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1.
New Zealand Medical Journal ; 133(1523):65-75, 2020.
Article in English | EMBASE | ID: covidwho-2207367

ABSTRACT

AIMS: To investigate changes in general practice consultation patterns in response to reduced face-to-face patient contact during the COVID-19 pandemic. METHOD(S): A retrospective before and after case notes review study of one urban general practice to investigate patient contact in the first two weeks of New Zealand general practices' COVID-19 response in 2020, compared to the same period in 2019. RESULT(S): Twenty percent of patients had contact with the practice in both samples, with similar proportions by age, gender, ethnicity, deprivation and presence of multimorbidity or mental health diagnoses. Similar numbers of acute illness, accident-related and prevention patient contacts occurred in both samples, with more long-term condition-related contact in 2020. While 70% of patient contacts were face-to-face in 2019, 21% were face-to-face in 2020. Most acute illness, accident-related and long-term condition-related contacts were able to be provided through virtual means, but most prevention-related contacts were face-to-face. CONCLUSION(S): This single practice study showed total patient contact was similar over both sample periods, but most contact in 2020 was virtual. Further longitudinal multi-practice studies to confirm these findings and describe future consultation patterns are needed to inform general practice service delivery post-COVID-19. Copyright © NZMA.

2.
New Zealand Medical Journal ; 133(1520):91-98, 2020.
Article in English | EMBASE | ID: covidwho-2207322

ABSTRACT

Coronavirus disease 2019 (COVID-19) has rapidly spread across the globe, driving radical transformation in the way patient care is delivered in primary and secondary care. As part of the response against COVID-19 across primary care in New Zealand, practices and medical centres have largely transitioned to telehealth over a short period of time while maintaining the traditional business model of in-person care on an as-required basis. To inform other primary care services and future practice, we describe our experience at one general practice and the challenges faced in the process of converting to telehealth in the midst of the COVID-19 pandemic. Copyright © NZMA.

3.
BMC Med Educ ; 23(1):65, 2023.
Article in English | PubMed | ID: covidwho-2214575

ABSTRACT

BACKGROUND: The Recorded Consultation Assessment (RCA) was developed rapidly during the COVID-19 pandemic to replace the Clinical Skills Assessment (CSA) for UK general practice licensing. Our aim was to evaluate examiner perceptions of the RCA. METHODS: We employed a cross-sectional design using a questionnaire survey of RCA examiners with attitudinal (relating to examiners thoughts and perceptions of the RCA) and free text response options. We conducted statistical descriptive and factor analysis of quantitative data with qualitative thematic analysis of free text responses. RESULTS: Overall, 182 of 260 (70%) examiners completed the questionnaire. Responders felt that consultations submitted were representative of the work of a typical GP during the pandemic and provided a good sample across the curriculum. They were also generally positive about the logistic, advisory and other support provided as well as the digital platform. Despite responders generally agreeing there was sufficient information available in video or audio consultations to judge candidates' data gathering, clinical management, and interpersonal skills, they were less confident about their ability to make judgments of candidates' performance compared with the CSA. The qualitative analysis of free text responses detailed the problems of case selection and content, explained examiners' difficulties when making judgments, and detailed the generally positive views about support, training and information technology. Responders also provided helpful recommendations for improving the assessment. CONCLUSION: The RCA was considered by examiners to be feasible and broadly acceptable, although they experienced challenges from candidate case selection, case content and judgments leading to suggested areas for improvement.

4.
Pharmaceutical Journal ; 309(7965), 2022.
Article in English | EMBASE | ID: covidwho-2196682
5.
Pharmaceutical Journal ; 309(7966), 2022.
Article in English | EMBASE | ID: covidwho-2196681
6.
BMC Prim Care ; 24(1):14, 2023.
Article in English | PubMed | ID: covidwho-2196059

