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2.
Br J Gen Pract ; 72(716): 104-105, 2022 03.
Article in English | MEDLINE | ID: covidwho-2201010
3.
Patient Educ Couns ; 105(7): 2371-2381, 2022 07.
Article in English | MEDLINE | ID: covidwho-2150394

ABSTRACT

OBJECTIVE: To report on patients' satisfaction and experience of care across three different modes of weight loss counseling. METHODS: 1407 patients with obesity in the rural Midwest were enrolled to a 2-year weight management trial through their primary care practice and assigned to one of three treatment conditions: in-clinic individual, in-clinic group, phone group counseling. Patients completed surveys assessing seven domains of satisfaction and experience of care at 6 and 24-months. Post-treatment interviews were conducted to add context to survey responses. RESULTS: 1295 (92.0%) and 1230 (87.4%) completed surveys at 6 and 24-months, respectively. Patients in phone group counseling reported lower satisfaction than patients who received in-clinic group or in-clinic individual counseling across all domains at 6-months and five out of seven domains at 24-months. Interviews revealed that patients were more satisfied when they received face-to-face counseling and had meaningful interactions with their primary care provider (PCP) about their weight. CONCLUSION: Rural patients with obesity have higher satisfaction and experience of care when weight loss counseling is delivered in a face-to-face environment and when their PCP is involved with their treatment. PRACTICE IMPLICATIONS: Primary care practices looking to offer weight loss treatment should consider incorporating some level of face-to-face treatment plans that involves meaningful interaction with the PCP.


Subject(s)
Obesity , Weight Loss , Counseling/methods , Humans , Obesity/psychology , Obesity/therapy , Primary Health Care/methods , Rural Population , Weight Loss/physiology
4.
PLoS One ; 17(10): e0274549, 2022.
Article in English | MEDLINE | ID: covidwho-2154244

ABSTRACT

BACKGROUND: Tuberculosis (TB) remains the leading cause of death among human immunodeficiency virus (HIV) infected individuals in South Africa. Despite the implementation of HIV/TB integration services at primary healthcare facility level, the effect of HIV on TB treatment outcomes has not been well investigated. To provide evidence base for TB treatment outcome improvement to meet End TB Strategy goal, we assessed the effect of HIV status on treatment outcomes of TB patients at a rural clinic in the Ugu Health District, South Africa. METHODS: We reviewed medical records involving a cohort of 508 TB patients registered for treatment between 1 January 2013 and 31 December 2015 at rural public sector clinic in KwaZulu-Natal province, South Africa. Data were extracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. The effect of HIV status on TB treatment outcomes was determined by using multinomial logistic regression. Estimates used were relative risk ratio (RRR) at 95% confidence intervals (95%CI). RESULTS: A total of 506 patients were included in the analysis. Majority of the patients (88%) were new TB cases, 70% had pulmonary TB and 59% were co-infected with HIV. Most of HIV positive patients were on antiretroviral therapy (ART) (90% (n = 268)). About 82% had successful treatment outcome (cured 39.1% (n = 198) and completed treatment (42.9% (n = 217)), 7% (n = 39) died 0.6% (n = 3) failed treatment, 3.9% (n = 20) defaulted treatment and the rest (6.6% (n = 33)) were transferred out of the facility. Furthermore, HIV positive patients had a higher mortality rate (9.67%) than HIV negative patients (2.91%)". Using completed treatment as reference, HIV positive patients not on ART relative to negative patients were more likely to have unsuccessful outcomes [RRR, 5.41; 95%CI, 2.11-13.86]. CONCLUSIONS: When compared between HIV status, HIV positive TB patients were more likely to have unsuccessful treatment outcome in rural primary care. Antiretroviral treatment seems to have had no effect on the likelihood of TB treatment success in rural primary care. The TB mortality rate in HIV positive patients, on the other hand, was higher than in HIV negative patients emphasizing the need for enhanced integrated management of HIV/TB in rural South Africa through active screening of TB among HIV positive individuals and early access to ART among HIV positive TB cases.


Subject(s)
HIV Infections , Tuberculosis , Anti-Retroviral Agents/therapeutic use , Antitubercular Agents/therapeutic use , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Primary Health Care , Retrospective Studies , South Africa/epidemiology , Treatment Outcome , Tuberculosis/complications , Tuberculosis/drug therapy , Tuberculosis/epidemiology
7.
Bull World Health Organ ; 100(11): 669-675, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2162832

