scholarly journals The Impact of Case Finding on the Recruitment Yield for COPD Research in Primary Care: An Observational Study

Respiration ◽  
2016 ◽  
Vol 92 (5) ◽  
pp. 308-315 ◽  
Author(s):  
Stefan Markun ◽  
Thomas Rosemann ◽  
Kaba Dalla-Lana ◽  
Claudia Steurer-Stey
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Case Finding ◽  
The Impact

scholarly journals Emergency care access to primary care records: an observational study

2020 ◽  
Vol 27 (3) ◽  
pp. e100153
Author(s):  
Thomas Bowden ◽  
David Lyell ◽  
Enrico Coiera
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Hospital Admission ◽  
Emergency Care ◽  
Patient Characteristics ◽  
Care Access ◽  
Process Outcomes ◽  
Primary Care Record ◽  
Access To Primary Care ◽  
The Impact

ObjectiveTo measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access.MeasuresRates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission.DesignA retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients’ primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories.Results6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=−9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=−36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081).DiscussionEmergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories.ConclusionFurther studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.

Primary-care-based social prescribing for mental health: an analysis of financial and environmental sustainability

2015 ◽  
Vol 17 (02) ◽  
pp. 114-121 ◽  
Author(s):  
Daniel L. Maughan ◽  
Alisha Patel ◽  
Tahmina Parveen ◽  
Isobel Braithwaite ◽  
Jonathan Cook ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Environmental Impacts ◽  
Carbon Footprint ◽  
Secondary Care ◽  
Small Sample ◽  
Environmental Costs ◽  
Healthcare Use ◽  
Social Prescribing ◽  
The Impact

AimTo assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs.BackgroundSocial prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level.MethodAn observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured.FindingsResults demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.

Paediatric NHS 111 Clinical Assessment Services pilot: an observational study

2021 ◽  
pp. archdischild-2021-322908
Author(s):  
Philippa Anna Stilwell ◽  
Gareth Stuttard ◽  
Robert Scott-Jupp ◽  
Adrian Boyle ◽  
Simon Kenny ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Nurse Practitioners ◽  
Clinical Assessment ◽  
Self Care ◽  
Data Sets ◽  
Reporting Framework ◽  
Telephone Advice ◽  
Future Work ◽  
The Impact

ObjectiveTo determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service.DesignObservational study.SettingSix NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians.PatientsUnder 16-year-olds prompting calls to NHS 111 over the study period.Main outcome measuresThe disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians’ and patient experience.Results70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers’ CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%).ConclusionsIntroducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.

scholarly journals Antibiotic Prescribing Trends in Belgian Out-of-Hours Primary Care during the COVID-19 Pandemic: Observational Study Using Routinely Collected Health Data

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1488
Author(s):  
Annelies Colliers ◽  
Jeroen De Man ◽  
Niels Adriaenssens ◽  
Veronique Verhoeven ◽  
Sibyl Anthierens ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Health Data ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Face To Face ◽  
Percentage Points ◽  
Routinely Collected Health Data ◽  
Tract Infections ◽  
The Impact

Antibiotic overprescribing is one of the main drivers of the global and growing problem of antibiotic resistance, especially in primary care and for respiratory tract infections (RTIs). RTIs are the most common reason for patients to consult out-of-hours (OOH) primary care. The COVID-19 pandemic has changed the way general practitioners (GPs) work, both during office hours and OOH. In Belgian OOH primary care, remote consultations with the possibility of issuing prescriptions and telephone triage were implemented. We aimed to describe the impact of COVID-19 on GPs’ antibiotic prescribing during OOH primary care. In an observational study, using routinely collected health data from GP cooperatives (GPCs) in Flanders, we analyzed GPs’ antibiotic prescriptions in 2019 (10 GPCs) and 2020 (20 GPCs) during OOH consultations (telephone and face-to-face). We used autoregressive integrated moving average (ARIMA) modeling to identify any changes after lockdowns were implemented. In total, 388,293 contacts and 268,430 prescriptions were analyzed in detail. The number of antibiotic prescriptions per weekend, per 100,000 population was 11.47 (95% CI: 9.08–13.87) or 42.9% lower after compared to before the implementation of lockdown among all contacts. For antibiotic prescribing per contact, we found a decrease of 12.2 percentage points (95% CI: 10.6–13.7) or 56.5% among all contacts and of 5.3 percentage points (95% CI: 3.7–6.9) or 23.2% for face-to-face contacts only. The decrease in the number of prescriptions was more pronounced for cases with respiratory symptoms that corresponded with symptoms of COVID-19 and for antibiotics that are frequently prescribed for RTIs, such as amoxicillin (a decrease of 64.9%) and amoxicillin/clavulanate (a decrease of 38.1%) but did not appear for others such as nitrofurantoin. The implementation of COVID-19 lockdown measures coincided with an unprecedented drop in the number of antibiotic prescriptions, which can be explained by a decrease in face-to-face patient contacts, as well as a lower number of antibiotics prescriptions per face-to-face patient contact. The decrease was seen for antibiotics used for RTIs but not for nitrofurantoin, the first-choice antibiotic for urinary tract infections.

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