Retos y estrategias para recuperar y dinamizar la atención primaria. Metodología DAFO (Debilidades, Amenazas, Fortalezas y Oportunidades)-CAME (Corregir, Afrontar, Mantener y Explotar) en un departamento de salud / Challenges and strategies to recover and dynamize primary care: SWOT-CAME analysis in a Health Department

Objetivo: Identificar fortalezas, obstáculos, cambios en el entorno y capacidades de los equipos y unidades de apoyo en atención primaria, con el objetivo de proporcionar atención de alta calidad en un área de salud integrada. Diseño: Estudio de métodos mixtos basado en la matriz DAFO y el análisis CAME. Emplazamiento: Atención primaria, Comunidad Valenciana. Participantes: En total han participado 271 profesionales de los diferentes colectivos y representantes de asociaciones de pacientes, 99 en la fase de captura de ideas, 154 en la fase de elaboración de la matriz DAFO y 18 en la fase de elaboración del análisis CAME. Intervenciones: Se condujo un análisis DAFO-CAME a partir del cual se establecieron líneas de acción. La captura de información se realizó mediante grupos nominales, la fase de consenso integrando al conjunto de profesionales mediante Delphi y conferencia de consenso. Mediciones principales: Priorización de propuestas para mantener las fortalezas, afrontar las amenazas, explotar las oportunidades, corregir las debilidades en el marco de un plan de acción de un área de salud integrada. Resultados: Se propusieron un total de 82 ideas diferentes (20 fortalezas, 40 debilidades, 4 amenazas, 12 oportunidades y 6 amenazas-oportunidades). Este análisis condujo a un plan estratégico con 7 líneas y 33 acciones/intervenciones priorizadas. Conclusiones: Atención integrada buscando fórmulas colaborativas entre niveles asistenciales, redefinición de roles, soluciones digitales, capacitación del personal y mejoras en equipamientos y procesos de soporte, junto a medidas para afrontar el envejecimiento de la población y las necesidades de centros sociosanitarios constituyen los retos sobre los que actuar.(AU)

Objective: To identify strengths, obstacles, changes in the environment, and capabilities of primary care teams and support units, with the aim of providing high-quality care in an integrated healthcare area. Design: Mixed methods study based on the SWOT matrix and CAME analysis. Location: Primary care, Valencian community. Participants: A total of 271 professionals from different collectives and patient association representatives participated. 99 in the idea generation phase, 154 in the SWOT matrix development phase, and 18 in the CAME analysis development phase. Interventions: A SWOT-CAME analysis was conducted, from which action lines were established. Information capture was carried out through nominal groups, and the consensus phase involved integrating all professionals through Delphi and consensus conference techniques. Main measurements: Prioritization of proposals to maintain strengths, address threats, exploit opportunities, and correct weaknesses within the framework of an integrated healthcare area action plan. Results: A total of 82 different ideas were proposed (20 strengths; 40 weaknesses; 4 threats; 12 opportunities; 6 threats-opportunities), which, once prioritized, were translated into 7 lines and 33 prioritized actions/interventions (CAME analysis). Conclusions: Integrated care, seeking collaborative approaches between care levels, redefining roles, digital solutions, staff training, and improvements in equipment and support processes, along with measures to address the aging population and the needs of socio-sanitary centers, constitute the challenges to be addressed.(AU)

Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study / Características de los pacientes con trastorno de pánico atendidos en atención primaria durante la pandemia por COVID-19: un estudio transversal multicéntrico

Objective: To assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic. Design: Cross-sectional multicenter study. Setting: Primary care. Participants: Participating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period. Main outcome measure: Diagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument. Results: Of a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6–7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7±17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes–Rahe scale>300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder. Discussion: This study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease. Conclusions: In non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.(AU)