ABSTRACT

Objective: To describe the Family and Community Physiotherapist model, which aims to incorporate rehabilitation services within primary health care in Tuscany, Italy. Methods: The Department of Health Professions of the Central Tuscany local health authority designed the model during 2020-2021. We describe the four phases of the organizational case study implementation of the model, namely: (i) analysis of the political and organizational framework, as well as determination of changing health-care needs; (ii) model co-design and training of multiprofessional health-care workers (local general practitioners, physiatrists and geriatricians); (iii) delivery and surveillance of rehabilitation services; and (iv) evaluation. Findings: During the initial roll-out of the project in April-December 2021, general practitioners referred 165 patients with a mean age of 83.7 years (standard deviation: 11.1) to the Family and Community Physiotherapist. Interventions were mainly activated for patients with comorbidities (64/165; 38.8%), followed by those with long-term immobilization issues (36/165; 21.8%). The most commonly provided intervention was counselling, contributing to the achievement of objectives for 127 patients (77.0%). A full rehabilitation path was proposed for only 10 patients (6.1%). No additional costs were incurred by the health authority during the implementation of the model. Conclusion: Our model facilitated the provision of rehabilitative care in the community, preventing the exacerbation of chronic conditions and meeting the population health needs in non-hospital environments. The model overcame the typical lack of integration within health-care services with flexibility, promoting care proximity solutions to cope with health challenges such as an ageing population and the coronavirus disease.


Subject(s)
Coronavirus Infections , Physical Therapy Modalities , Humans , Aged, 80 and over , Health Personnel , Referral and Consultation , Primary Health Care
8.
Rev Saude Publica ; 56: 94, 2022.
Article in English, Portuguese | MEDLINE | ID: covidwho-2145225

ABSTRACT

OBJECTIVE: Mapping available scientific evidence on the organization of primary health care services and professionals during the Covid-19 pandemic. METHODS: This is a scoping review that followed the Joanna Briggs Institute method. Articles published in Portuguese, Spanish, and English from January 2020 to January 2021 in the CINAHL, Lilacs, Medline, PubMed, and Web of Science databases were included. RESULTS: We selected 24 articles that presented the reorganization of primary health care services and professionals to care suspected or confirmed Covid-19 cases. Coordination measures to tackle this disease in primary health care help to control its infection, especially by the active search for respiratory symptoms, the detection of new cases, and the monitoring of confirmed cases. CONCLUSION: This study presents an overview of how primary health care services and professionals organized themselves to tackle the Covid-19 pandemic, addressing adjustments in infrastructure and care flows, such as establishing specific Covid-19 care units, separating infected and non-infected patients, using telemedicine as an alternative modality of care, and monitoring cases by applications and phone.


Subject(s)
COVID-19 , Telemedicine , Humans , COVID-19/epidemiology , Pandemics , Brazil , Primary Health Care
9.
Br J Gen Pract ; 72(724): 532-533, 2022 11.
Article in English | MEDLINE | ID: covidwho-2143821
10.
Int J Environ Res Public Health ; 19(12)2022 06 10.
Article in English | MEDLINE | ID: covidwho-2142774

ABSTRACT

Much of the differences in health care outcomes can be attributed to the differential rates of primary health care utilization and resource allocation across population subgroups [...].


Subject(s)
Patient Acceptance of Health Care , Rural Population , Healthcare Disparities , Humans , Primary Health Care , Urban Population
11.
Ann Fam Med ; 20(6): 568-572, 2022.
Article in English | MEDLINE | ID: covidwho-2140354

ABSTRACT

Conducting research in primary care during the COVID-19 pandemic is hard, due to baseline stresses on primary care, which have been compounded by the pandemic. We acknowledge and validate primary care researchers' frustrations. Using our experience on over 15 individual projects during the pandemic we identify 3 key challenges to conducting primary care research: (1) practice delivery trickle-down effects, (2) limited/changing resources and procedures for research, and (3) a generally tense milieu in US society during the pandemic. We present strategies, informed by a set of questions, to help researchers decide how to address these challenges observed during our studies. In order to overcome and grow from these challenging times we encourage normalization and self-compassion, and encourage researchers and funders to embrace pragmatic and adaptive research designs as the circumstances with COVID-19 evolve over time.


Subject(s)
COVID-19 , Humans , Pandemics , Self-Compassion , Primary Health Care
12.
BMC Health Serv Res ; 22(1): 1370, 2022 Nov 18.
Article in English | MEDLINE | ID: covidwho-2139279

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been a catalyst for rapid uptake of virtual care through the use of virtual health resources (VHR). In the Department of Veterans Affairs (VA) Healthcare System, virtual care has been critical to maintaining healthcare access for patients during COVID-19. In the current study we describe primary care patient aligned care team (PACT) VHR use patterns within one VA medical center (i.e., hospital facility and five community-based outpatient clinics) pre- and post-COVID-19 onset. METHODS: VHR provider and patient use data from 106 individual PACTs were extracted monthly between September 2019 to September 2020. Data were extracted from VHA web-based project application and tracking databases. Using longitudinal data, mixed effect models were used to compare pre- and post-COVID onset slopes. RESULTS: Findings highlight an increase in patient users of secure messaging (SM) and telehealth. The rate of utilization among these patients increased for SM but not for telehealth visits or online prescription refill (RxRefill) use. Finally, VetLink Kiosk check ins that are done at in person visits, diminished abruptly after COVID-19 onset. CONCLUSIONS: These data provide a baseline of VHR use at the PACT level after the initial impact of the COVID-19 pandemic and can inform healthcare delivery changes within the VA systems over time. Moreover, this project produced a data extraction blueprint, that is the first of its kind to track VA VHR use leveraging secondary data sources.