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is increasingly used to support general practice in the early detection of disease and treatment recommendations. However, AI systems aimed at alleviating time-consuming administrative tasks currently appear limited. This scoping review thus aims to summarize the research that has been carried out in methods of machine learning applied to the support and automation of administrative tasks in general practice. METHODS: Databases covering the fields of health care and engineering sciences (PubMed, Embase, CINAHL with full text, Cochrane Library, Scopus, and IEEE Xplore) were searched. Screening for eligible studies was completed using Covidence, and data was extracted along nine research-based attributes concerning general practice, administrative tasks, and machine learning. The search and screening processes were completed during the period of April to June 2022. RESULTS: 1439 records were identified and 1158 were screened for eligibility criteria. A total of 12 studies were included. The extracted attributes indicate that most studies concern various scheduling tasks using supervised machine learning methods with relatively low general practitioner (GP) involvement. Importantly, four studies employed the latest available machine learning methods and the data used frequently varied in terms of setting, type, and availability. CONCLUSION: The limited field of research developing in the application of machine learning to administrative tasks in general practice indicates that there is a great need and high potential for such methods. However, there is currently a lack of research likely due to the unavailability of open-source data and a prioritization of diagnostic-based tasks. Future research would benefit from open-source data, cutting-edge methods of machine learning, and clearly stated GP involvement, so that improved and replicable scientific research can be done.

7.
Menopause ; 29(12):1462, 2022.
Article in English | EMBASE | ID: covidwho-2190882

ABSTRACT

Objective: Sexual desire and responses may change due to natural menopause and could potentially negatively impact a once-healthy sexual relationship between a heterosexual couple. The objective of this study was to describe the lived experience of perceived changes in sexual desire and responses from a menopausal female or a male partner of a menopausal female during or after menopause. Design(s): A descriptive phenomenological approach was used to reveal the true essence of a participant's lived experience of perceived changes in sexual desire and responses which highlighted perceptions, feelings, and personal reactions. The theoretical framework used for this study was Meleis' (2010) transitions theory defined as a passage from one fairly stable state to another fairly stable state (Chick & Meleis, 1986). In transitions theory, a clinician considers inhibitors of successful transitions along with factors that facilitate successful transitions while considering, the recipient's personal meaning and attitude. In-depth interviews were used for data collection and research took place at a family practice clinic located in southeast Texas, and via ZOOM because of the COVID-19 pandemic. Result(s): Participant's ages ranged from 43 years to 68 years. 95% were married. 75% had 20 or more marriage years with the same partner. 75% were African American, 5% Asian, 10% Caucasian, and 10% Hispanic. 5% had a high school education completing through grade 12, 35% had some college, 20% had a 4-year degree, and 40% had beyond a 4-year degree. Results are presented as developed themes. Theme 1: An uncomfortable experience with decreased desire. 84% of females experienced a decreased or non-existant sexual desire because of pain due mostly to vaginal dryness. 100% of males sexual desire remained the same. Theme 2: Conflicting messages of desire. 75% of females gave a conflicting message saying she had no sexual desire yet voiced she enjoyed sex. All males were consistent with their responses.Theme 3: Physical and mental metamorphosis. 83% of females explained a disconnect between her mind thinking she achieved vaginal moisture but her body had not responded as such. 25% of males perceived a strong erection but in essence he lacked rigidity. Theme 4: A sense of duty 92% of females felt obligated to perform her wifely duty. 87.5% of males did not feel obligated. Theme 5: The disappearance of spontaneity. 90% of all participants described the inability to no longer be spontaneous with sex resulted in decreased sexual desire because of preperation needed beforehand. Females because of having to apply a vaginal lubricant and males because of the need to use erectile dysfunction medication. Theme 6: A natural part of aging. 31% of females described age affects her physical appearance and perceived this influenced her male partner's desire. 62.5% of males said age correlated with other life-obligations affecting sexual desire, but not because of his partner's menopausel state. Theme 7: Love conquers all. 81% of females stressed her decrease in sexual desire was not reflective of her love for her partner. 75% of males emphasized changes in his partner's sexual desire or response did not negatively affect his love for his partner. Conclusion(s): This phenomenological inquiry subsidized a gap in the literature by creating new data that provided insight into lived experiences of perceived changes in sexual desire and responses during the menopause transition or after menopause from the perspective of both females and males which is scarcely acknowledged in current literature. A new data finding in this research uncovered participant's living an experience described as a disappearance of spontaneity that decreased sexual desire. Also, this research uncovered a lived experience described by participant as having engaged and exciting sexual thoughts and seemingly being physically prepared for sexual intercourse but resulted in physical unresponsiveness. It is the recommendation of this researcher that health care providers who attend to perimen pausal or menopausal aged patients take advantage of screening and educational opportunities. Continued research on this unique population of menopause aged females and males would help define evidenced-based care that positively and accurately reflect patient needs.