Objetivo: Evaluar la prevalencia del trastorno de pánico durante la segunda y tercera olas de la pandemia por COVID-19. Diseño: Estudio transversal multicéntrico. Emplazamiento: Atención primaria. Participantes: Los médicos participantes seleccionaron a pacientes atendidos en atención primaria por cualquier motivo durante 16 meses. Medición principal: Trastorno de pánico diagnosticado usando el cuestionario Primary Care Evaluation Mental Disorders (PRIME-MD).Resultados: De un total de 678 pacientes elegibles, 36 presentaban un trastorno de pánico, con una prevalencia del 5,3% (intervalo de confianza del 95% 3,6-7,0). Un 63,9% de los casos se presentaron en mujeres. La edad media fue de 46,7±17,1 años. Las dificultades socioeconómicas, como bajos ingresos mensuales, falta de empleo y restricciones económicas para pagos de la vivienda y llegar a final de mes eran más frecuentes en los pacientes con trastorno de pánico que en aquellos sin. Los factores asociados al trastorno de pánico fueron un alto nivel de estrés (escala de Holmes-Rahe > 300), síndrome de fatiga crónica concomitante e intestino irritable y dificultades económicas en los últimos 6 meses. Discusión: Este estudio caracteriza a los pacientes con trastorno de pánico diagnosticados mediante un instrumento validado durante la pandemia por COVID-19 e identifica los factores de riesgo. Conclusiones: En pacientes consecutivos no seleccionado en condiciones del mundo real durante la pandemia por COVID-19, la prevalencia del trastorno de pánico fue del 5,3%, siendo más frecuente en mujeres. Es necesario aumentar los recursos para la salud mental durante y más allá de la duración de la pandemia.(AU)

Abordaje de la transformación digital en salud para reducir la brecha digital / Approach to digital transformation in healthcare to reduce the digital divide

La transformación digital implica la integración de tecnología en todas las áreas de una organización y un cambio en la forma de operar y de proporcionar valor. En el sector de la salud, la transformación digital debe centrarse en mejorar la salud para todos, acelerando el desarrollo y la adopción de soluciones digitales. La OMS considera la salud digital como un factor clave para garantizar la cobertura sanitaria universal, la protección frente a emergencias sanitarias y un mejor bienestar para mil millones de personas en todo el mundo. La transformación digital en salud debe incluir los determinantes digitales en salud como nuevos factores de desigualdad junto a los determinantes sociales clásicos. Abordar los determinantes digitales de la salud y la brecha digital es esencial para garantizar que todas las personas tengan acceso a los beneficios de la tecnología digital para su salud y su bienestar.(AU)

Digital transformation involves the integration of technology into all areas of an organization and a change in the way of operating and providing value. In the healthcare sector, digital transformation should focus on improving health for all by accelerating the development and adoption of digital solutions. The WHO considers digital health as a key factor in ensuring universal health coverage, protection against health emergencies, and better well-being for one billion people worldwide. Digital transformation in healthcare should include digital determinants of health as new factors of inequality alongside classic social determinants. Addressing digital determinants of health and the digital divide is essential to ensure that all people have access to the benefits of digital technology for their health and well-being.(AU)

Evaluación quinquenal de los ejes sanitarios de un programa nacional de Atención Primaria de la Salud / Five-year evaluation of the sanitary axes of a national program of Primary Health Care

Se realizó una evaluación quinquenal de los ejes sanitarios (que dan lugar a objetivos estratégicos con sus correspondientes metas e indicadores, áreas de intervención y líneas de acción) dentro del marco de la gestión sanitaria de uno de los 10 principales agentes de la seguridad social argentinos quien implementaba desde hacía 20 años un Programa Nacional de Atención Primaria de la Salud (PNAPS). El mismo promedió alrededor de 800 mil beneficiarios anuales dentro de una red asistencial nacional propia en el primer nivel de atención compuesta por 45 Centros de Atención Primaria (CAPs). Se implementó una investigación evaluativa que incluyó un trazado de línea de base con la valoración de cinco Ejes Sanitarios (ES). Se trata de un diseño de corte transversal de un periodo de 5 años. Se definieron metas, indicadores y recomendaciones para cada uno de los ES, recopilando información de fuentes diferentes y complementarias para su análisis. Los resultados mostraron una evolución favorable en el período evaluado, aunque el cumplimiento de las metas estuvo bastante alejado de lo propuesto de manera teórica. Conclusiones: este trabajo aporta información valiosa y original para subsidiar la toma de decisiones e incentivar la investigación en el ámbito de la APS, buscando reformular los actuales modelos de gestión y de atención de la salud (AU)

A five-year evaluation of the health axes (which give rise to strategic objectives with their corresponding goals and indicators, areas of intervention and lines of action) was carried out within the framework of health management of one of the 10 main argentine social security agents who had been implementing a National Primary Health Care Program (PNAPS) for 20 years. It averaged around 800,000 annual beneficiaries within its own national care network at the first level of care made up of 45 Primary Care Centers (CAPs). An evaluative investigation was implemented that included a baseline drawing with the assessment of five Sanitary Axis (ES). It is a cross-sectional design of a period of 5 years. Goals, indicators and recommendations were defined for each of the ES, collecting information from different and complementary sources for analysis. Results: they showed a favorable evolution in the period evaluated, although the fulfillment of the goals was quite far from what was theoretically proposed. The results of this work provides valuable and original information to support decision-making and encourage research in the field of PHC, seeking to reformulate current management and health care models (AU)

Substitution or addition: An observational study of a new primary care initiative in the Netherlands.

OBJECTIVE: In 2014, the Primary Care Plus (PC+) model was introduced in the Netherlands to shift low-complex specialised care from the hospital to the primary care setting. While positive effects of PC+ have been documented at individual patient level concerning health-related quality of life, perceived quality of care and care costs, its impacts on service use at the population level remain uncertain. METHODS: In this observational study, we used retrospective health insurance reimbursement claims data from the largest health insurer in the intervention region to determine service use. We assessed PC+ and secondary care insurance claims (i.e. claims of the regional hospital and claims of other secondary care settings in and outside the region visited by patients from the intervention region) from 2015 to 2018 and compared these to the national level. RESULTS: The total number of claims related to low-complex specialised care in the intervention region showed an increase over time. The increase in claims was related to PC+. The number of claims related to the regional hospital and other secondary care settings decreased over time. During the same period, a declining trend in claims at the national level was observed. CONCLUSION: The introduction of the PC+ model in one region in the Netherlands was associated with an increase in the use of low-complex specialised care. This suggests that the ability of the PC+ model to substitute for specialist care at population level may be limited. Going forward, it will be important to continue monitoring and evaluating service use as substitution effects may materialise only over a longer timeframe.

Primary care patterns among dual eligibles with Alzheimer's disease and related dementias.

BACKGROUND: Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS: Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS: Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS: A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.

¿Cómo evolucionó la distribución de médicas y médicos especialistas en Argentina?: un análisis demográfico de la profesión médica al 2020 / How did the distribution of doctors and medical specialists evolve in Argentina?: a demographic analysis of the medical profession to 2020

Las políticas sobre trabajadores/as de salud deben garantizar su distribución adecuada. En Argentina dicha distribución es desigual, sobre todo en especialistas en atención primaria de la salud (APS). El objetivo de este trabajo fue describir la distribución de médicos/as, especialistas lineales y en APS en Argentina, durante el año 2020, teniendo en cuenta la situación económica y sanitaria de cada jurisdicción. Se trata de un trabajo descriptivo y analítico, que utilizó fuentes de datos primarias y secundarias. Se correlacionó la tasa de mortalidad infantil y el producto bruto per cápita de cada jurisdicción ordenándolas de mejores a peores indicadores. La tasa de médicos fue 3,88 médicos/as cada 1000 habitantes, 72% concentrándose en 4 jurisdicciones (Ciudad Autónoma de Buenos Aires, Provincia de Buenos Aires, Córdoba y Santa Fe). El 53% son especialistas y el 27,6% lo son en APS. CABA tuvo una tasa de 16,5 médicos/as por mil; Santiago del Estero y Formosa alcanzaron valores de 1,8 y 1,9 médicas/os por mil habitantes respectivamente. Con respecto a 2014, se observó disminución de especialistas en APS (-14,8%), registrándose las mayores pérdidas en Santiago del Estero, Formosa y Catamarca (-84,5%; -70,1% y -87,3%). La situación nacional sobre la distribución de médicos/as en Argentina desde 1954 a la actualidad fue empeorando en detrimento de las provincias con mayores necesidades. La baja adherencia al sistema de residencias a especialidades de APS pronostica un empeoramiento de la situación de no haber cambios estructurales. Será necesario un fortalecimiento del rol rector del estado en el abordaje de esta problemática (AU)

