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1.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-336111

ABSTRACT

Objective: We quantified changes in dispensing of common medicines proposed for “repurposing” due to their perceived benefits as therapeutic or preventive for COVID-19 in Australia, a country with relatively low COVID-19 incidence in the first year of the pandemic. Methods: We performed an interrupted time series analysis and cross-sectional study using nationwide dispensing claims data (January 2017-November 2020). We focused on six subsidised medicines proposed for re-purposing: hydroxychloroquine, azithromycin, ivermectin, colchicine, corticosteroids, and calcitriol (Vitamin D analogue). We quantified changes in monthly dispensing and initiation trends during COVID-19 (March-November 2020) using autoregressive integrated moving average models (ARIMA) and compared characteristics of initiators in 2020 and 2019. Results: In March 2020, we observed a 99% (95%CI 96%-103%) increase in hydroxychloroquine dispensing (of which approximately 22% attributable to new use), and a 199% increase (95%CI 184%-213%) in initiation, with a shift towards prescribing by general practitioners (42% in 2020 vs 25% in 2019) rather than specialists. These increases subsided following regulatory restrictions on prescribing to relevant specialties. There was a small but sustained increase in ivermectin dispensing over multiple months, with a 80% (95%CI 42%-118%) increase in initiation in May 2020 following its first identification as potentially disease-modifying in April. Other than increases in March related to stockpiling, we observed no increases in initiation of calcitriol or colchicine during COVID-19. Dispensing of corticosteroids and azithromycin remained lower than expected in April through November 2020. Conclusions: While most increases in dispensing observed early on during COVID-19 were temporary and appear to be related to stockpiling among existing users, we did observed increases in initiation of hydroxychloroquine and ivermectin and a shift in prescribing patterns which may be related to media hype around these medicines. A quick response by regulators can help limit inappropriate repurposing to lessen the impact on medicine supply and patient harms.

2.
Osteopathic Family Physician ; 13(6):9-16, 2021.
Article in English | EMBASE | ID: covidwho-1822746

ABSTRACT

Introduction: Telemedicine is an emerging field in which physicians can interact electronically with patients to improve health. During the COVID-19 pandemic, the use of telemedicine has grown exponentially. As physicians work to provide equally high-quality care for their patients remotely, their experiences must be considered. Methods: This study utilized an online anonymous survey of physicians to assess their satisfaction, comfort level and student involvement when using telemedicine for patient care. Results: Overall, physicians’ experiences with the integration of telemedicine into their practices varied based on gender, the presence of medical students, age and prior experience with telemedicine. Physicians are more comfortable with telemedicine now than they had been prior to the start of the COVID-19 pandemic, and physicians who had prior experience were less likely to find it stressful to incorporate. Physicians in both the youngest (30–39 years old) and oldest (60 and older) categories reported the highest levels of satisfaction with telemedicine. Female physicians indicated they will be more likely to incorporate more telemedicine into practice in the future, beyond the COVID-19 pandemic. Of the specialties surveyed, family physicians report the lowest levels of comfort and satisfaction with telemedicine. Conclusion: Physician respondents of this survey provided valuable data on the perceptions of the widespread incorporation of telemedicine during the COVID-19 pandemic. Further research can follow which physicians choose to keep telemedicine integrated into their practices and how the demand for these virtual visits may change in the coming months.

3.
Deutsche Medizinische Wochenschrift ; 147(8):443-444, 2022.
Article in German | EMBASE | ID: covidwho-1821638
4.
Iranian Red Crescent Medical Journal ; 23(12), 2021.
Article in English | EMBASE | ID: covidwho-1819094
5.
Pediatria Polska ; 97(1):66-70, 2022.
Article in English | EMBASE | ID: covidwho-1818534

ABSTRACT

Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) is a new disease in children, connected with the COVID-19 pandemic. The main cause of this disease is dysregulation of the immune homeostasis. We report the first case of PIMS-TS in the Polish Mother’s Memorial Hospital Research Institute in Lodz. Many non-specific symptoms presented by the patient were the cause of the primary care physician’s therapeutic failure, which resulted in the boy being transferred to the district hospital and then to the institute in Lodz. During the complex diagnostic process anti-SARS-CoV-2 antibodies in the IgM and IgG classes were detected. The initial diagnosis of PIMS-TS was made, and treatment with immunoglobulins and acetylsalicylic acid was initiated. The patient’s condition improved the following day. The aim of this report is to emphasize that typical symptoms do not always determine known disease entities, and to point out the need to constantly improve one’s knowledge.

