Characteristics and Influencing Factors of Healthcare Utilization in Post-conflict Primary Care Attendees in Northern Sri Lanka

Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.

Characteristics and Influencing Factors of Healthcare Utilization in Post-conflict Primary Care Attendees in Northern Sri Lanka.

Sri Lanka's healthcare systems attempts to provides access to universal healthcare services for all citizens and is designed to be free of out-of-pocket payments. Despite a 30-year civil conflict, natural disasters, and COVID-19, the healthcare system within the country remains robust and strong. However, due to a lack of formalized pathways and centralized record keeping, the pattern of service utilization is still relatively unknown, which raises concerns regarding effective allocation of scarce resources and efficiency of referral pathways. To address this gap in knowledge, part of the parent study (COMGAP-S), consisted of a survey on healthcare service use conducted among adults attending primary care facilities. The results from this quantitative data analysis indicate the majority of people seeking care originate from rural areas, are older (50+), attend divisional hospitals, and report paying fees at point of contact. Our findings indicate a need for more efficient use of healthcare services, creation of referral routes to ensure limited healthcare resources are used effectively. Additionally, further investment in services is needed to ensure Sri Lanka's healthcare system meets the standard of universal healthcare as proposed by the World Health Organization. These findings address a gap in knowledge for national decision-makers within Sri Lanka along with other similar post-conflict healthcare settings across the globe.

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

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

Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-19.

OBJECTIVE: To identify whether active use of nonsteroidal antiinflammatory drugs (NSAIDs) increases susceptibility to developing suspected or confirmed coronavirus disease 2019 (COVID-19) compared to the use of other common analgesics. METHODS: We performed a propensity score-matched cohort study with active comparators, using a large UK primary care data set. The cohort consisted of adult patients age ≥18 years with osteoarthritis (OA) who were followed up from January 30 to July 31, 2020. Patients prescribed an NSAID (excluding topical preparations) were compared to those prescribed either co-codamol (paracetamol and codeine) or co-dydramol (paracetamol and dihydrocodeine). A total of 13,202 patients prescribed NSAIDs were identified, compared to 12,457 patients prescribed the comparator drugs. The primary outcome measure was the documentation of suspected or confirmed COVID-19, and the secondary outcome measure was all-cause mortality. RESULTS: During follow-up, the incidence rates of suspected/confirmed COVID-19 were 15.4 and 19.9 per 1,000 person-years in the NSAID-exposed group and comparator group, respectively. Adjusted hazard ratios for suspected or confirmed COVID-19 among the unmatched and propensity score-matched OA cohorts, using data from clinical consultations in primary care settings, were 0.82 (95% confidence interval [95% CI] 0.62-1.10) and 0.79 (95% CI 0.57-1.11), respectively, and adjusted hazard ratios for the risk of all-cause mortality were 0.97 (95% CI 0.75-1.27) and 0.85 (95% CI 0.61-1.20), respectively. There was no effect modification by age or sex. CONCLUSION: No increase in the risk of suspected or confirmed COVID-19 or mortality was observed among patients with OA in a primary care setting who were prescribed NSAIDs as compared to those who received comparator drugs. These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic.