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1.
J Prim Care Community Health ; 11: 2150132720975517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33213264

RESUMO

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.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Consulta Remota/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária , Adulto Jovem
2.
J Prim Care Community Health ; 11: 2150132720969557, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174495

RESUMO

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.


Assuntos
Assistência Ambulatorial , Saúde da Criança , Infecções por Coronavirus , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Betacoronavirus , Chicago/epidemiologia , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Humanos , Imunização , Lactente , Visita a Consultório Médico/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Estudos Retrospectivos , Isolamento Social , Telemedicina
3.
Br J Gen Pract ; 70(700): 528-529, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33122266
4.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020109

RESUMO

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Saúde Pública , Adulto , Fatores Etários , Betacoronavirus , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , População Rural
5.
JAMA Netw Open ; 3(10): e2021476, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33006622

RESUMO

Importance: Little is known about the association between the coronavirus disease 2019 (COVID-19) pandemic and the level and content of primary care delivery in the US. Objective: To quantify national changes in the volume, type, and content of primary care delivered during the COVID-19 pandemic, especially with regard to office-based vs telemedicine encounters. Design, Setting, and Participants: Analysis of serial cross-sectional data from the IQVIA National Disease and Therapeutic Index, a 2-stage, stratified nationally representative audit of outpatient care in the US from the first calendar quarter (Q1) of 2018 to the second calendar quarter (Q2) of 2020. Main Outcomes and Measures: Visit type (office-based or telemedicine), overall and stratified by patient population and geographic region; assessment of blood pressure or cholesterol measurement; and initiation or continuation of prescription medications. Results: In the 8 calendar quarters between January 1, 2018, and December 31, 2019, between 122.4 million (95% CI, 117.3-127.5 million) and 130.3 million (95% CI, 124.7-135.9 million) quarterly primary care visits occurred in the US (mean, 125.8 million; 95% CI, 121.7-129.9 million), most of which were office-based (92.9%). In 2020, the total number of encounters decreased to 117.9 million (95% CI, 112.6-123.2 million) in Q1 and 99.3 million (95% CI, 94.9-103.8 million) in Q2, a decrease of 21.4% (27.0 million visits) from the average of Q2 levels during 2018 and 2019. Office-based visits decreased 50.2% (59.1 million visits) in Q2 of 2020 compared with Q2 2018-2019, while telemedicine visits increased from 1.1% of total Q2 2018-2019 visits (1.4 million quarterly visits) to 4.1% in Q1 of 2020 (4.8 million visits) and 35.3% in Q2 of 2020 (35.0 million visits). Decreases occurred in blood pressure level assessment (50.1% decrease, 44.4 million visits) and cholesterol level assessment (36.9% decrease, 10.2 million visits) in Q2 of 2020 compared with Q2 2018-2019 levels, and assessment was less common during telemedicine than during office-based visits (9.6% vs 69.7% for blood pressure; P < .001; 13.5% vs 21.6% for cholesterol; P < .001). New medication visits in Q2 of 2020 decreased by 26.0% (14.1 million visits) from Q2 2018-2019 levels. Telemedicine adoption occurred at similar rates among White individuals and Black individuals (19.3% vs 20.5% of patient visits, respectively, in Q1/Q2 of 2020), varied by region (low of 15.1% of visits [East North Central region], high of 26.8% of visits [Pacific region]), and was not correlated with regional COVID-19 burden. Conclusions and Relevance: The COVID-19 pandemic has been associated with changes in the structure of primary care delivery, with the content of telemedicine visits differing from that of office-based encounters.


