numéricos , Adolescente , Adulto , África del Sur del Sahara/etnología , Anciano , Anciano de 80 o más Años , Asia Sudoriental/etnología , Bután/etnología , Índice de Masa Corporal , Niño , Preescolar , Colombia/etnología , Conducta Anticonceptiva/etnología , Conducta Anticonceptiva/tendencias , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/etnología , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Infecciones por VIH/etnología , Infecciones por Helicobacter/etnología , Helicobacter pylori , Humanos , Hipertensión/tratamiento farmacológico , Hipertensión/etnología , Lactante , Recién Nacido , Parasitosis Intestinales/etnología , Irak/etnología , Masculino , Salud Mental/etnología , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Prevalencia , Enfermedades de Transmisión Sexual/etnología , Uso de Tabaco/etnología , Tuberculosis Pulmonar/etnología , Deficiencia de Vitamina D/etnología , Adulto Joven
14.
Rev Saude Publica ; 54: 149, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-33331492

RESUMEN

OBJECTIVE: To characterize the access and use of health services considered reference among the older rural population from a municipality in southern Brazil, whose rural area has full coverage of the Family Health Strategy (FHS), investigating factors associated with the choice of the Basic Family Health Unit (BFHU) as reference. METHODS: This is a cross-sectional study conducted in 2017 with systematic sampling of rural households in the municipality of Rio Grande (RS) using a standardized in-house questionnaire. We performed descriptive analyses of sociodemographic profile, type of reference service chosen, and reasons for choosing/using the prime-choice service and the nearest BFHU. Poisson regression was used to investigate factors associated with the type of reference service chosen. RESULTS: Among the 1,030 older adults who participated in the study, 61.4% considered the BFHU a prime choice/reference service mostly due to its proximity (82.6%); the others sought other places due to a greater ease (34.6%) and resoluteness (52.6%). Almost ⅔ of the respondents sought care at the BFHU during the last year, and the reasons differed among those who considered the unit as reference (chronic disease) and those who sought another place (procedures). We also found that the lower the age, income, education, and household-unit distance, the greater the likelihood of the older adult considering the nearest BFHU as reference service. CONCLUSIONS: The FHS has reached the vulnerable older rural population, approaching an equitable public health system. However, further evaluations are necessary to verify the quality and adequacy of care, given that social structure, enabling factors (such as economic condition), and possible beliefs regarding health still establish the standards for choosing a service.


Asunto(s)
Accesibilidad a los Servicios de Salud , Atención Primaria de Salud , Población Rural , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos
15.
J Prim Care Community Health ; 11: 2150132720975517, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33213264

RESUMEN

Coronavirus disease 2019 (COVID-19) is a newly-identified infectious diseases that has rapidly spread throughout the world with rising fatalities with declaration by World Health Organization as the pandemic. Online consultations have been shown to alleviate the pandemic with our study aims to demonstrate whether online consultation can be a solution for acute health crisis. Retrospective analysis of the characteristics of online consultations through two primary care online-consultation platforms during COVID-19 pandemic was performed at the Third Affiliated Hospital of Sun Yat-Sen University, which led the assessment of COVID-19-symptoms patients in Guangzhou. The 3473 online consultations were divided into pre-pandemic and pandemic period groups with Chi-square test as statistical analysis method. The number of online consultations has increased with diagnosis of upper respiratory tract infection, psychological conditions, COVID-19-related investigations and interventions. The increased online consultations met the increased demand of the relevant clinical services and reduced the overwhelming hospital presentations, thus decreasing the potential COVID-19 spread inside the major tertiary hospital and sparing the resources for acute crisis management. The epidemiology and disease characteristics of online consultations during the pandemic have been demonstrated with identification of the enabling factors and potential barriers in improving online healthcare in China with online consultation model being a durable solution for pandemic in future.


Asunto(s)
Infecciones por Coronavirus/terapia , Neumonía Viral/terapia , Consulta Remota/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos , Centros de Atención Terciaria , Adulto Joven
16.
J Prim Care Community Health ; 11: 2150132720969557, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33174495

RESUMEN

OBJECTIVE: In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. METHODS: We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. RESULTS: There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. CONCLUSIONS: Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.


Asunto(s)
Atención Ambulatoria , Salud del Niño , Infecciones por Coronavirus , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Neumonía Viral , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Betacoronavirus , Chicago/epidemiología , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Registros Electrónicos de Salud , Humanos , Inmunización , Lactante , Visita a Consultorio Médico/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Estudios Retrospectivos , Aislamiento Social , Telemedicina
17.
BMC Psychol ; 8(1): 124, 2020 Nov 25.
Artículo en Inglés | MEDLINE | ID: mdl-33239078

RESUMEN

BACKGROUND: Marital separation is associated with mental health problems, but little is known about how this translates into healthcare use. In this study, we examine the relationship between marital separation and primary healthcare use for mental health problems. METHODS: We used data covering the period from 2005 to 2015 from the Norwegian Population Register, Statistics Norway's Educational Registration System and the Norwegian Health Economics Database. Data were analyzed using logistic regression analysis. To control for time invariant characteristics, we estimated fixed-effect models. RESULTS: Marital separation was associated with increased contact with primary healthcare services for mental health problems (MH-consultations). The prevalence of MH-consultations peaked during the year of marital separation. MH-consultations were more common following marital separation than prior to the separation. This pattern remained significant in the fixed-effect models. CONCLUSIONS: Men and women who experienced marital separation were more likely to consult primary healthcare services for mental health problems than those who remained married. Our study suggests that several mechanisms are in play. The prevalence of MH-consultations of those who eventually separated were higher several years prior to the separation. This lends support to selection mechanisms, whereas the sharp rise in the prevalence of MH-consultations around the time of marital separation coupled to higher levels several years after separation, indicate that marital separation induces both transient stress and leads to more lasting strain.


Asunto(s)
Divorcio/psicología , Salud Mental/normas , Atención Primaria de Salud/estadística & datos numéricos , Femenino , Humanos , Masculino , Estado Civil , Noruega/epidemiología , Prevalencia
18.
Aten. prim. (Barc., Ed. impr.) ; 52(9): 600-607, nov. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-ET6-1372

RESUMEN

OBJETIVO: Determinar la cantidad de envases de broncodilatadores de corta duración (SABA) dispensados en farmacia en un año que se asocia con mayor riesgo de hospitalización por asma en el mismo periodo en pacientes con asma activa. Diseño descriptivo transversal multicéntrico. EMPLAZAMIENTO: Atención primaria, cohorte MAJORICA. Incluye datos codificados durante la práctica asistencial, sociodemográficos, clínicos y del sistema de prescripción electrónica de 68.578 pacientes con EPOC y asma de Baleares. PARTICIPANTES: Se incluyeron 7.648 pacientes mayores de 18 años con asma activa, que retiraron envases de SABA durante el periodo 2014-2015. Se excluyeron pacientes con EPOC. Mediciones principales: Hospitalización por asma, utilización de fármacos respiratorios, tabaquismo, comorbilidades, edad y sexo. RESULTADOS: Edad promedio 47 años, 38% mujeres, 23,2% fumadores activos. Setenta y siete pacientes (1%) ingresaron por exacerbación de asma en el periodo de estudio. Los pacientes que recibieron más de 8 envases de SABA por año aumentaron el riesgo de hospitalización (OR 2,81; IC95% 1,27-6,24). El escalón terapéutico de gravedad, la cantidad de corticoides inhalados, así como la insuficiencia cardíaca y la apnea del sueño se asociaron también significativamente con la hospitalización. CONCLUSIONES: Un mayor escalón terapéutico de gravedad, la presencia de algunas comorbilidades, el consumo de mayor cantidad de corticoides inhalados y de un mayor número de envases de SABA identifica a asmáticos con mayor riesgo de hospitalización. Existe una asociación significativa entre el riesgo de hospitalización y la retirada de un mayor número de envases de SABA de la farmacia. El número de envases/año que mejor define un mayor riesgo de hospitalización es ≥ 8 y se podría utilizar para identificar asmáticos de riesgo


OBJECTIVE: To determine the number of short-acting beta-agonists (SABA) canisters dispensed in a pharmacy during one year that is associated with higher asthma hospitalization risk in the same period in patients with active asthma. Multi-centre cross-sectional descriptive design. LOCATION: Primary care, MAJORICA cohort including sociodemographic, clinical and electronic prescription system data coded during clinical practice from 68,578 patients with COPD and asthma in the Balearic Islands. PARTICIPANTS: A total of 7,648 patients older than 18 years with active asthma, who got any SABA canister from the pharmacy during the 2014-2015 period were included. COPD patients were excluded. Main measurements: Asthma hospitalization, respiratory medication, tobacco, comorbidities, age and gender. RESULTS: Mean age 47 years, 38% women, 23.2% active smokers. Seventy-seven patients (1%) were admitted for asthma exacerbation in the study period. Patients who received more than 8 SABA containers per year increased the risk of hospitalization (OR 2.81; 95% CI 1.27-6.24). Severity by therapeutic step and amount of inhaled corticosteroids, as well as heart failure and sleep apnea were also significantly associated with hospitalization. CONCLUSIONS: There is a significant association between the risk of hospitalization and the higher number of SABA canisters dispensed from the pharmacy. The number of canisters/year that best defines a higher risk of hospitalization is ≥ 8 and could be used to identify asthma at risk


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Broncodilatadores/provisión & distribución , Embalaje de Medicamentos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Asma/epidemiología , Estudios Transversales , Factores de Riesgo , Modelos Logísticos , Factores Sexuales , Factores de Edad , Atención Primaria de Salud/estadística & datos numéricos , España/epidemiología , Azidas , Serotonina/análogos & derivados
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