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1.
BMJ ; 375: e065834, 2021 12 29.
Article in English | MEDLINE | ID: covidwho-1599220

ABSTRACT

OBJECTIVES: To describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19. DESIGN: Population based study. SETTING: 1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database. PARTICIPANTS: 456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803). MAIN OUTCOME MEASURES: Comparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression. RESULTS: Relative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease. CONCLUSIONS: GP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.


Subject(s)
COVID-19/complications , Community Health Services , General Practitioners , Hospitalization , Office Visits/statistics & numerical data , SARS-CoV-2 , Venous Thromboembolism/diagnosis , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , Proportional Hazards Models , State Medicine , United Kingdom/epidemiology , Venous Thromboembolism/etiology
3.
J Med Internet Res ; 23(2): e26433, 2021 02 08.
Article in English | MEDLINE | ID: covidwho-1574673

ABSTRACT

BACKGROUND: The COVID-19 pandemic imposed an acute, sharp rise in the use of video consultations (VCs) by general practitioners (GPs) in Norway. OBJECTIVE: This study aims to document GPs' experiences with the large-scale uptake of VCs in the natural experiment context of the pandemic. METHODS: A nationwide, cross-sectional online survey was conducted among Norwegian GPs during the pandemic lockdown (April 14-May 3, 2020). Each respondent was asked to evaluate up to 10 VCs. Basic demographic characteristics of the GPs and their practices were collected. The associations between GPs' perceived suitability of the VCs, the nature of the patients' main problems, prior knowledge of the patients (relational continuity), and follow-up of previously presented problems (episodic continuity) were explored using descriptive statistics, diagrams, and chi-square tests. RESULTS: In total, 1237 GPs (26% of the target group) responded to the survey. Among these, 1000 GPs offered VCs, and 855 GPs evaluated a total of 3484 VCs. Most GPs who offered VCs (1000/1237; 81%) had no experience with VCs before the pandemic. Overall, 51% (1766/3476) of the evaluated VCs were considered to have similar or even better suitability to assess the main reason for contact, compared to face-to-face consultations. In the presence of relational continuity, VCs were considered equal to or better than face-to-face consultations in 57% (1011/1785) of cases, as opposed to 32% (87/274) when the patient was unknown. The suitability rate for follow-up consultations (episodic continuity) was 61% (1165/1919), compared to 35% (544/1556) for new patient problems. Suitability varied considerably across clinical contact reasons. VCs were found most suitable for anxiety and life stress, depression, and administrative purposes, as well as for longstanding or complex problems that normally require multiple follow-up consultations. The GPs estimate that they will conduct about 20% of their consultations by video in a future, nonpandemic setting. CONCLUSIONS: Our study of VCs performed in general practice during the pandemic lockdown indicates a clear future role for VCs in nonpandemic settings. The strong and consistent association between continuity of care and GPs' perceptions of the suitability of VCs is a new and important finding with considerable relevance for future primary health care planning.


Subject(s)
COVID-19/diagnosis , Telemedicine/methods , COVID-19/therapy , Cross-Sectional Studies , Female , General Practitioners , Humans , Male , Norway , Pandemics , Prospective Studies , Referral and Consultation , SARS-CoV-2/isolation & purification , Surveys and Questionnaires
4.
PLoS One ; 16(3): e0248387, 2021.
Article in English | MEDLINE | ID: covidwho-1573672

