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.

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

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

2007 ◽  
Vol 30 (4) ◽  
pp. 36
Author(s):  
M. L. Russell ◽  
L. McIntyre
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Community Health ◽  
Royal College ◽  
Community Medicine ◽  
Work Setting ◽  
Public Health Medicine ◽  
Work Settings ◽  
Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

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 Seasonal Influenza Vaccination and Recommendation: The Difference between General Practitioners and Public Health Workers in China

Vaccines ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 265 ◽  
Author(s):  
Hongguo Rong ◽  
Xiaozhen Lai ◽  
Xiaochen Ma ◽  
Zhiyuan Hou ◽  
Shunping Li ◽  
...  
Keyword(s):  
Public Health ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
General Practitioners ◽  
Seasonal Influenza ◽  
Health Workers ◽  
The Elderly ◽  
Vaccine Uptake ◽  
Knowledge And Attitudes ◽  
Public Health Workers

Seasonal influenza vaccination for healthcare workers (HCWs) is critical to the protection of HCWs and their patients. This study examined whether the separation of public health workers and general practitioners could affect the influenza vaccine uptake and recommendation behaviors among HCWs in China. A survey was conducted from August to October 2019, and HCWs from 10 provinces in China were recruited. A self-administered and anonymous questionnaire was used to assess HCWs’ demographic information, knowledge, and attitudes toward influenza vaccination, as well as vaccine uptake and recommendation behaviors. The primary outcome was HCWs’ vaccination and recommendation status of seasonal influenza vaccine. Multivariate logistic regression models were used to identify the influence factors of influenza vaccine uptake and recommendation among HCWs. Of the 1159 HCWs in this study, 25.3% were vaccinated against influenza in the previous season. “No need to get vaccinated” was the primary reason for both unvaccinated public health workers and general practitioners. Multivariate logistic regression showed that public health workers were more likely to get vaccinated against influenza (OR = 2.20, 95% CI 1.59–3.05) and recommend influenza vaccination to children (OR = 2.10, 95% CI 1.57–2.80) and the elderly (OR = 1.69, 95% CI 1.26–2.25) than general practitioners. Besides, the knowledge and perceived risk of influenza can give rise to HCWs’ vaccination and recommendation behaviors, and HCWs who got vaccinated in the past year were more likely to recommend it to children and the elderly in their work. The influenza vaccine coverage and recommendation among HCWs are still relatively low in China, especially for general practitioners. Further efforts are needed to improve the knowledge and attitudes toward influenza and influenza vaccination among HCWs, and coherent training on immunization for both public health workers and general practitioners might be effective in the face of separated public health and clinical services in China.

scholarly journals Primary care and public health a natural alliance? The introduction of the guidelines for obesity and undernutrition of the Dutch College of General Practitioners

2012 ◽  
Vol 29 (suppl 1) ◽  
pp. i31-i35 ◽  
Author(s):  
M. J. P. van Avendonk ◽  
P. A. J. S. Mensink ◽  
A. J. M. Drenthen ◽  
J. J. van Binsbergen
Keyword(s):  
Public Health ◽  
Primary Care ◽  
General Practitioners

scholarly journals Recruiting and retaining general practitioners to a primary care asthma-intervention study in Australia

2014 ◽  
Vol 20 (1) ◽  
pp. 98 ◽  
Author(s):  
Smita Shah ◽  
Jessica K. Roydhouse ◽  
Brett G. Toelle ◽  
Craig M. Mellis ◽  
Christine R. Jenkins ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Retention Rate ◽  
Controlled Trial ◽  
Independent Research ◽  
Project Staff ◽  
Recruitment Methods ◽  
General Practices ◽  
Randomised Controlled ◽  
First Contact

The need for more evidence-based interventions in primary care is clear. However, it is challenging to recruit general practitioners (GPs) for interventional research. This paper reports on the evaluation of three methods of recruitment that were sequentially used to recruit GPs for a randomised controlled trial of an asthma communication and education intervention in Australia. The recruitment methods (RMs) were: general practices were contacted by project staff from a Department of General Practice, University of Sydney (RM1); general practices were contacted by staff from an independent research organisation (RM2); and general practices were contacted by a medical peer (chief investigator) (RM3). A GP was defined as ‘recruited’ once they consented and were randomised to a group, and ‘retained’ if they provided baseline data and did not notify staff of their intention to withdraw at any time during the 12-month study. RM1 was used for the first 6 months, during which 34 (4%) GPs were recruited and 21 (62%) retained from a total of 953 invitations. RM2 was then used for the next 5 months, during which 32 (6%) GPs were recruited and 26 (81%) were retained. Finally over the next 7 months, RM3 recruited 84 (12%) GPs and retained 75 (89%) GPs. In conclusion, use of a medical peer as the first contact was associated with the highest recruitment and retention rate.

scholarly journals The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
Nicholas Jones ◽  
Jienchi Dorward ◽  
Rachel Byford ◽  
Harshana Liyanage ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trials ◽  
General Practice ◽  
General Practitioners ◽  
Royal College ◽  
Digital Health ◽  
Health Data ◽  
Clinical Informatics ◽  
Data Sets ◽  
The United Kingdom

BACKGROUND Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. OBJECTIVE The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. METHODS We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. RESULTS The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. CONCLUSIONS ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19773

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