6.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:55, 2021.
Article in English | EMBASE | ID: covidwho-1817118

ABSTRACT

Introduction: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort. Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https://apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic. Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world. Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkit materials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic, we are looking to present this material in more venues in 2022 and beyond. The toolkit is available free of charge at the above address.

7.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:77, 2021.
Article in English | EMBASE | ID: covidwho-1817116

ABSTRACT

Introduction: The covid19 pandemic has forced the health system to restructure to prevent contagion of our patients. In this context, the members of the Orthogeriatric Group of the Catalan Society of Geriatrics and Gerontology (SCGiG) created a document that collected all the considerations to take into account during the pandemic, based on the current guides and scientific societies, in order to perform a correct follow-up, enhance adherence and prevent future falls. Methods: A bibliographic review was performed, defining the key points in the care of the fractured patient through telemedicine (document is available at http://scgig.cat/docs/gt-orto-covid.pdf). Results: During hospital admission, antiosteoporotic treatment should be started, evaluating indications with the patient and family, to ensure adherence. Diet intake of calcium and vitamin D will be assessed. Discharge report includes evaluation of treatment and monitoring plan, to be useful for liaison nurse, rehabilitator and general practitioner. Six-monthly follow up is recommended for patients with comorbidities, polypharmacy, confusion, fall-risk, or parenteral anti-osteoporotic treatment. With denosumab or teriparatide, annual laboratory tests are recommended, with GFR <20, every six months, at home if possible. Bisphosphonates can be followed by the GP. Zoledronate is not recommended due to delayed administration after surgery, and possibility of transient flu-like simptoms. In the telematic follow-up visit, in patients undergoing zoledronic acid treatment, the new dose can be delayed for 6-12 months, without risk. Consider sequential treatment. Denosumab treatment cannot be delayed, so the patient and family will be trained in self-administration. Support materials from laboratories will be useful to patient and caregivers. Conclusion: Telemedicine is a good strategy for a follow-up, to avoid hospital contact, and starts on hospital admission. Patient and caregivers need access to new technologies and able to understand medical instructions.

8.
International Journal of Pharmacy Practice ; 30(SUPPL 1):i9-i10, 2022.
Article in English | EMBASE | ID: covidwho-1816113

ABSTRACT

Introduction: Practice-based pharmacists (PBPs) have been introduced into general practice across the United Kingdom (UK) to relieve some of the pressures within primary care (1,2). However, there is little existing UK literature that has explored healthcare professionals' (HCPs') views about PBP integration and how this role has evolved. Aim: To explore the views and experiences of general practitioners (GPs), PBPs, and community pharmacists (CPs) about PBPs' integration into general practice and their impact on primary healthcare delivery. Methods: Purposive and snowball sampling were used to recruit triads (a GP, a PBP, and a CP) from across five administrative healthcare areas in one region in the UK to participate in one-to-one semi-structured interviews. Sampling of practices to recruit GPs and PBPs commenced in August 2020. These HCPs identified the CPs who had most contact with the general practices in which the recruited GPs and PBPs were working. The interview topic guides were developed based on the published literature, and through discussion within the research team;they were piloted with two GPs, two PBPs, and two pharmacists. Due to the Covid-19 pandemic, interviews were conducted via telephone or Microsoft Teams platform. All interviews were recorded, transcribed verbatim, and analysed using inductive thematic analysis. Results: Eleven triads were recruited from across the five administrative areas. Analysis of interview transcripts is ongoing. Findings to date have revealed four main themes in relation to PBPs' integration into general practices (Table): evolution of the role, PBP attributes, collaboration and communication, and impact on care. A number of areas for development were identified such as patient awareness of the role and communication pathways between PBPs and CPs. Many saw PBPs as a central hub-middleman' between general practice and community pharmacies and between primary and secondary care. Conclusion: Participants reported that PBPs had integrated well, and perceived a positive impact on primary health care delivery. Although recruitment was limited to one UK geographical region, the triad approach provided a more comprehensive overview of the working relationships between the three HCP groups. Further work is needed to increase patient awareness of the PBP role.

9.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779469

ABSTRACT

Introduction: The COVID-19 pandemic led to a decrease in the incidence of breast cancer diagnoses in the Netherlands. This was due to the encouragement to stay at home, a lack of capacity at the general practitioner (GP) and an increased reluctance of patients to visit the GP. Moreover, from the 16th of March the Dutch breast cancer screening program was halted and gradually restarted from June onwards. Part of the follow-up visits for breast cancer survivors were also postponed or changed to an appointment by phone. However, it is not known how this affected the incidence of second primary breast cancer (SPBC) and pathologically confirmed breast cancer recurrences. Objective: To investigate the effect of the COVID-19 pandemic on the diagnosis of SPBC and breast cancer recurrences. Methods: Women diagnosed with a pathological confirmed SPBC or recurrence (locoregional recurrences (LRR) + distant metastasis (DM)) between January 1st 2017 and February 28th 2021 were selected from the Netherlands Cancer Registry, based on diagnoses of the Nationwide Histopathology and Cytopathology Data Network and Archive (PALGA). Patients with a SPBC or recurrence who had their primary breast tumor diagnosed more than five years ago were excluded. March 1st 2020 till February 28th 2021 was regarded as the S COVID-19 period. Incidence was expressed per 100, 000 women, who were diagnosed with breast cancer less than 5 years ago, and who were still alive. Incidence of SPBCs and recurrences was calculated for the total COVID-19 period and for four subperiods, and compared with the corresponding periods in 2017/2019 (averaged). Results: A total of 393 patients were diagnosed with a SPBCs in 2017, 340 in 2018, 299 in 2019, 342 in 2020 and 71 up to February 2021. A total of 447 patients were diagnosed with a recurrence in 2017, 520 in 2018, 516 in 2019, 529 in 2020 and 80 up to February 2021. During the COVID-19 period a total of 449 patients were diagnosed with a SPBCs per 100, 000 breast cancer survivors, this was comparable to the 445 patients diagnosed per year per 100, 000 breast cancer survivors in 2017/2019 (p=0.91) (Table 1). The incidence of SPBCs was significantly lower during March-May 2020 compared to the same period in 2017/2019 (86 vs. 121) (p=0.03), leading to 50 less SPBCs diagnoses. The incidence was higher during June-August 2020 (124 vs. 95), however this was not significant (p=0.09). The incidence of recurrences in the COVID-19 period, and within all four subperiods, was comparable to the incidence in 2017/2019. Conclusion: The COVID-19 pandemic led to a decrease in the detection of SPBCs at the beginning of the pandemic. However, this drop in incidence was caught up in the period thereafter. This might be related to the restart of the regular follow-up visits (partly in real-life consultations), the call to go to the GP in case of complaints and the improved accessibility of the GPs. The incidence of recurrences did not decrease since it includes also DM, which cause worrisome symptoms for which care is sought.

10.
Journal of the American College of Cardiology ; 79(9):1579, 2022.
Article in English | EMBASE | ID: covidwho-1768628

ABSTRACT

Background Telemedicine was quickly adopted by health systems throughout the United States during the COVID 19 pandemic crisis suggesting its relative feasibility and implementation. Nevertheless, there is limited data on whether a virtual blood pressure (BP) management approach is better than an office led approach. In this systematic review and meta-analysis of randomized clinical trials (RCTs) we aim to compare the differences in systolic BP (SBP) by NP or Pharmacist virtually as compared with primary care physician (PCP) in office. Methods We searched PubMed, MEDLINE, EMBASE, and Cochrane database for studies from January 2000 till October, 2021 with inclusion criteria of RCTs on pharmacist or NP based virtual (tele) BP management versus PCP based office visit (Usual Care) for BP management. Review manager 5.4 was used for data analysis. We used PRISMA guidelines to report synthesize and report our findings. Results We included nine RCTs which met our inclusion criteria with total of 3234 participants in both groups. There were 1615 participants in the APP tele visit group and 1619 participants in the PCP usual care/office visit group. Our results show that the use of NP/Pharmacist based telemedicine visit for SBP management was associated with statistically significant decrease in SBP compared to PCP based office visit (MD: -8.19, 95% CI -10.17, -6.21, P< 0.001, I2= 75%). In the analysis restricted to duration of follow up for less than 6 months (MD: -8.19, 95% CI: -11.74, -4.65, p<0.001) and 12 months (MD:-8.82, 95% CI: -11.21, -6.43, p=0.08), there is no statistically significant difference (p value=0.77). Both the NP as well as Pharmacist based tele visit to control SBP has shown better outcomes compared to PCP based office visit, NP vs PCP (MD: -8.78, 95% CI: -13.93, -3.64, P<0.001) and Pharmacist vs PCP (MD: -8.32, 95% CI: -10.58,-6.06, P<0.001), respectively. Conclusion Our study showed that tele-based intervention by NP/Pharmacist decreased SBP better than usual care in office by PCP. Virtual BP management should be further explored in these times of COVID-19 despite widespread heterogeneity of results and challenges related to the scope of practice and reimbursement of NP/pharmacists.

11.
Osteoarthritis and Cartilage ; 30:S230-S231, 2022.
Article in English | EMBASE | ID: covidwho-1768339

ABSTRACT

Purpose: After the age of fifty years, the incidence of osteoarthritis (OA) increases rapidly in women, suggesting an effect of menopause on the development of OA. Because it is still unclear how menopause precisely influences the development of OA, we aim to investigate this in a novel human model: the Females discontinuing Oral Contraceptives Use at Menopausal age (FOCUM) model. This model consists of women between fifty and sixty years of age, who are currently using a combined oral contraceptive (OC) and aim to stop OC use at short term. When these women stop using OC, a rapid change in hormones is expected, modelling a “sudden menopause”. Therefore, this model provides an opportunity to study changes occurring during menopausal transition. Because the FOCUM model is new, it is unknown if women want to participate, are willing to stop OC use shortly, and will not start hormone replacement after stopping OC use. Therefore, we aim to investigate the feasibility of the FOCUM study. We define the study to be feasible when: 1) 50 participants are included within one year and received their baseline measurements (including questionnaires, blood samples and Magnetic Resonance Imaging (MRI) assessments), 2) the loss of follow-up at 6 weeks is less than 5%, and 3) no hormone replacement therapy is used by the participants at 6 weeks follow-up. Methods: For the inclusion of participants, pharmacies in and nearby Rotterdam were invited to participate. Pharmacies were asked to search in their information systems to identify all possible eligible subjects, based on age and OC use. All eligible subjects received an invitation letter with information about the study. Interested subjects were contacted by the researchers for more information. Inclusion criteria were: 1) woman, 2) between 50 and 60 years of age, 3) currently using a combined OC (with Anatomical Therapeutic Chemical (ATC) code G03AA or G03AB), and 4) started OC use before the age of 45. Exclusion criteria were: 1) already known with osteoarthritis (self-reported or registered by their general practitioner), 2) already known with another inflammatory rheumatic condition, 3) having a contra-indication for MRI assessment, 4) having a terminal or mental illness, and 5) not being able to give informed consent. In this study, measurements are performed at baseline, just before stopping OC use (T0 = 0 to 30 days), and after (T1 = 6 weeks;T2 = 6 months;T3 = 1 year;T4 = 2 years) stopping OC use. At every time point, a digital questionnaire is filled in and a blood sample is drawn. At T0 and T4, also an MRI of one of the knees is performed. Results: In January 2020, invitations were sent to 106 pharmacies of which 48 were willing to participate. Due to COVID restrictions, the first invitations to possible eligible subjects were sent in July 2020. Until April 2021, a total of 1037 invitation letters were sent. 206 subjects replied positively, of which 175 were screened by the researchers. After screening for in- and exclusion criteria, 85 subjects were eligible. The most common reason why subjects were not eligible, was because they did not use their OC anymore. Eventually, 54 subjects gave informed consent and were all seen for their baseline measurements between August 2020 and July 2021. All baseline questionnaires, blood samples and MRI assessments were available. At 6 weeks follow-up, all 54 subjects were still participating in the study. From one participant the blood sample has not been drawn at 6 weeks follow-up and one participant started hormone replacement therapy after baseline measurements (see flowchart 1). [Formula presented] Conclusions: We reached the number of 54 participants within one year, which is more than the initially targeted number of 50. All baseline measurements, including questionnaires, blood samples and MRI assessments, have been collected from these 54 participants. At 6 weeks follow-up, there was no loss of follow-up, of one participant no blood sample was available and one participant started hormone replacement therapy. Therefore, we conclude that the FOCUM study is feasible. The next step will be to investigate differences in cardiometabolic and inflammatory biomarkers, joint complaints and structural OA features between baseline and follow-up measurements.

12.
British Journal of Oral and Maxillofacial Surgery ; 60(1):e4, 2022.
Article in English | EMBASE | ID: covidwho-1767938

ABSTRACT

Introduction/Aims: The implementation of COVID lockdown on 26 March 2020, led to a significant drop in urgent cancer referrals. This study looks at the quality of urgent cancer referrals and the impact of pandemic on the proportion of referrals to Royal Derby Hospital Head and Neck Unit with an eventual diagnosis of cancer. The data emphasises the need for us to look at the ways to improve the cancer referral pathway and service delivery. Materials and Methods: Retrospective electronic case note review was performed of urgent cancer referrals from general practitioners and general dental practitioners to Oral and Maxillofacial Surgery and Ear, Nose and Throat Head & Neck Cancer service at the Royal Derby Hospital. Results/Statistics: A total of 661 appointments were performed between 8 January 2020 and 30 June 2020 at the Head and Neck Cancer service. 98.9% of appointments pre-lockdown were seen face-to-face. This reduced to 62% of appointments post-lockdown. Only 60.1% of patients were informed of their urgent cancer referral pre-lockdown. 55.1% of patients were informed post-lockdown. The proportion of referrals with an eventual diagnosis of cancer increased from 6.4% to 13.3% in the 3 months following lockdown. Conclusions/Clinical Relevance: The outcome of this study showed an increase in proportion of referrals diagnosed with cancer despite reduced face to face appointments.This demonstrates the need to improve the quality of urgent cancer referrals including provision of the referral pathway information to patients and re-evaluate the current referral system criteria.This would be with a specific focus on educating the General Dental and Medical practitioners and reconfiguraton of hospital services.

13.
Toxics ; 10(3)2022 Mar 12.
Article in English | MEDLINE | ID: covidwho-1765928

ABSTRACT

Poor indoor air quality can have adverse effects on human health, especially in susceptible populations. The aim of this study was to measure the concentrations of dioxide carbon (CO2), fine particulate matter (PM2.5) and total volatile organic compounds (TVOCs) in situ in private healthcare and elderly care facilities. These pollutants were continuously measured in two rooms of six private healthcare facilities (general practitioner's offices, dental offices and pharmacies) and four elderly care facilities (nursing homes) in two French urban areas during two seasons: summer and winter. The mean CO2 concentrations ranged from 764 ± 443 ppm in dental offices to 624 ± 198 ppm in elderly care facilities. The mean PM2.5 concentrations ranged from 13.4 ± 14.4 µg/m3 in dental offices to 5.7 ± 4.8 µg/m3 in general practitioner offices. The mean TVOC concentrations ranged from 700 ± 641 ppb in dental offices to 143 ± 239 ppb in general practitioner offices. Dental offices presented higher levels of indoor air pollutants, associated with the dental activities. Increasing the ventilation of these facilities by opening a window is probably an appropriate method for reducing pollutant concentrations and maintaining good indoor air quality.

15.
Rural Remote Health ; 22(1): 7138, 2022 03.
Article in English | MEDLINE | ID: covidwho-1761523

ABSTRACT

INTRODUCTION: Over the course of the COVID-19 pandemic, Australian general practices have rapidly pivoted to telephone and video call consultations for infection control and prevention. Initially these telehealth consultations were required to be bulk billed (doctors could only charge fees equivalent to the national Medicare Benefits Schedule (MBS)). The potential impact of this policy on general practices − and particularly rural general practices - has been difficult to assess because there is limited published data about which practices are less likely to bulk bill and therefore more impacted by mandatory bulk billing policies. There was concern that bulk billing only policies could have a broader impact on rural practices, which may rely on mixed or private billing for viability in small communities where complex care is often needed. This study aimed to understand the patterns of bulk billing nationally and explore the characteristics of practices more or less likely to bulk bill patients, to identify the potential impact of a rapid shift to bulk billing only policies. METHODS: General practice bulk billing patterns were described using aggregate statistics from Australian Department of Health public MBS datasets. Bulk billing rates were explored over time by rurality, and state or territory. Next, questions about bulk billing were included in a cross-sectional survey of practices conducted in 2019 by General Practice Supervisors Australia (GPSA). Practice bulk billing patterns were explored by rurality, state or territory and practice size at univariate level before a multivariate logistic regression model was done, including the statistically significant variables. RESULTS: Nationally, bulk billing rates for general practice non-referred attendances increased over 2012-2019 from 82% to 86% but declined slightly in Modified Monash Model (MMM)2−7 (rural areas) at the end of this period. Further, bulk billing rates varied by rurality, and were highest in very remote (MMM7) (89-91%) and metropolitan areas (MMM1) (83-87%) and lowest in regional centres (MMM2) (76-82%) over this period. The results from the GPSA survey concurred with national data, showing that the proportion of practices bulk billing all patients was highest in metropolitan locations (28%) and lowest in regional centres and large rural towns (MMM2−3) (16%). Smaller practices (five or fewer general practitioners) were more likely to bulk bill all patients than were larger ones (six or more general practitioners). Multivariate modelling showed that bulk billing all patients was statistically significantly (p<0.05) less likely for larger practices compared with smaller ones, and for rural practices (MMM2−7) compared with those in metropolitan areas. CONCLUSION: Mandatory bulk billing policies should accommodate the fact that bulk billing varies by context, including rurality and the size of a practice, and has been decreasing in rural areas over recent years. Rapidly pivoting to bulk billing only service models may put pressure on rural and large practices unless they have time to adjust their business models and have ways to offset the loss of billings. Policies that allow for a range of billing arrangements may be important for practices to fit billings to their local context of care, including in rural settings, thereby supporting business viability and the availability of sustainable primary care services.


Subject(s)
COVID-19 , Pandemics , Aged , Australia , Cross-Sectional Studies , Humans , National Health Programs , Policy
16.
Romanian Journal of Military Medicine ; 125(1):42-49, 2022.
Article in English | Web of Science | ID: covidwho-1755948

ABSTRACT

Family doctors and general practitioners have long been those who were to be the first to deal with family's health problems. After primary care systems administration, general practitioners acquired a special role in the operation and efficiency of these systems. Their existence as institution contributes to the most complete and better prevention and treatment of health issues, as well as to the resources saving for the insurance systems. In Greece, since the formation of the Greek National Health System in 1983, numerous interventions have been legislated, most of them referring to the institution of family doctor. However, factors related to political will, financial interests, administrative and educational inadequacies, financial problems and geographical particularities did not allow the establishment of a strong primary healthcare. COVID-19 outbreak has exposed the weaknesses of all types of health systems. However, health systems based on primary care seem to better cope with the pandemic, as well as the continuity of care and quality of health services have been secured. In order, that Greek primary healthcare be organized from now on, many actions are required such as the establishment of electronic health records, the creation of properly staffed and equipped health centers, as well as more governmental financing programs about the modernization of primary care. Last but not least, pressure should also be exerted on governments to pass more groundbreaking bills and implement some of the older provisions.

17.
Osteoporosis International ; 32(SUPPL 1):S100, 2022.
Article in English | EMBASE | ID: covidwho-1748523

ABSTRACT

While it is increasingly evident that preventing secondary fractures can be a feasible and cost-effective task through active steps taken on those identified at higher risk, after suffering a fragility fracture;the burden in morbidity, mortality, and resources needed for acute and chronic care, still will be significant. Patients with fragility fractures requiring attention in a hospital, may not be overwhelming in terms of space and resources needed-as the COVID-19 pandemic-but, as the population ages and the prevalence of osteoporosis grows, the tendency is clearly upwards. Are there realistic interventions to decrease the number or first fragility fracture (FFF) at the population level? Since the early days of the COVID-19 pandemic, proposals to control its burden included ideas on accelerating preparedness on testing, personal protection, and tools to help in medical decisions;on mitigation of the burden of social distancing;on the use of digital technologies, like Tele-Health and artificial intelligence to notify those at risk;on adaptations of legal, regulatory, and support framework;on the need to invest and support innovators and on the need to improve communications on these topics1. In the case of osteoporosis, some of these thoughts may help. We can improve preparedness by broadening the involvement of primary care physicians on detection with simple tools and, if possible, access to DXA. Well informed health professionals may increase awareness among general population on the disease and how to help it. Involvement of the community in identifying those at higher risk, through a broader use of digital technologies and artificial intelligence seems feasible, now that the community sees as normal, a number of intrusive activities. If the world wide web allows a number of entities to identify potential customers, it can certainly provide clues on identification of candidates to be tested. This will require reviews of the legal basis for some of the required actions. There is a need to create sources of funding to support innovators on the design of new approaches-beyond pharmacological developments-for the prevention of osteoporotic fractures and their burden. All of these ideas require a massive distribution through strong communication efforts. The SCOOP study demonstrated that a systematic, community-based screening program of fracture risk in older women brought a significant improvement in terms of prevention of fractures2. A number of lifestyle changes may also have a positive impact in the community, with low cost3. These are only 2 of the many concepts that may find a way in our communication developments to decrease the burden of fragility fractures.

18.
Osteoporosis International ; 32(SUPPL 1):S299, 2022.
Article in English | EMBASE | ID: covidwho-1748514

ABSTRACT

Objective: The Asia Pacific Fragility Fracture Alliance (APFFA) is a federation committed to reducing the burden of low trauma fracture throughout the region. Education on fracture prevention to those at the forefront of patient care is an important part of this effort Methods: APFFA has curated educational materials developed by others (https://apfracturealliance.org/education-directory/) and developed a Primary Care Physician (PCP) Education Toolkit (https:// apfracturealliance.org/education-toolkit/). Here we describe the toolkit and report its introduction during the COVID-19 pandemic Results: The PCP Education Toolkit is designed as a half-day educational program together with supporting resources to highlight the role of primary care providers in this effort. The educational program includes a lecture focused on the burden of fracture, a lecture focused on clinical assessment of fracture risk, a discussion kit, and materials to assist with meeting planning. The discussion kit is designed to be adaptable to local practices and constraints. The supporting material features a patient handbook that gives practical advice on nutrition, home safety, and issues to be raised during medical encounters. COVID-19 hampered rollout of these materials. In addition, APFFA has relied on its constituent organizations to provide educational content to promote best practices in acute fracture management, rehabilitation, and secondary fracture prevention through the development of an education directory. The directory includes synopses and links to high quality materials from around the world Conclusion: The PCP Education Toolkit was designed with the expectation that the program would be presented as live meetings. The pandemic made this infeasible. Despite the restrictions, the PCP Education Toolkitmaterials have been enthusiastically received in New Zealand and disseminated by Osteoporosis NZ. As the world emerges from the pandemic we are looking to present this material inmore venues in 2022 and beyond. The toolkit is available free of charge at the above address Acknowledgements: Development of the PCP Education Toolkit and Education Directory was funded via an unrestricted grant from Amgen Asia to APFFA and its content was developed independently by APFFA.