Policies on health workers must guarantee their adequate distribution. In Argentina, this distribution is unequal, particularly among primary care specialists (PHC).The objective of this article is to describe the distribution of physicians, PHC and non-PHC specialists in Argentina in 2020, considering the economic and health situation of each jurisdiction.We conducted a descriptive cross-sectional study with an analytical stage using primary and secondary data sources. The jurisdictions were classified according to the correlation between infant mortality rate and gross product per capita.The rate of physicians in Argentina in 2020 was 3.88 physicians per 1,000 inhabitants. 72% are concentrated in 4 jurisdictions (City of Buenos Aires, Province of Buenos Aires, Córdoba and Santa Fe). 53% are specialists and 27.6% are PHC specialists. The City of Buenos Aires has a rate of 16.5 physicians per thousand; and Santiago del Estero and Formosa reach values of 1.8 and 1.9 physicians per thousand inhabitants, respectively.There was a decrease in PHC specialists (-14.8%), with major losses recorded in Santiago del Estero, Formosa and Catamarca (-84.5%; -70.1% and -87.3%, respectively).The distribution of physicians in Argentina from 1954 to the present has worsened to the detriment of the provinces with the greatest needs. The lack of adheren-ce to the specialty of PHC predicts a worsening of the situation if there are no structural changes. It is necessary to strengthen the leading role of the state in addressing this problem (AU)

COPEDI-CAT: estrategia de calidad para la investigación en covid-19 pediátrica en Cataluña / COPEDI-CAT: estratègia de qualitat per a la recerca en covid-19 pediàtrica a Catalunya / COPEDI-CAT: quality strategy for pediatric covid-19 research in Cataloni

Fundamento. El estallido brusco de la pandemia de la covid-19suposo la necesidad de iniciar proyectos de investigación coordinados. La creación del grupo COPEDI-CAT (julio 2020; más de170 profesionales) para estudiar la covid-19 pediátrica en Cataluña es un buen ejemplo de ello.Objetivo. Dar a conocer los resultados del grupo COPEDI-CAT, paramostrar la viabilidad de una estrategia de investigación multidisciplinaria de calidad con amplia participación de la atención primaria (AP).Método. Recogida de la producción científica del grupo COPEDICAT, resultado del trabajo multidisciplinario a partir de una extensa base de datos. En el grupo se revisan los estudios en cursoy los datos recogidos, se proponen nuevos proyectos, se realizanintervenciones de profesionales expertos (locales y de otros ámbitos y países) y se genera un espacio de debate y seguimiento de lapandemia.Resultados. Se han respondido las principales cuestiones sobre clínica, transmisibilidad, gravedad y principales complicaciones dela covid-19 en pediatría (síndrome pediátrico inflamatorio multisistémico y covid-19 persistente). Esta investigación ha generadocomunicaciones en congresos nacionales e internacionales, publicaciones científicas de alto impacto, la guía clínica de recomendaciones para el manejo de la covid-19 persistente, modelos depredicción clínica, becas de investigación (beca Prandi y MaratóTV3) y la participación en el proyecto «Escoles Sentinella».Conclusiones. La pandemia de covid-19 ha representado una oportunidad única para realizar investigación multidisciplinaria de calidad en pediatría de AP. COPEDI-CAT puede ser un modelo parala investigación futura de las patologías que afectan a los niños y adolescentes de nuestro país.

