scholarly journals Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
Jamie Lopez Bernal ◽  
Maria Zambon ◽  
Oluwafunmi Akinyemi ◽  
Gayatri Amirthalingam ◽  
...  
Keyword(s):  
Public Health ◽  
General Practice ◽  
General Practitioners ◽  
Royal College ◽  
Medical Records ◽  
Influenza Surveillance ◽  
General Practices ◽  
New Codes ◽  
Containment Policy ◽  
Tract Infections

BACKGROUND The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. OBJECTIVE The aim of this study is the surveillance of COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections to ascertain both the rate and pattern of COVID-19 spread and to assess the effectiveness of the containment policy. METHODS The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. RESULTS General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. CONCLUSIONS We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18606

scholarly journals Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England

10.2196/18606 ◽  
2020 ◽  
Vol 6 (2) ◽  
pp. e18606 ◽  
Author(s):  
Simon de Lusignan ◽  
Jamie Lopez Bernal ◽  
Maria Zambon ◽  
Oluwafunmi Akinyemi ◽  
Gayatri Amirthalingam ◽  
...  
Keyword(s):  
Public Health ◽  
General Practice ◽  
General Practitioners ◽  
Royal College ◽  
Medical Records ◽  
Influenza Surveillance ◽  
General Practices ◽  
New Codes ◽  
Containment Policy ◽  
Tract Infections

Background The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. Objectives The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. Methods The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. Results General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. Conclusions We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. International Registered Report Identifier (IRRID) DERR1-10.2196/18606

scholarly journals Seasonal influenza surveillance and vaccine effectiveness at a time of co-circulating COVID-19: Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) protocol for winter 2020/21 (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
Jamie Jamie Lopez Bernal ◽  
Rachel Byford ◽  
Gayatri Amirthalingam ◽  
Fillipa Ferreira ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
General Practitioners ◽  
Royal College ◽  
Distribution System ◽  
Winter Season ◽  
Vaccine Uptake ◽  
Influenza Surveillance ◽  
Secure Networks ◽  
General Practices

BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when coronavirus 2019 infections (COVID-19) are likely to be co-circulating with usual winter infections. OBJECTIVE To conduct surveillance of influenza, other monitored respiratory conditions, and report vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerised medical records (CMR) systems. Practices also collect virology and serology specimens and participate in trials and other interventional research. METHODS The RCGP RSC network comprises over 1,700 general practices in England and Wales. We extract pseudonymised data twice weekly and are migrating to daily extracts. 1. We collect pseudonymised routine coded clinical data for the surveillance of monitored as well as unexpected conditions; vaccine exposure and adverse events of interest (AEIs), and approved research study outcomes. 2. We provide dashboards to give practices feedback about levels of care and data quality, compared to other network practices. We focus on collecting data about influenza-like-illness (ILI), upper and lower respiratory infections (URTI and LRTI) and suspected coronavirus 2019 disease (COVID-19). 3. Approximately 300 practices, will participate in the 2020/21 in virology and serology surveillance, this will include responsive surveillance and long term follow up of previous COVID-19 infections. 4. Member practices can recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point of care testing. 5. The legal basis for our surveillance with PHE is Regulation 3 of The Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval. RESULTS The RCGP RSC network has tripled in size, there were previously 100 virology and 500 practices overall, we now have 322 and 1,724 respectively. The Oxford RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network, currently 1,076 practices are uploaded. We are implementing a central swab distribution system to patients self-swabbing at home, in addition to in-practice sampling. We have migrated to use the systematised nomenclature of medicine clinical terms (SNOMED CT). Throughout spring and summer the network has continued to collect specimens in preparedness for the winter, or any second wave of COVID-19 cases. We have collected 5,404 swabs and detected 623 cases of COVID-19 through extended virological sampling and 19,341 samples collected for serology. This shows our preparedness for the winter season. CONCLUSIONS The COVID-19 has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, Royal College and University collaboration.

Adoption of ICT in Rural Medical General Practices in Australia

2012 ◽  
pp. 40-51 ◽  
Author(s):  
Patricia Deering ◽  
Arthur Tatnall ◽  
Stephen Burgess
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Network Theory ◽  
Medical Records ◽  
Actor Network Theory ◽  
Actor Network ◽  
Its Analysis ◽  
General Practices ◽  
Suitable Framework

ICT has been used in medical General Practice throughout Australia now for some years, but although most General Practices make use of ICT for administrative purposes such as billing, prescribing and medical records, many individual General Practitioners themselves do not make full use of these ICT systems for clinical purposes. The decisions taken in the adoption of ICT in general practice are very complex, and involve many actors, both human and non-human. This means that actor-network theory offers a most suitable framework for its analysis. This article investigates how GPs in a rural Division of General Practice not far from Melbourne considered the adoption and use of ICT. The study reported in the article shows that, rather than characteristics of the technology itself, it is often seemingly unimportant human issues that determine if and how ICT is used in General Practice.

scholarly journals 629Influenza-like illness surveillance in Australia: comparison of general practice data with laboratory-confirmed influenza notifications

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Carla Bernardo ◽  
David Gonzalez ◽  
Nigel Stocks
Keyword(s):  
General Practice ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Research Network ◽  
Practice Research ◽  
Influenza Surveillance ◽  
Surveillance Systems ◽  
Australian General Practice ◽  
General Practices ◽  
Highly Correlated