ABSTRACT

OBJECTIVES: The study aims to investigate GPs' experiences of how UK COVID-19 policies have affected the management and safety of complex elderly patients, who suffer from multimorbidity, at the primary care level in North West London (NWL). DESIGN: This is a service evaluation adopting a qualitative approach. SETTING: Individual semi-structured interviews were conducted between 6 and 22 May 2020, 2 months after the introduction of the UK COVID-19 Action Plan, allowing GPs to adapt to the new changes and reflect on their impact. PARTICIPANTS: Fourteen GPs working in NWL were interviewed, until data saturation was reached. OUTCOME MEASURES: The impact of COVID-19 policies on the management and safety of complex elderly patients in primary care from the GPs' perspective. RESULTS: Participants' average experience was fourteen years working in primary care for the NHS. They stated that COVID-19 policies have affected primary care at three levels, patients' behaviour, work conditions, and clinical practice. GPs reflected on the impact through five major themes; four of which have been adapted from the Safety Attitudes Questionnaire (SAQ) framework, changes in primary care (at the three levels mentioned above), involvement of GPs in policy making, communication and coordination (with patients and in between medical teams), stressors and worries; in addition to a fifth theme to conclude the GPs' suggestions for improvement (either proposed mitigation strategies, or existing actions that showed relative success). A participant used an expression of "infodemic" to describe the GPs' everyday pressure of receiving new policy updates with their subsequent changes in practice. CONCLUSION: The COVID-19 pandemic has affected all levels of the health system in the UK, particularly primary care. Based on the GPs' perspective in NWL, changes to practice have offered opportunities to maintain safe healthcare as well as possible drawbacks that should be of concern.


Subject(s)
COVID-19/prevention & control , General Practitioners/psychology , Patient Safety , Primary Health Care , Aged , Attitude of Health Personnel , COVID-19/epidemiology , COVID-19/pathology , COVID-19/virology , Health Policy , Humans , Interviews as Topic , Pandemics , Policy Making , Qualitative Research , SARS-CoV-2/isolation & purification , United Kingdom/epidemiology
7.
Aust J Gen Pract ; 50(11): 845-849, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1543140

ABSTRACT

BACKGROUND AND OBJECTIVES: The approach to performing COVID-19 testing in general practice has been going through an evolution and is variable. The aim of this study was to determine what underlying factors, if any, impeded onsite COVID-19 testing in general practices for patients during the second wave of the pandemic in Victoria. METHOD: This study was conducted during August 2020 and October 2020. Fourteen semi-structured interviews with general practitioners, practice nurses and practice managers were conducted. RESULTS: Barriers to performing onsite testing for COVID-19 were identified as: 1) individual, 2) practitioner perception of fear, 3) lack of personal protective equipment, 4) inappropriate clinic design/location, 5) risk of patient avoidance, 6) financial risk, 7) a lack of knowledge and 8) lack of guidelines. DISCUSSION: This study's findings relate to a unique period in Victoria, which at the time accounted for 70% of the nation's total cases and 90% of deaths. Therefore, the barriers identified in this study may help inform policymakers in regard to planning for future responses to similar situations.


Subject(s)
COVID-19 , General Practice , General Practitioners , COVID-19 Testing , Humans , SARS-CoV-2
8.
Front Public Health ; 9: 736976, 2021.
Article in English | MEDLINE | ID: covidwho-1528871

ABSTRACT

Introduction: Italy was one of the earliest countries to experience a severe COVID-19 epidemic and vaccinating the elderly, who constitute 23% of the population and have experienced the highest mortality rates, is a top priority. Estimating prevalences and understanding risk factors for COVID-19 vaccine hesitancy or refusal are important for development of targeted interventions. Methods: We used data from a specially developed COVID-19 module of PASSI D'Argento, an ongoing surveillance system of residents 65+ years of age to measure the prevalence and identify risk factors for hesitancy and refusal to receive the COVID-19 vaccine. We calculated multinomial regression relative risk ratios to examine the association between demographic characteristics, health status, COVID-19 attitudes and experiences and likely vaccine hesitancy and refusal. Results: Of the 1876 respondents, 55% reported they would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, we identified several risk factors in common between the hesitancy group and the refusal group, including not having received vaccination against influenza during the previous flu season (hesitancy: RRR = 2.0; 95% CI 1.4-2.9; refusal: RRR = 12.1; 95%CI 7.6-19.4) and lower risk of having had a death from COVID-19 among family or friends (hesitancy: RRR = 4.8; 95%CI 2.0-11.4; refusal: RRR = 15.4; 95%CI 3.7-64.5). The hesitancy group was significantly more likely being worried and they did not know if consequences of the disease would be serious for them. Conclusion: Our findings show the importance of establishing and maintaining active contact between the preventive services, primary care providers and the population because trust is difficult to establish during an emergency like the COVID-19 pandemic. Italian public health is based on a capillary network of general practitioners and having them reach out to their patients who have not previously received influenza vaccine may be a useful strategy for targeting efforts to further encourage uptake of COVID-19 vaccination.