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Afro-Americanos , Idoso , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
6.
PLoS One ; 15(9): e0238100, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32886675

RESUMO

BACKGROUND: The Affordable Care Act led to improvements in reporting a usual source of care, but it is unclear whether patients are changing their usual source of care in response to coverage gains. We assess whether prior insurance instability is associated with changes in use of emergency and office-based care after the Marketplace and Medicaid expansion were introduced. METHODS: Our study draws from the 2013-14 Medical Expenditure Panel Survey, identifying a cohort of non-elderly adults with full-year health insurance coverage in 2014. We use linear and multinomial logistic regression to assess the relationship between insurance instability prior to 2014 (uninsured for 1-11 months, ≥12 months) and person-level changes in use of health care after gaining coverage (change in ED and office visits from 2013 to 2014) with continuously insured individuals serving as a comparison group. RESULTS: Being uninsured for at least one year prior to gaining full-year coverage in 2014 was associated with a 33% increase in ED visits (0.06 visits, p<0.01) and a 47% increase in office visits (1.10 visits, p<0.01), driven by those gaining public coverage. We found no evidence of substitution across settings in the short term, often a stated goal of expansion. CONCLUSION: The long-term uninsured may have substantial health needs and pent-up demand for health care, seeing more physicians across multiple settings in the year after gaining coverage as they seek to get unmanaged conditions under control. Closing the gap in primary care use between the previously uninsured and those with health insurance coverage may help improve long-term health outcomes.


Assuntos
Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Adulto Jovem
7.
Br J Gen Pract ; 70(700): e817-e824, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32988955

RESUMO

BACKGROUND: The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable. AIM: To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic. DESIGN AND SETTING: Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care. METHOD: Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon's signed-rank test, and McNemar's test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations. RESULTS: Data were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia. CONCLUSION: Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.


Assuntos
Infecções por Coronavirus , Solidão/psicologia , Saúde Mental/tendências , Doenças não Transmissíveis , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral , Atenção Primária à Saúde , Isolamento Social/psicologia , Idoso , Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Comportamento de Busca de Ajuda , Hong Kong/epidemiologia , Humanos , Masculino , Multimorbidade , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/psicologia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Carência Psicossocial , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia
8.
Aust Health Rev ; 44(5): 733-736, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32878685

RESUMO

The COVID-19 pandemic has resulted in multiple changes in the delivery of general practice services. In response to the threat of the pandemic and in order to keep their businesses safe and viable, general practices have rapidly moved to new models of care, embraced Medicare-funded telehealth and responded to uncertain availability of personal protective equipment with innovation. These changes have shown the adaptability of general practice, helped keep patients and practice staff safe, and undoubtedly reduced community transmission and mortality. The pandemic, and the response to it, has emphasised the potential dangers of existing fragmentation within the Australian health system, and is affecting the viability of general practice. These impacts on primary care highlight the need for improved integration of health services, should inform future pandemic planning, and guide the development of Australia's long-term national health plan.


Assuntos
Infecções por Coronavirus/diagnóstico , Diagnóstico Precoce , Medicina Geral/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Atenção Primária à Saúde/organização & administração , Medicina Estatal/organização & administração , Telemedicina/organização & administração , Austrália , Betacoronavirus/patogenicidade , Medicina Geral/métodos , Medicina Geral/estatística & dados numéricos , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Telemedicina/métodos
9.
Lancet Public Health ; 5(10): e543-e550, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32979305