Abstract Background Influenza is a respiratory infection responsible for 645,000 annual deaths worldwide. Surveillance systems provide valuable data for monitoring influenza in order to detect outbreaks and guide public health responses. This study aimed to investigate the epidemiology of influenza-like illness (ILI) using two Australian general practice databases (MedicineInsight and the Australian Sentinel Practice Research Network (ASPREN)) and compare them with laboratory-confirmed influenza from the National Notifiable Diseases Surveillance System (NNDSS). Methods All patients who had a consultation in MedicineInsight general practices or ASPREN and all laboratory-confirmed influenza reported by the NNDSS between 2015-2017 were included. Weekly ILI rates per 1,000 consultations (MedicineInsight/ASPREN) were compared with influenza notifications (NNDSS). Results Data was consistent among sources, with higher cases in 2017, among women and patients aged 20-49 years. The peak rate in MedicineInsight almost doubled in 2017 compared to 2015, while in ASPREN it was less pronounced. MedicineInsight ILI curves more closely resembled NNDSS patterns (shape, the start of the season, peaks) than ASPREN, although both were highly correlated with NNDSS (r = 0.90 to 0.97 and r = 0.88 to 0.98, respectively). Conclusions MedicineInsight and ASPREN provided consistent ILI results, both resembling confirmed influenza epidemic curves, suggesting the potential use of routinely collected electronic medical records (MedicineInsight) in influenza surveillance. MedicineInsight provides comprehensive medical data, such as underlying conditions, medications prescribed and vaccination status, which could be used to improve accuracy on influenza detection. Key messages Electronic medical records could be used to monitor ILI in combination with ASPREN for effective early detection of outbreaks.

Adoption of ICT in Rural Medical General Practices in Australia

2010 ◽  
Vol 2 (1) ◽  
pp. 54-69 ◽  
Author(s):  
Patricia Deering ◽  
Arthur Tatnall ◽  
Stephen Burgess
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Network Theory ◽  
Medical Records ◽  
Actor Network Theory ◽  
Actor Network ◽  
Its Analysis ◽  
General Practices ◽  
Suitable Framework

ICT has been used in medical General Practice throughout Australia now for some years, but although most General Practices make use of ICT for administrative purposes such as billing, prescribing and medical records, many individual General Practitioners themselves do not make full use of these ICT systems for clinical purposes. The decisions taken in the adoption of ICT in general practice are very complex, and involve many actors, both human and non-human. This means that actor-network theory offers a most suitable framework for its analysis. This article investigates how GPs in a rural Division of General Practice not far from Melbourne considered the adoption and use of ICT. The study reported in the article shows that, rather than characteristics of the technology itself, it is often seemingly unimportant human issues that determine if and how ICT is used in General Practice.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

Affective Disorders Among Elderly General Practice Patients

1994 ◽  
Vol 165 (4) ◽  
pp. 533-537 ◽  
Author(s):  
C. Turrina ◽  
R. Caruso ◽  
R. Este ◽  
F. Lucchi ◽  
G. Fazzari ◽  
...  
Keyword(s):  
General Practice ◽  
Major Depression ◽  
Elderly Patients ◽  
General Practitioners ◽  
Affective Disorders ◽  
Dysthymic Disorder ◽  
Not Otherwise Specified ◽  
Prevalence Of Depression ◽  
General Practices

BackgroundWe investigated the prevalence of depression among 255 elderly general practice patients and the practitioners' performance in identifying depression.MethodElderly patients attending 14 general practices entered a screening phase with GHQ-12 and MMSE. Those positive were then interviewed with GMS and HAS.ResultsDSM-III-R major depression affected 22.4%, dysthymic disorder 6.3%, not otherwise specified (n.o.s.) depression 7.1 %. General practitioners performed fairly well: identification index 88.4%, accuracy 0.49, bias 1.85.ConclusionsDepression was markedly high. A selective progression of depressed elderly from the community to general practitioners is implied.

scholarly journals A Five-Year Study of Influenza in Families Joint Public Health Laboratory Service/Royal College of General Practitioners Working Group

1981 ◽  
Vol 87 (2) ◽  
pp. 191-200 ◽  
Author(s):  
P. G. Mann ◽  
M. S. Pereira ◽  
J. W. G. Smith ◽  
R. J. C. Hart ◽  
W. O. Williams ◽  
...  
Keyword(s):  
Public Health ◽  
General Practitioners ◽  
Royal College ◽  
Working Group ◽  
Virus Isolation ◽  
Collaborative Study ◽  
Influenza Viruses ◽  
Public Health Laboratory ◽  
Laboratory Service ◽  
Before And After

SummaryA five year collaborative study of influenza in volunteer families from 1973–78 covered a period in which there were outbreaks every year but no major epidemics of influenza. Volunteers over the age of 15 years were bled before and after each of the five winters, and virus isolation was attempted from as many as possible when they reported episodes of illness. Children under 15 in the volunteer families were also swabbed when they were ill. Although most families experienced one or more attacks by influenza viruses, there was little transmission within families.

scholarly journals Repeat prescribing policy in New Zealand general practice: making it better

2020 ◽  
Vol 12 (4) ◽  
pp. 373
Author(s):  
Steven Lillis ◽  
Liza Lack
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Local Development ◽  
Policy Research ◽  
Practice Research ◽  
Annual Conference ◽  
Protected Time ◽  
Repeat Prescribing ◽  
General Practices

ABSTRACT INTRODUCTIONRepeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIMTo inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODSAt the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTSIssues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSIONThis research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.

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