Subject(s)
COVID-19 , General Practitioners , Influenza Vaccines , Aged , COVID-19 Vaccines , Cross-Sectional Studies , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2 , Vaccination
9.
Int J Environ Res Public Health ; 18(21)2021 10 26.
Article in English | MEDLINE | ID: covidwho-1512282

ABSTRACT

Healthcare professionals (HCPs) have a key role in promoting physical activity, particularly among populations at greatest risk of poor health due to physical inactivity. This research explored HCPs' knowledge, decision making, and routine practice of physical activity promotion with older adults. Furthermore, it aimed to enhance our understanding of the supports that HCPs need to effectively promote physical activity in routine practice across a wide range of healthcare professions, settings, and sectors. Semi-structured online interviews were completed with HCPs between November 2020-March 2021. Data were first analysed by coding instances within the transcripts, mapping onto relevant Theoretical Domains Framework (TDF) domains utilising a deductive thematic analysis approach. The data were then analysed utilising an inductive approach to thematically generate explanatory subthemes within the identified domains. Participants (n = 63) included general practitioners (15.87%), occupational therapists (30.16%), physiotherapists (38.10%), and nurses (15.87%) from the island of Ireland (Ireland and Northern Ireland). Of those interviewed, 10 (15.87%) were male and 53 (84.13%) were female. Two thirds (65.08%) were HCPs practicing in Ireland. Domains and subthemes related to the application of physical activity, and emergent themes on developing practice to support the application and integration of physical activity in routine practice are discussed. HCPs identified that focused education, appropriate training, and access to tailored resources are all essential to support the promotion of physical activity in routine practice. For such supports to be effective, a 'cultural shift' is required in HCP training and health service provision to adopt the growing evidence base that physical activity promotion must be part of disease prevention and treatment in routine practice. HCPs highlighted a range of areas for service development to support them to promote physical activity. Further research is required to explore the feasibility of implementing these recommendations in routine practice.


Subject(s)
Exercise , General Practitioners , Aged , Delivery of Health Care , Female , Health Personnel , Humans , Male , Northern Ireland , Qualitative Research
10.
Aust J Gen Pract ; 492020 Sep 02.
Article in English | MEDLINE | ID: covidwho-1503118

ABSTRACT

The COVID-19 pandemic's effects on movement restriction and family finances appear to be exacerbating domestic violence incidence and creating barriers to help-seeking for women, men and children.


Subject(s)
COVID-19 , Domestic Violence , General Practitioners , Child , Female , Humans , Male , Pandemics , SARS-CoV-2
11.
Aust J Gen Pract ; 502021 10 29.
Article in English | MEDLINE | ID: covidwho-1498368

ABSTRACT

During the COVID-19 pandemic, general practitioners have played the crucial part of health gatekeepers, which should be acknowledged and appreciated.


Subject(s)
COVID-19 , General Practitioners , China/epidemiology , Disease Outbreaks , Humans , Pandemics , SARS-CoV-2
13.
BMJ Open ; 11(10): e047991, 2021 10 19.
Article in English | MEDLINE | ID: covidwho-1476598

ABSTRACT

OBJECTIVE: The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media. DESIGN: A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis. SETTING AND PARTICIPANTS: Participants were general practitioner tutors and third year medical students who had just completed placement on the University of Limerick longitudinal integrated clerkship. Five students and three general practitioners affiliated with the medical school were invited to participate in one-to-one interviews. RESULTS: Three overarching themes, each containing subthemes were reported. 'Staying in contact and up to date' outlines how social media platforms provide useful resources and illustrates the potential risks of social media. 'Online persona' considers how social media has contributed to changing the nature of interpersonal relationships. 'Towards standards and safety' raises the matter of how to protect patients, doctors and the medical profession. CONCLUSION: Guidance is required for students and medical practitioners on how to establish reasonable boundaries between their personal and professional presence on social media and in their private life so that poorly judged use of social media does not negatively affect career prospects and professional efficacy.