8.
Journal of Primary Health Care ; 14(4):302-309, 2022.
Article in English | MEDLINE | ID: covidwho-2186677

ABSTRACT

Introduction New Zealand general practice and primary care is currently facing significant challenges and opportunities following the impact of the coronavirus disease 2019 (COVID-19) pandemic and the introduction of health sector reform. For future sustainability, it is important to understand the workload associated with differing levels of patient case mix seen in general practice. Aim To assess levels of morbidity and concomitant levels of socio-economic deprivation among primary care practices within a large primary health organisation (PHO) and associated Maori provider network. Methods Routinely collected practice data from a PHO of 57 practices and a Maori provider (PHO) of five medical practices in the same geographical area were used to compare a number of population health indicators between practices that had a high proportion of high needs patients (HPHN) and practices with a low proportion of high needs patients (Non-HPHN). Results When practices in these PHOs are grouped in terms of ethnicity distribution and deprivation scores between the HPHN and Non-HPHN groups, there is significantly increased clustering of both long-term conditions and health outcome risk factors in the HPHN practices. Discussion In this study, population adverse health determinants and established co-morbidities are concentrated into the defined health provider grouping of HPHN practices. This 'concentration of complexity' raises questions about models of care and adequate resourcing for quality primary care in these settings. The findings also highlight the need to develop equitable and appropriate resourcing for all patients in primary care.

9.
Revue d'Epidemiologie et de Sante Publique ; 70(Supplement 4):S276-S277, 2022.
Article in French | EMBASE | ID: covidwho-2182749

ABSTRACT

Figures [Formula presented] Fig. 1. Effets univaries de l'age, Severite Scanner TDM, CRP et Saturation O2. Chaque point represente un patient, avec la valeur de la variable explicative en abscisse et l'influence associee en ordonnee. [Formula presented] Fig 2. Influences des patients correspondant aux patients les plus representatifs des trois groupes identifies. Les noms des variables sont raccourcis pour les groupes 2 et 3. Les valeurs initiales des variables sont indiquees apres le trait d'union et arrondies afin qu'elles apparaissent toutes comme des nombres entiers. References 1. Institut Pasteur: Projection 'a court terme des besoins hospitaliers pour les patients COVID-19;. 2. Chen T,et al. A scalable tree boosting system. In: Proceedings of the 22nd acm sigkdd international conference on knowledge discovery and data mining;2016. p. 785-794. 3. Bottino F, et al. COVID Mortality Prediction with Machine Learning Methods: A Systematic Review and Critical Appraisal. Journal of personalized medicine. 2021;11(9):893. 4. Lundberg SM, Lee SI. A unified approach to interpreting model predictions. In: Proceedings of the 31st international conference on neural information processing systems;2017. p. 4768-4777. 5. Dera JD. Risk stratification: A two-step process for identifying your sickest patients. Family practice management. 2019;26(3):21-26. 6. Gestions Hospitalieres: Naviguer dans la tempete, ndegree 605 - April 2021;. Copyright © 2022

10.
Journal Europeen des Urgences et de Reanimation ; 2023.
Article in English, French | EMBASE | ID: covidwho-2180488

ABSTRACT

Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS

11.
American Journal of Obstetrics and Gynecology ; 228(1 Supplement):S160, 2023.
Article in English | EMBASE | ID: covidwho-2175888

ABSTRACT

Objective: Maternal mortality in the United States (US) is rising and many deaths are preventable. We sought to determine the efficacy of virtual simulation training to optimize management of obstetric emergencies within low and moderate volume delivery hospitals that are disproportionately affected by adverse maternal outcomes. Study Design: The educational platform was designed and deployed within urban non-teaching and rural hospitals, with low and moderate delivery volumes, in the US during the COVID-19 pandemic. Self-paced, interactive, online didactics on postpartum hemorrhage and hypertensive disorders of pregnancy were followed by two, 2-hour live virtual simulation trainings and debriefings. In this innovative simulation modality, participants verbalized actions to their co-participants and the simulation faculty as scenarios evolved with images, vitals and videos displayed on a PowerPoint. Participants completed multiple-choice questionnaires and confidence and attitude surveys prior to, immediately after and 3-months post-training. The multiple-choice questions were evidence-based using information from published guidelines and were validated by local experts. Paired t-tests were performed to asses for changes in knowledge and confidence. Result(s): From December 2021 to March 2022, four hospitals received training (Table 1). Participants (n=22) were comprised of nurses (59%), certified nurse midwives (14%) and attending physicians (23%) in Obstetrics, Family Practice or Anesthesiology. The survey response rate was 59%. The mean difference in knowledge and confidence scores significantly improved immediately post-training compared to baseline (P < 0.05 for all, Table 2). This improvement was maintained 3 months following the training. Participants reported their preferred training format was hybrid (43%), virtual (35.7%) or in-person (21.4%). Conclusion(s): Virtual obstetric simulation is feasible and improves knowledge and confidence, which can be retained over time. This educational modality is sustainable, scalable and an accessible format to enhance education and training. [Formula presented] [Formula presented] Copyright © 2022