RESUMO

BACKGROUND: To date, research on the indirect impact of the COVID-19 pandemic on the health of the population and the health-care system is scarce. We aimed to investigate the indirect effect of the COVID-19 pandemic on general practice health-care usage, and the subsequent diagnoses of common physical and mental health conditions in a deprived UK population. METHODS: We did a retrospective cohort study using routinely collected primary care data that was recorded in the Salford Integrated Record between Jan 1, 2010, and May 31, 2020. We extracted the weekly number of clinical codes entered into patient records overall, and for six high-level categories: symptoms and observations, diagnoses, prescriptions, operations and procedures, laboratory tests, and other diagnostic procedures. Negative binomial regression models were applied to monthly counts of first diagnoses of common conditions (common mental health problems, cardiovascular and cerebrovascular disease, type 2 diabetes, and cancer), and corresponding first prescriptions of medications indicative of these conditions. We used these models to predict the expected numbers of first diagnoses and first prescriptions between March 1 and May 31, 2020, which were then compared with the observed numbers for the same time period. FINDINGS: Between March 1 and May 31, 2020, 1073 first diagnoses of common mental health problems were reported compared with 2147 expected cases (95% CI 1821 to 2489) based on preceding years, representing a 50·0% reduction (95% CI 41·1 to 56·9). Compared with expected numbers, 456 fewer diagnoses of circulatory system diseases (43·3% reduction, 95% CI 29·6 to 53·5), and 135 fewer type 2 diabetes diagnoses (49·0% reduction, 23·8 to 63·1) were observed. The number of first prescriptions of associated medications was also lower than expected for the same time period. However, the gap between observed and expected cancer diagnoses (31 fewer; 16·0% reduction, -18·1 to 36·6) during this time period was not statistically significant. INTERPRETATION: In this deprived urban population, diagnoses of common conditions decreased substantially between March and May 2020, suggesting a large number of patients have undiagnosed conditions. A rebound in future workload could be imminent as COVID-19 restrictions ease and patients with undiagnosed conditions or delayed diagnosis present to primary and secondary health-care services. Such services should prioritise the diagnosis and treatment of these patients to mitigate potential indirect harms to protect public health. FUNDING: National Institute of Health Research.


Assuntos
Infecções por Coronavirus/epidemiologia , Diagnóstico , Pandemias , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/diagnóstico , Transtornos Cerebrovasculares/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Modelos Estatísticos , Neoplasias/diagnóstico , Estudos Retrospectivos , Reino Unido/epidemiologia , Adulto Jovem
10.
Ann Agric Environ Med ; 27(3): 435-441, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32955227

RESUMO

INTRODUCTION: E-Health tools allow a medical facility to set a given patient's data in order using ICT techniques, and the patient to use those techniques when contacting a given organisation. MATERIAL AND METHODS: Secondary statistical data was used in the research. The study was carried out among primary health care patients. Mining for affinity rules was done in the R programme. The apriori and inspect functions from the arules package were used. Moreover, any redundant rules were removed from thoseobtained using the afero-mentioned method. Applying the general description of the affinity analysis method onto the survey described herein, it should be stressed that the aim of using affinity analysis was to discover the rules which contain the sub-transaction B={V_6=1} as a consequent. This was determined by the intention to discover associations regarding the knowledge about a uniform information system that the patients under study might have. RESULTS: In the discovered rules, the antecedent most often contained an indication of the need for introducing a uniform solution as regards telemedicine. Moreover, according to the opinions of 'conscious'patients, a uniform IT system should improve the work at primary health care institutions, introducing an on-line booking system for visits should improve the productivity and comfort of doctors, and an IT system should provide unambiguous identification of a patient. CONCLUSIONS: There is potential in using affinity analysis within e-Health. The example of affinity analysis described in his study led to the discovery of interesting and important (from the point of view of a medical facility) regularities regarding the knowledge and expectations of patients as regards e-Health.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Adulto Jovem
11.
PLoS One ; 15(8): e0238353, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32866964

RESUMO

OBJECTIVE: Our aim was to identify the patterns of multimorbidity among a group of patients who visited primary care in Singapore. METHODS: A cross-sectional study of electronic medical records was conducted on 437,849 individuals aged 0-99 years who visited National Healthcare Group Polyclinics from 1 Jul 2015 to 30 Jun 2016 for the management of chronic conditions. Patients' health conditions were coded with the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10), and patient records were extracted for analysis. Patients' diagnosis codes were grouped by exploratory factor analysis (EFA), and patterns of multimorbidity were then identified by latent class analysis (LCA). RESULTS: EFA identified 19 groups of chronic conditions. Patients with at least three chronic conditions were further separated into eight classes based on demographics and probabilities of various diagnoses. We found that older patients had higher probabilities of comorbid hypertension, kidney disease and ischaemic heart disease (IHD), while younger patients had a higher probability of comorbid obesity. Female patients had higher probabilities of comorbid arthritis and anaemia, while male patients had higher probabilities of comorbid kidney diseases and IHD. Indian patients presented with a higher probability of comorbid diabetes than Chinese and Malay patients. CONCLUSIONS: This study demonstrated that patients with multimorbidity in primary care could be classified into eight patterns. This knowledge could be useful for more precise management of these patients in the multiethnic Asian population of Singapore. Programmes for early intervention for at-risk groups can be developed based on the findings.