Subject(s)
General Practitioners , Social Media , Students, Medical , Attitude of Health Personnel , Humans , Qualitative Research
15.
Work ; 70(2): 395-403, 2021.
Article in English | MEDLINE | ID: covidwho-1463452

ABSTRACT

BACKGROUND: Physicians are at higher risk for burnout than workers in other fields. Burnout negatively impacts physician health, care delivery and healthcare cost. Existing studies quantify the workforce affected by burnout whilst qualitative studies use specific specialty groups limiting generalisability of solutions. This is important given increased stress during the COVID-19 pandemic. OBJECTIVE: The study aimed to understand the causes of work-related burnout, identify what supportive resources physicians utilise, and to propose solutions. METHODS: A questionnaire was circulated between March and May 2019 via the 'Doctors' Association UK' website and social media. RESULTS: 721 responses were received. 94%of respondents worked in the NHS, with over half being either general practitioners (GPs) or consultants. One in two (53%) respondents felt unable to raise workplace concerns regarding wellbeing, stress or workload. Almost all respondents (97%) felt the NHS has a culture of viewing excessive stress and workload as the norm. Three themes emerged from qualitative analysis: negative workplace culture; high workload and lack of resources; and generational change. CONCLUSIONS: Respondents described system-level factors which negatively impacted their wellbeing whilst organisations focused on physician-level factors. The research literature supports multi-level change beyond the individual tackling work unit and organisational factors. These include providing infrastructure to allow delegation of administrative work and physical space for relaxation and flexible work with time for leave. At a national level, there is greater urgency for an increase in healthcare funding and resourcing especially during increased clinician workloads during a pandemic where burnout rates will increase.


Subject(s)
Burnout, Professional , COVID-19 , General Practitioners , Burnout, Professional/epidemiology , Humans , Pandemics , SARS-CoV-2 , State Medicine , Surveys and Questionnaires , Workload
16.
Eur J Gen Pract ; 27(1): 277-285, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1462199

ABSTRACT

BACKGROUND: Responsibility of general practitioners (GPs) in delivering safe and effective care is always high but during the COVID-19 pandemic they face even growing pressure that might result in unbearable stress load (allostatic overload, AO) leading to disease. OBJECTIVES: We aimed to measure AO of Hungarian GPs during the COVID-19 pandemic and explore their recreational resources to identify potential protective factors against stress load. METHODS: In a mixed-method design, Fava's clinimetric approach to AO was applied alongside the Psychosocial Index (PSI); Kellner's symptom questionnaire (SQ) to measure depression, anxiety, hostility and somatisation and the Public Health Surveillance Well-being Scale (PHS-WB) to determine mental, social, and physical well-being. Recreational resources were mapped. Besides Chi-square and Kruskal-Wallis tests, regression analysis was applied to identify explanatory variables of AO. RESULTS: Data of 228 GPs (68% females) were analysed. Work-related changes caused the biggest challenges leading to AO in 60% of the sample. While female sex (OR: 1.99; CI: 1.06; 3.74, p = 0.032) and other life stresses (OR: 1.4; CI: 1.2; 1.6, p < 0.001) associated with increased odds of AO, each additional day with 30 min for recreation purposes associated with 20% decreased odds (OR: 0.838; CI: 0.72; 0.97, p = 0.020). 3-4 days a week when time was ensured for recreation associated with elevated mental and physical well-being, while 5-7 days associated with lower depressive and anxiety symptoms, somatisation, and hostility. CONCLUSION: Under changing circumstances, resilience improvement through increasing time spent on recreation should be emphasised to prevent GPs from the adverse health consequences of stress load.


Subject(s)
COVID-19/psychology , General Practitioners/psychology , Occupational Stress/epidemiology , Resilience, Psychological , Adult , Aged , Cross-Sectional Studies , Female , Humans , Hungary , Male , Mental Health , Middle Aged , Recreation , Surveys and Questionnaires
17.
J Prim Health Care ; 13(2): 102-105, 2021 06.
Article in English | MEDLINE | ID: covidwho-1462063

ABSTRACT

Vulnerability during the coronavirus disease 2019 (COVID-19) pandemic is an emotional state that affects all of us globally. The Italian experience shows that our general practitioners (GPs) seem to have a higher rate of death due to COVID-19 infection than other physicians.