12.
European Geriatric Medicine ; 13(Supplement 1):S42-S43, 2022.
Article in English | EMBASE | ID: covidwho-2175468

ABSTRACT

Introduction: Inappropriate antibiotic use for urinary tract infections (UTIs) in older adults is an important driver of antibiotic resistance. We aimed to evaluate whether antibiotic prescribing for UTIs in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention (ASI). Method(s): We conducted a pragmatic cluster randomized controlled trial (registered: NCT03970356) in older adult care organizations and general practices in Poland, the Netherlands, Norway and Sweden. The intervention group received an ASI consisting of a decision tool for restrictive antibiotic use, implemented using a modified participatory- action-research approach. The control group received usual care. Data was collected during a 5-month baseline period and a 7-month follow-up period (September 2019-July 2021). In between, the intervention was implemented and the trial was paused for 6 months due to COVID-19. The primary outcome was the number of antibiotic prescriptions for suspected UTIs during the follow-up period. Result(s): We included 38 clusters with 1041 frail older adults in the analysis. The primary outcome was 54 antibiotic prescriptions in 202 patient-years in the intervention group and 121 in 209 patient-years in the usual care group, resulting in an adjusted rate ratio of 0.42 (95% CI 0.26-0.68, p<0.001) to receive an antibiotic prescription for a suspected UTI. Incidence of complications and hospitalizations within 3 weeks after suspected UTIs and all-cause mortality did not differ between groups. Key conclusions: Implementation of a multifaceted antibiotic stewardship intervention in older adult care organizations safely reduces antibiotic prescription rates for suspected UTIs in frail older adults.

13.
New Zealand Medical Journal ; 135(1566):103-105, 2022.
Article in English | EMBASE | ID: covidwho-2167698
14.
European Journal of Molecular and Clinical Medicine ; 9(7):4243-4262, 2022.
Article in English | EMBASE | ID: covidwho-2167419

ABSTRACT

Background: Proper use of Personal Protective Equipment (PPE) is an integral part of infection control and prevention of cross-infection during dental treatment, which has gained momentum following the SARS-CoV-2 pandemic. Aim(s): This cross-sectional descriptive study aimed to assess the attitude and commitments of Dental Health Care Providers (DHCP) and students at Riyadh Elm University (REU) teaching hospitals to (PPE) during their daily practice. Material(s) and Method(s): Data was collected using an electronic, close-ended questionnaire uploaded through Google Forms and sent via email to the study population. It consisted of twenty questions targeting the health care provider at (REU) dental hospitals in Riyadh, Saudi Arabia. In addition to the demographic data, the questions were directed at assessing the participants' attitudes and commitment toward (PPE) during their daily clinical work. Result(s): The total number of participants was 136 (57.4% male and 42.6% female). Most of the participants used to wear surgical medical masks (63.2%). N95 masks were used by only 11.8% of the respondents. More than half of the participants (58.8%) used to wear the masks for four hours, with a statistically significant difference between males and females regarding the masks' time (P-value =.0021). 91.9% of the time, the mask was worn during the patient examination and history taking. Only 58.1% and 85.3% of respondents reported using face coverage and eye protection, respectively. A head cap was used routinely by 55.1% of the participants. Dental assistants adhered to PPE and measures better than the other groups, especially when wearing gowns and head caps (P 0.05). Only 69.9% of the respondents answered correctly about the correct sequence of wearing PPE, and only 54.1% knew the correct sequence of removing PPE. Conclusion(s): The general practices and commitment to PPE among DHCPs at REU are acceptable. There was a lack of knowledge regarding proper donning and doffing sequences. Compliance with eye protection and hand hygiene practice recommendations needs improvement. Dental assistance demonstrated better commitment to eye protection, gown, and head cap-wearing and better knowledge regarding donning and doffing than other DHCPs. Copyright © 2022 Ubiquity Press. All rights reserved.

15.
Journal of Clinical and Diagnostic Research ; 16(11):LC29-LC32, 2022.
Article in English | EMBASE | ID: covidwho-2155786

ABSTRACT

Introduction: Many frontline workers including doctors and nurses have succumbed to the Coronavirus Disease-19 (COVID-19) pandemic. In the COVID-19 pandemic, medical postgraduate (PG) aspirants had to deal with a variety of problems, including an increased workload, delay in National Eligibility cum Entrance Test (NEET) PG test and counselling. Aim(s): To assess the effect of COVID-19 pandemic and various factors influencing career choice among medical PG aspirants in Chennai. Material(s) and Method(s): The present cross-sectional questionnaire-based study was conducted in the Department of Community Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India from August 2021 to September 2021 among 272 medical Postgraduate (PG) aspirants. A Google form questionnaire was sent to students who were in an internship in the past six months or had completed their internship in the past one year. There were 28 multiple choice questions comprising of socio-demographic details (with exception of age) and various factors related to career choice. Five questions were scored yes/no, and 15 questions were scored using 5-point Likert scale. Result(s): The mean age of the participants was 24.41+/-1.81 years and there were 129 males and 143 females in total among the study participants. Change in career choice was observed in 39.33% of the participants. The top two choices prior to and during the COVID-19 pandemic was General Surgery and General Medicine. Among the participants who had a change in career choice, the mean score of four questions in COVID-19 pandemic domain was higher when compared with participants who had no change. Conclusion(s): Most of the participants believed that the COVID-19 pandemic limited the learning opportunities for postgraduates and the violence against doctors had an impact on their decision to pursue a particular career. Due to the present pandemic, participants interest in community medicine and infectious diseases has increased. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

16.
European Psychiatry ; 65(Supplement 1):S593, 2022.
Article in English | EMBASE | ID: covidwho-2154133

ABSTRACT

Introduction: The current period is marked by several negative aspects of the COVID 19 pandemic, which have led to a series of emotional and cognitive changes that affect our functioning. The ability to "read" the minds of others is the key aspect of social behavior, helping us understand our context. Objective(s): To identify the level of emotion recognition in Medicine students during the Covid 19 pandemic. Method(s): Throughout 2021, we evaluated 649 Romanian General Medicine students in years 4, 5 and 6, by using a Google Play application (android and iOS).We analyzed socio-demographic parameters and the affective component of Theory of Mind (The Reading the Mind in the Eyes Test). The mean scores between groups were compared with the Student's t and the ANOVA tests. Result(s): The mean score was 25.83+/-3.36 (min 11, max 33) out of a possible maximum of 36. We noted that women have a higher capacity for recognizing emotions than men (26.04 +/-3.22 vs. 25.01 +/- 3.78, P = 0.0016) without differences in terms of the study year. Also, women showed a greater ability to recognize negative emotions compared to men (16.57 +/- 2.44 vs. 15.49 +/- 2.75, P <0.001). No statistically significant differences were found between the two genders in terms of positive emotions' recognition. Conclusion(s): The ability to recognize emotions seems to be more developed in women, especially when it entails recognizing negative emotions. Theory of Mind abilities are important for empathy and the therapeutic relationship required in Medicine.

17.
European Psychiatry ; 65(Supplement 1):S229-S230, 2022.
Article in English | EMBASE | ID: covidwho-2153856

ABSTRACT

Introduction: During the COVID-19 pandemic residents of the central region of Hungary also had to adapt to several challenges such as changes of hospitals' specialty profiles and delegation of health care workers to COVID wards. Hungarian residents have their practical training in various hospitals, while their psychiatric academic training is organised in groups. Objective(s): Our aim is to share our personal experiences about how our work and training have changed during the pandemic and it's effect on our patients. Method(s): Participants of the study were the authors of the poster. Responses to open questions were structured based on the following topics: competencies in internal medicine, infectious diseases and psychiatry, our collaboration with other medical disciplines, psychiatric training and attitudes towards mental health patients. Result(s): We worked min 2 weeks max 8 months at COVID wards and also treated COVID-19 infected psychiatric patients, thus gaining a greater experience in general medicine. In psychiatric work, acute care became prominent, communication in PPE and restricted contact with patients' relatives were particularly difficult. Our relationship with other specialists has improved, consultation became easier. Increased use and misuse of psychiatric consultation requests led to further pressure. Restrictions, stigmatisation and discrimination increased against psychiatric patients, including difficult access to care. Psychiatric training in the hospitals became limited, however seminars organized by the university continued online with our active participation. Conclusion(s): During the pandemic we gained greater experience in general medicine. Psychiatric care and our training was negatively affected, however the latter was mitigated by online seminars.