Assuntos
Múltiplas Afecções Crônicas/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Multimorbidade , Adulto Jovem
12.
PLoS Med ; 17(9): e1003336, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32956399

RESUMO

BACKGROUND: Research has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care. METHODS AND FINDINGS: We analyzed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately. Crude and adjusted associations between exposure and outcome were estimated using generalized estimating equations. A total of 147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0.4% (1,025/244,963) of UTI episodes with immediate antibiotics versus 0.6% (228/35,499) of episodes without immediate antibiotics. After adjusting for patient demographics, year of consultation, comorbidities, smoking status, recent hospitalizations, recent accident and emergency (A&E) attendances, recent antibiotic prescribing, and home visits, the odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio [aOR] 1.13, 95% CI 0.97-1.32, p-value = 0.105). Delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1.17, 95% CI 1.09-1.26, p-value < 0.001), but there was limited evidence that increased deaths were attributable to urinary-source BSI. Limitations include overlap between the categories of immediate and delayed antibiotic prescribing, residual confounding underlying differences between patients who were/were not treated with antibiotics, and lack of microbiological diagnosis for BSI. CONCLUSIONS: In this study, we observed that delaying or withholding antibiotics in older adults with suspected UTI did not increase patients' risk of BSI, in contrast with a previous study that analyzed the same dataset, but mortality was increased. Our findings highlight uncertainty around the risks of delaying or withholding antibiotic treatment, which is exacerbated by systematic differences between patients who were and were not treated immediately with antibiotics. Overall, our findings emphasize the need for improved diagnostic/risk prediction strategies to guide antibiotic prescribing for suspected UTI in older adults.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/etiologia , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Registros Eletrônicos de Saúde , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pacientes , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco
13.
Br J Gen Pract ; 70(699): e696-e704, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32895242

RESUMO

BACKGROUND: The first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care. AIM: To quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record. DESIGN AND SETTING: Cross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England. METHOD: Suspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status. RESULTS: GPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57). CONCLUSION: Using data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.


Assuntos
Infecções por Coronavirus , Grupos Étnicos/estatística & dados numéricos , Medicina Geral/métodos , Pandemias , Pneumonia Viral , Atenção Primária à Saúde/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/etnologia , Diagnóstico Diferencial , Feminino , Disparidades nos Níveis de Saúde , Humanos , Londres/epidemiologia , Masculino , Registros Médicos Orientados a Problemas/estatística & dados numéricos , Pessoa de Meia-Idade , Saúde das Minorias/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/etnologia , Prevalência , Fatores de Risco
14.
Popul Health Manag ; 23(5): 378-385, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32810418

RESUMO

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable care organization (Delaware Valley ACO), and statewide data from Pennsylvania; and (4) What should be the priorities and focus of the delivery system of the future given the dramatic financial and clinical disruption of COVID-19?


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Efeitos Psicossociais da Doença , Feminino , Planejamento em Saúde/métodos , Humanos , Masculino , Pandemias/estatística & dados numéricos , Planejamento de Assistência ao Paciente/organização & administração , Pennsylvania , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde/métodos , Estados Unidos
15.
Artigo em Inglês | MEDLINE | ID: mdl-32796632

RESUMO

Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (ß = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (ß = 9.7; 95% CI, 1.5 to 18.0).


Assuntos
Neoplasias da Mama/mortalidade , Neoplasias dos Genitais Femininos/mortalidade , Atenção Primária à Saúde/organização & administração , Brasil/epidemiologia , Feminino , Genitália , Serviços de Saúde , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Fatores Socioeconômicos
16.
Curationis ; 43(1): e1-e8, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32787428

RESUMO

BACKGROUND: Nurse managers are leaders in mining primary healthcare. Their leadership roles include inspiring and empowering operational managers and nursing personnel, by leading with competence developing them to become followers with insight and direction. However, these leadership roles are not clearly defined, and are negatively influenced by the traditional mining leadership style. OBJECTIVES: The aim of this study was to explore and describe the nurse managers' experiences of their leadership roles in a specific mining primary healthcare service on the West Rand, to develop recommendations to enhance these roles. METHOD: A qualitative, exploratory, descriptive and contextual research design was used in this study, following a phenomenological approach as a research method. A non-probability purposive sampling method was used. Nurse managers described experiences of their leadership roles during individual phenomenological interviews. Data saturation was reached on participant number 7. To analyse data, four stages of Giorgi's descriptive phenomenological data analysis was used. An independent coder coded the data and a consensus meeting was held. The study was guided by the theoretical framework of Winkler's role theory. RESULTS: The following subthemes emanated from data analysis: (1) leadership role ambiguity, (2) leadership roles experienced and (3) challenges experienced in leadership roles. CONCLUSION: This study revealed that the leadership roles for nurse managers in a specific mining primary healthcare service are not clearly defined. Hence enhancements and expansions of these leadership roles remained stagnant. A clearly defined policy on leadership roles for nurse managers should be developed.


Assuntos
Liderança , Enfermeiras Administradoras/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras Administradoras/estatística & dados numéricos , Papel do Profissional de Enfermagem/psicologia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa Qualitativa , África do Sul
17.
Am J Public Health ; 110(10): 1472-1475, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816543

RESUMO

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.


Assuntos
Redes Comunitárias/tendências , Tempestades Ciclônicas , Reforma dos Serviços de Saúde/organização & administração , Atenção Primária à Saúde , Assistência à Saúde/estatística & dados numéricos , Desastres , Financiamento Governamental/economia , Humanos , Louisiana , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências
18.
PLoS One ; 15(8): e0237083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780769

RESUMO

INTRODUCTION: Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS: A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS: Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS: These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.


Assuntos
Hospitais Públicos/normas , Hipertensão/terapia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Malásia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos
20.
PLoS One ; 15(8): e0235411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822368

RESUMO

BACKGROUND: Delayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. However, there is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia. OBJECTIVE: To assess the factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. METHODS: The study design was cross-sectional. A total of 875 new adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling technique and tuberculosis cases from the health facilities were consecutively enrolled. Data were collected using structured questionnaire within the first 2 weeks of treatment initiation. Delay was categorized as patient, health system and total delays. Data were analyzed using SPSS version 21 and logistic regression was used to identify factors associated with the odds of delays to initiate treatment. A p-value of less than 0.05 was reported as statistically significant. RESULTS: The median patient, health system and total delays were 30, 18 and 62 days, respectively. Rural residence, being poor, visiting non-formal medication sources, being primary health care and the private clinic had higher odds of patient delay whereas being HIV positive had lower odds of patient delay. Illiteracy, first visit to primary health care and private clinic had higher odds of health system delay whereas a visit to health facility one time and have no patient delay had lower odds of health system delay. CONCLUSION: The median patient delay was higher than the median health system delay before initiating treatment. Hence, improved awareness of the community and involving the informal medication sources in the tuberculosis pathways would reduce patient delay. Similarly, improved cough screening and diagnostic efficiency of the lower health facilities would shorten health system delay.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Comorbidade , Etiópia , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia
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