Background. The sudden outbreak of the covid-19 pandemic resulted in a need to start coordinated research projects on the disease. The creation of the COPEDI-CAT group (July 2020; more than 170professionals) to study pediatric covid-19 in Catalonia representsa good example of this effort.Objective. To disseminate the results of the COPEDI-CAT group toshow the feasibility of a quality multidisciplinary research strategywith wide participation of primary care (PC).Method. Review of the scientific production of the COPEDI-CATgroup generated by a multidisciplinary team. The group reviewedongoing studies and collected data, proposed new projects, implemented interventions recommended by expert professionals (local,national, and international), and created a space for debate andmonitoring of the pandemic.Results. The main questions about the symptoms, transmissibility,severity, and main complications of covid-19 in pediatrics (multisystem inflammatory syndrome and long covid-19) have beenaddressed. This research has generated papers at national andinternational conferences, high-impact scientific publications,recommended clinical guidelines for the management of longcovid-19, clinical prediction models, research grants (Prandi andMarató TV3 scholarship) and the participation in the «Escoles Sentinella» project.Conclusions. The covid-19 pandemic has represented a unique opportunity to carry out quality multidisciplinary research in pediatrics at PC. COPEDI-CAT can be a model for future research ondiseases that affect children and adolescents in our country. (AU)

Fonament. L’esclat brusc de la pandèmia va comportar la necessitat d’iniciar projectes de recerca coordinats. La creació del grup COPEDI-CAT (juliol 2020; més de 170 professionals) per estudiar la covid-19 pediàtrica a Catalunya n’és un bon exemple. Objectiu. Donar a conèixer els resultats del grup COPEDICAT, per mostrar la viabilitat d’una estratègia d’investigació multidisciplinària de qualitat amb àmplia participació de l’atenció primària (AP). Mètode. Recollida de la producció científica del grup COPEDI-CAT, resultat del treball multidisciplinari a partir d’una extensa base de dades. Al grup es revisen els estudis en curs i les dades recollides, es proposen nous projectes, es fan intervencions de professionals experts (locals i d’altres àmbits i països) i es genera un espai de debat i seguiment de la pandèmia. Resultats. S’han respost les principals qüestions sobre clínica, transmissibilitat, gravetat i principals complicacions de la covid-19 pediàtrica (síndrome pediàtrica multisistèmica i covid-19 persistent). Aquesta recerca ha generat comunicacions a congressos nacionals i internacionals, publicacions científiques d’alt impacte, la guia clínica de recomanacions pel maneig de la covid-19 persistent, models de predicció clínica, beques d’investigació (beca Prandi i Marató TV3) i la participació al projecte «Escoles Sentinella». Conclusions. La pandèmia de covid-19 ha representat una oportunitat única per fer investigació multidisciplinària de qualitat en pediatria d’AP. COPEDI-CAT pot ser un model per a la recerca futura de les patologies que afecten els infants i adolescents del nostre país. (AU)

Trends in quality of primary care in the United States, 2007-2016.

During the past decade, many reforms were proposed and implemented for improving primary care in the US. This study assessed improvements in quality of primary care, using a nationally representative database. We conducted a retrospective trend analysis of National Inpatient Sample data (2007-2016). The quality of primary care was assessed using Prevention Quality Indicators (PQIs), which consist of 13 sets of preventable hospitalization conditions. PQI hospitalization decreased from 154,565 to 151,168 per million hospitalizations during the study period (relative decrease, 2.2%; P = 0.041). Age-adjusted hospitalization rate increased for diabetes short-term complications (relative increase, 46.9%; P < 0.001) and lower-extremity amputations (relative increase, 15.1%; P = 0.035). Age stratified trends showed that hospitalization rates decreased significantly in all age-groups for diabetes short-term complications. For lower-extremity amputations, hospitalization rates increased significantly in younger age groups and decreased significantly in the older age groups. All other PQIs showed either decreasing or no change in trends. Adults aged 18-64 years should be the focus for future prevention attempts for diabetes complications. Identifying and acting on the factors responsible for these changes could help in reversing the concerning trends observed in this study. Existing strategies should focus on improving access to diabetes care and self-management.

Consultation rates in people with type 2 diabetes with and without vascular complications: a retrospective analysis of 141,328 adults in England.

OBJECTIVE: To assess trends in primary and specialist care consultation rates and average length of consultation by cardiovascular disease (CVD), type 2 diabetes mellitus (T2DM), or cardiometabolic multimorbidity exposure status. METHODS: Observational, retrospective cohort study used linked Clinical Practice Research Datalink primary care data from 01/01/2000 to 31/12/2018 to assess consultation rates in 141,328 adults with newly diagnosed T2DM, with or without CVD. Patients who entered the study with either a diagnosis of T2DM or CVD and later developed the second condition during the study are classified as the cardiometabolic multimorbidity group. Face to face primary and specialist care consultations, with either a nurse or general practitioner, were assessed over time in subjects with T2DM, CVD, or cardiometabolic multimorbidity. Changes in the average length of consultation in each group were investigated. RESULTS: 696,255 (mean 4.9 years [95% CI, 2.02-7.66]) person years of follow up time, there were 10,221,798 primary and specialist care consultations. The crude rate of primary and specialist care consultations in patients with cardiometabolic multimorbidity (N = 11,881) was 18.5 (95% CI, 18.47-18.55) per person years, 13.5 (13.50, 13.52) in patients with T2DM only (N = 83,094) and 13.2 (13.18, 13.21) in those with CVD (N = 57,974). Patients with cardiometabolic multimorbidity had 28% (IRR 1.28; 95% CI: 1.27, 1.31) more consultations than those with only T2DM. Patients with cardiometabolic multimorbidity had primary care consultation rates decrease by 50.1% compared to a 45.0% decrease in consultations for those with T2DM from 2000 to 2018. Specialist care consultation rates in both groups increased from 2003 to 2018 by 33.3% and 54.4% in patients with cardiometabolic multimorbidity and T2DM, respectively. For patients with T2DM the average consultation duration increased by 36.0%, in patients with CVD it increased by 74.3%, and in those with cardiometabolic multimorbidity it increased by 37.3%. CONCLUSIONS: Annual primary care consultation rates for individuals with T2DM, CVD, or cardiometabolic multimorbidity have fallen since 2000, while specialist care consultations and average consultation length have both increased. Individuals with cardiometabolic multimorbidity have significantly more consultations than individuals with T2DM or CVD alone. Service redesign of health care delivery needs to be considered for people with cardiometabolic multimorbidity to reduce the burden and health care costs.

Ramadan is not associated with increased infection risk in Pakistani and Bangladeshi populations: Findings from controlled interrupted time series analysis of UK primary care data.

BACKGROUND: The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan. METHOD: Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively. FINDINGS: Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988-1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999-1.013, p = 0.082). INTERPRETATION: In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.

Changing antibiotic prescribing practices in outpatient primary care settings in China: Study protocol for a health information system-based cluster-randomised crossover controlled trial.

BACKGROUND: The overuse and abuse of antibiotics is a major risk factor for antibiotic resistance in primary care settings of China. In this study, the effectiveness of an automatically-presented, privacy-protecting, computer information technology (IT)-based antibiotic feedback intervention will be evaluated to determine whether it can reduce antibiotic prescribing rates and unreasonable prescribing behaviours. METHODS: We will pilot and develop a cluster-randomised, open controlled, crossover, superiority trial. A total of 320 outpatient physicians in 6 counties of Guizhou province who met the standard will be randomly divided into intervention group and control group with a primary care hospital being the unit of cluster allocation. In the intervention group, the three components of the feedback intervention included: 1. Artificial intelligence (AI)-based real-time warnings of improper antibiotic use; 2. Pop-up windows of antibiotic prescription rate ranking; 3. Distribution of educational manuals. In the control group, no form of intervention will be provided. The trial will last for 6 months and will be divided into two phases of three months each. The two groups will crossover after 3 months. The primary outcome is the 10-day antibiotic prescription rate of physicians. The secondary outcome is the rational use of antibiotic prescriptions. The acceptability and feasibility of this feedback intervention study will be evaluated using both qualitative and quantitative assessment methods. DISCUSSION: This study will overcome limitations of our previous study, which only focused on reducing antibiotic prescription rates. AI techniques and an educational intervention will be used in this study to effectively reduce antibiotic prescription rates and antibiotic irregularities. This study will also provide new ideas and approaches for further research in this area. TRIAL REGISTRATION: ISRCTN, ID: ISRCTN13817256. Registered on 11 January 2020.