Subject(s)
COVID-19/psychology , General Practitioners/psychology , Pandemics , COVID-19/epidemiology , Humans , Italy/epidemiology , Occupational Exposure , Risk
18.
Aust J Prim Health ; 27(5): 357-363, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1442865

ABSTRACT

Limited studies at the beginning of the COVID-19 pandemic found GPs have been negatively affected by increased workload, reduced income and major concerns about staff and patient safety. This study aimed to investigate the challenges of COVID-19 in general practice 1 year since it was declared a pandemic. A national cross-sectional online survey was conducted in March 2021 of a convenience sample of 295 Australian GPs attending an online educational webcast. Twenty-five multipart and free-text questions collected information regarding GPs' main COVID-19-related issues and concerns, including COVID-19 vaccines, useful sources of information, information needs and their perceived role as GPs in COVID-19 management. Descriptive statistics were calculated for all quantitative variables. Content analysis was used to analyse text data from open-ended questions. Of the 596 eligible attendees of the online educational webcast, 295 completed the survey (49.5% response rate). One year since COVID-19 was declared a pandemic, GPs still have concerns regarding patients ignoring prescreening and presenting with flu-like symptoms, the safety of their colleagues and family and catching COVID-19 themselves, as well as concerns about the effect of the pandemic on their patients and patients delaying essential care for non-COVID-19 conditions. More education and resources about vaccines was identified as the top information need, which will assist with what GPs' perceived to be their key roles in managing the COVID-19 pandemic, namely educating the public, correcting misunderstandings and providing the COVID-19 vaccine. These findings highlight gaps in communication and information, particularly regarding COVID-19 vaccines. GPs need high-quality information and resources to support them in undertaking complex risk communication with their patients.


Subject(s)
COVID-19 , General Practitioners , Australia , COVID-19 Vaccines , Cross-Sectional Studies , Humans , Pandemics , SARS-CoV-2
19.
Int J Environ Res Public Health ; 18(18)2021 09 17.
Article in English | MEDLINE | ID: covidwho-1430858

ABSTRACT

Front-line doctors are at high risk of exposure to COVID-19. The mental resilience of general practitioners and their areas of concerns and support required are important during this COVID-19 period. A total of 403 general practitioners attending a webinar on resiliency, hosted by the College of Family Physicians, Singapore, participated in the survey anonymously. Participants provided responses to questions relating to COVID-19 in the domains of Family and friends, Myself, Practice, and Community. Responses are categorized into LEARNING, FEAR, and GROWTH zones. The majority of the doctors reported to be in the GROWTH zone in relation to Family and friends (39%) and Myself (38%) as compared to Practice and Community, aOR = 4.5 (95% CI 3.4 to 5.9), p < 0.001. 34% of the participants reported being in the FEAR zone in relation to Family and friends, aOR = 8.0 (95% CI = 5.6 to 11.2), p < 0.001; at least 81% reported being in the LEARNING zone in relation to Practice and Community, aOR = 7.5 (95% CI = 5.8 to 9.6), p < 0.001, compared to other domains. Supporting and protecting the doctors is important in strategic planning and management of the current pandemic and building preparedness and an effective response towards future crises.


Subject(s)
COVID-19 , General Practitioners , Humans , Pandemics , SARS-CoV-2 , Singapore
20.
J Am Board Fam Med ; 34(5): 1010-1013, 2021.
Article in English | MEDLINE | ID: covidwho-1430643

ABSTRACT

A second epidemic has appeared among some patients infected with COVID-19 persistent disorders, commonly called "long COVID syndrome." Our study sought to identify the proportion of French GPs dealing with patients with potential long COVID syndrome and their symptoms in an online cross-sectional questionnaire-based survey among a representative national panel of GPs. The majority (53.8%) reported at least 1 patient with COVID-19 and persistent symptoms, and 33% 2 or more such patients. Their most frequent symptoms were respiratory difficulties (60.6%), psychological distress (42.8%), and anosmia-dysgeusia (40.8%). Long COVID syndrome's recognition, management, and rehabilitation are priorities requiring effective coordination between primary and secondary care.


Subject(s)
COVID-19 , General Practitioners , COVID-19/complications , Cross-Sectional Studies , Humans , SARS-CoV-2 , Surveys and Questionnaires
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