19.
Annals of Emergency Medicine ; 78(4):S105-S106, 2021.
Article in English | EMBASE | ID: covidwho-1748253

ABSTRACT

Study Objectives: Social determinants of health (SDOH) impact patients’ health outcomes, yet screening methods in emergency departments (EDs) are inconsistent. Patients who seek care in EDs may be at greater risk for adverse SDOH than those seen by their primary care physician (PCP), but little comparable data is available. The authors sought to identify SDOH among ED Fast Track patients during the COVID-19 pandemic at an urban, safety-net hospital, measure preferred methods of resource referrals and barriers to accessing resources, and compare the prevalence of adverse SDOH among of ED Fast Track patients to that of adult PCP clinic patients. Methods: ED Fast Track patients were screened using a validated SDOH screener, and asked about the impact of COVID-19 on their SDOH. This was a convenience sample conducted from 1/15/21 to 4/13/21 and determined to be exempt by the IRB. Trained study staff completed screening and provided a printed resource guide. A two-week follow-up telephone survey assessed for barriers to resource connection. ED Fast Track patient data was then compared to concurrent SDOH data for adult PCP clinic patients, which collected the same validated SDOH screening data but was self-reported. Results: Among 414 adult ED Fast Track patients, 296 (71.5%) screened positive for at least one adverse SDOH, most commonly education (38.41%), food (35.0%), and housing insecurity (20.5%). Most (56.8%) endorsed COVID-19 affecting their SDOH. Fewer patients (36/156, 23.1%) reported attempting to connect with a resource. Barriers to accessing resources included having no time to call or visit the resource (59%), not recalling being given the resource guide (41%) or having lost it (28%). When compared to adult PCP clinic patients (Table 1), ED Fast Track patients were 10 times more likely to report at least one adverse SDOH (OR 10.0, 95% CI 6.9-14.4), 13 times more likely to report housing needs (OR 13.1, 95% CI 5.2-32.7), 8 times more likely to have food insecurity (OR 8.2, 95% CI 4.7-14.1) and 11 times more likely to have employment difficulty (OR 11.1, 95% CI 5.7-21.6). Conclusion: Most ED Fast Track patients reported at least one adverse SDOH negatively impacted by the COVID-19 pandemic. Providing printed resource guides at ED discharge may be insufficient for linking patients to resources. ED Fast Track patients were far more likely to report adverse SDOH than adult PCP clinic patients based on the unadjusted odds ratio analyses. This finding, however, is limited by the negative impact of COVID-19 on ambulatory SDOH screening rate, and a potential selection bias as patients with adverse SDOH may have experienced difficulty accessing their PCP clinics. This finding further emphasizes the need to standardize and expand SDOH screening and strengthen further resources from EDs. [Formula presented]

20.
European Urology ; 79:S265, 2021.
Article in English | EMBASE | ID: covidwho-1747433

ABSTRACT

Introduction & Objectives: During the first wave of COVID-19 patients’ anxieties around contracting the virus during an emergency hospital admission were high. As further COVID-19 surges are possible it is important for healthcare service providers to inform patients of the risk of catching COVID-19 after an emergency hospital admission. Our aim was to establish the risk of catching COVID-19 as a urology emergency inpatient in our Trust and to assess patients fears and attitudes towards seeking medical help for their acute urological problems. Materials & Methods: A single centre study was conducted. A retrospective audit of all urological emergency admissions was made over a 10-week period (mid- March – end of May) in 2019 and compared to (mid-March – end of May) 2020 during the COVID-19 pandemic. The number of patients who developed new COVID-19 symptoms whilst an in-patient or had positive swabs within 28 days of discharge was obtained. We performed a post discharge telephone survey of patients based on a COVID-19 fear questionnaire (FC19-HVQ) adapted from the validated Fear of COVID-19 scale. Results: Compared to 2019 (n=187), 2020 (n=122) there was a 35% reduction in the number of patients presenting acutely to our department. 43 of the 122 (35%) patients were swabbed on admission due to possible symptoms of COVID-19. One patient was found to be COVID-19 positive. 5 patients had further swabs during their admission;one patient who was negative on admission became positive whilst an inpatient. Accordingly, the overall in-hospital infection rate with COVID-19 was 0.82% (1 patient) during or within 28 days of discharge. There was no mortality (0%) related to COVID -19. The majority of patients were afraid to visit A&E or be admitted to hospital during the COVID-19 pandemic crisis. Fewer patients were afraid to visit their local Family Doctor (GP). 28% (n=14) of responders ignored their symptoms during the pandemic. Patients were reluctant to seek medical input during COVID-19 with up 64% (n=32) of them stating that they attempted treat themselves at home. There was also a degree of intentional delay to visit A&E and the hospital with 56% (n=28) of our patients admitting to having delayed their visit. Conclusions: The risk of contracting COVID-19 whilst a urology in patient in a COVID-19 epicentre was very low (0.82%) with no COVID-19 related mortality. Our data supports the message that patients with urological emergencies should be educated and encouraged to attend hospital, rather than staying at home, during future surges in the current pandemic. This is to prevent further non COVID-19 related harm from delayed presentations, undiagnosed pathologies and self-treatment approaches.

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