18.
European Psychiatry ; 65(Supplement 1):S9, 2022.
Article in English | EMBASE | ID: covidwho-2153763

ABSTRACT

Psychiatry is facing major challenges during times of a pandemic as illustrated by the current COVID-19 pandemic. The challenges involve its actual and perceived role within the medical system, in particular how psychiatric hospitals can maintain their core mission of attending to the mentally ill while at the same time providing relief to general medicine. Since psychiatric disorders are the top leading causes of global burden of disease, we need to strengthen mental health care in the wake of the massive onslaught of the pandemic. While nobody can deny the need to act decisively and swiftly and ramp up intensive care readiness, we believe that the immediate availability of psychiatric care is just as important. In order to provide the best possible treatment conditions for people suffering from mental illness but as well for those suffering from the immediate pandemic's consequences such as isolation, reduced social interaction etc. instant and comprehensive provision is inevitable.

19.
Arch Public Health ; 80(1):250, 2022.
Article in English | PubMed | ID: covidwho-2153674

ABSTRACT

BACKGROUND: The COVID-19 outbreak had an important impact on general practice, for example the lack of personal protective equipment (PPE) and the switch to telephone consultations. We installed a monitoring instrument and reported the burden the COVID-19 pandemic placed on Belgian general practitioners (GPs) during the first wave of the pandemic. METHODS: We conducted an observational longitudinal prospective study from the 19(th) of March until the 17(th) of August 2020. Daily data were collected by using a structured electronic form integrated into the GPs' electronic medical records (EMRs). Data were collected on the GPs' need for support and workload, epidemiological indicators and the availability of PPE. Reports with graphical presentations were made for GP circles and primary care zones, and governments of different administrative levels had access to all data to guide their policy. RESULTS: A total of 3.769 different GP centres participated, which included more than 10.000 GPs. Throughout the first three weeks, 20% declared they had insufficient resources (personnel and material) for the following week. Approximately 10% continued to report this during the entire study. The majority reported being able to complete their daily tasks without loss of quality. During the first week, 30% indicated an increased workload. Afterwards, this number decreased and stabilized to an average of 10-20%. More than 70% of the consultations in March 2020 were conducted by telephone. This percentage declined in April and stabilized at approximately 30% in June 2020. Consultations due to respiratory symptoms peaked at 4000/100,000 inhabitants at the beginning of the outbreak, then decreased over time along with the COVID-19 incidence. We noticed a lack of disinfectant hand gel, surgical masks and FFP2 masks, the latter remaining problematic in the long term. CONCLUSION: We introduced an instrument in Belgian EMR systems to monitor the burden on GPs during the first wave of the COVID-19 pandemic. The lack of PPE and increased workload were considered to be the main obstacles. A large number of the GP offices switched to teleconsultations to provide healthcare. Our monitoring instrument provided information for policy makers to intervene on a local level.

20.
Palliat Med ; : 2692163221140435, 2022.
Article in English | PubMed | ID: covidwho-2153352

ABSTRACT

BACKGROUND: The need for end-of-life care in the community increased significantly during the COVID-19 pandemic. Primary care services, including general practitioners and community nurses, had a critical role in providing such care, rapidly changing their working practices to meet demand. Little is known about primary care responses to a major change in place of care towards the end of life, or the implications for future end-of-life care services. AIM: To gather general practitioner and community nurse perspectives on factors that facilitated community end-of-life care during the COVID-19 pandemic, and to use this to develop recommendations to improve future delivery of end-of-life care. DESIGN: Qualitative interview study with thematic analysis, followed by refinement of themes and recommendations in consultation with an expert advisory group. PARTICIPANTS: General practitioners (n = 8) and community nurses (n = 17) working in primary care in the UK. RESULTS: General practitioner and community nurse perspectives on factors critical to sustaining community end-of-life care were identified under three themes: (1) partnership working is key, (2) care planning for end-of-life needs improvement, and (3) importance of the physical presence of primary care professionals. Drawing on participants' experiences and behaviour change theory, recommendations are proposed to improve end-of-life care in primary care. CONCLUSIONS: To sustain and embed positive change, an increased policy focus on primary care in end-of-life care is required. Targeted interventions developed during COVID-19, including online team meetings and education, new prescribing systems and unified guidance, could increase capacity and capability of the primary care workforce to deliver community end-of-life care.

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