Subject(s)
COVID-19 , United States Department of Veterans Affairs , Humans , United States/epidemiology , COVID-19/epidemiology , Pandemics , Health Services Accessibility , Primary Health Care
13.
BMC Med Inform Decis Mak ; 22(1): 302, 2022 Nov 19.
Article in English | MEDLINE | ID: covidwho-2139265

ABSTRACT

INTRODUCTION: Telemedicine is increasingly relied upon for care delivery in primary care, but the impact of visit type on clinical ordering behavior is uncertain. METHODS: Within Kaiser Permanente Northern California, we identified patients who self-scheduled and completed telemedicine encounters with their personal primary care provider or another available primary care provider in the same medical group, between April 1st, 2020, and October 31st, 2020, while physical distancing restrictions for COVID-19 were in place. We collected patient sociodemographic and clinical characteristics, measures of technology access, and categorized the most common primary encounter diagnoses. We measured proportions of patient-scheduled video versus telephone visits for each of eight diagnosis groups (Skin & Soft Tissue, Musculoskeletal Pain, Back Pain, General Gastrointestinal, Hypertension & Diabetes, Mental Health, Upper Respiratory, and Abdominal Pain), and compared physician orders for medications, antibiotics, lab and imaging studies by visit type within each diagnosis group. RESULTS: There were 273,301 included encounters, with 86,676 (41.5%) video visits and 122,051 (58.5%) telephone visits. Of the diagnosis groups, Skin & Soft Tissue conditions had the highest proportion of video visits (59.7%), while Mental Health conditions had the highest proportion of telephone visits (71.1%). After adjusting for covariates, the overall rates of medication orders (46.6% vs. 44.5%), imaging orders (17.3% vs. 14.9%), lab orders (19.5% vs. 17.2%), and antibiotic orders (7.5% vs. 5.2%) were higher during video visits as compared to telephone visits (p < 0.05). The largest difference within diagnosis groups was for Skin & Soft Tissue conditions, where the rate of medication orders was 9.1% higher than during video visits than telephone visits (45.5% vs. 36.5%, p < 0.05). CONCLUSIONS: We observed statistically significant differences in clinician orders by visit type during telemedicine encounters for common primary care conditions. Our findings suggest that, for certain conditions, visual information conveyed during video visits may promote clinical work-up and treatment.


Subject(s)
COVID-19 , Telemedicine , Humans , Delivery of Health Care/methods , Telephone , Primary Health Care
14.
BMC Prim Care ; 23(1): 294, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2139155

ABSTRACT

BACKGROUND: The COVID-19 pandemic has caused a rapid shift to virtual care in primary care practices around the globe. There has been little focus on the experiences of interprofessional teams through the lens of primary care practice leaders. The objective of this study was to examine the experience of primary care teams during the first wave of the COVID-19 pandemic from the perspective of primary care leadership. METHODS: Qualitative study using qualitative description methods. Executive Directors of interprofessional primary care teams belonging to the Association of Family Health Teams of Ontario (AFHTO) were invited to participate. Executive Directors were interviewed and the interview transcripts were analyzed using thematic analysis. RESULTS: Seventy-one Executive Directors from across all regions of Ontario were interviewed for the study, representing 37% of the AFHTO member clinics. Four themes were identified in the data: i) Complexities of Virtual Care, ii) Continuation of In-person Care, iii) Supporting Patients at Risk, and iv) Stepping up and into New Roles. CONCLUSIONS: Primary care teams rapidly mobilized to deliver the majority of their care virtually, while continuing to provide in-person and home care as required. Major challenges to virtual care included technological infrastructure and unfamiliarity with virtual platforms. Advantages to virtual care included convenience and time savings. Virtual care will likely continue to be an important mode of primary care delivery moving forward.


Subject(s)
COVID-19 , Humans , Ontario/epidemiology , COVID-19/epidemiology , Pandemics , Qualitative Research , Primary Health Care
15.
J Telemed Telecare ; 28(10): 764-770, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2138416

ABSTRACT

Long-term weight loss can reduce the risk of type 2 diabetes for people living with obesity and reduce complications for patients diagnosed with type 2 diabetes. We investigated whether a telehealth lifestyle-coaching program (Liva) leads to long-term (24 months) weight loss compared to usual care. In a randomized controlled trial, n = 340 participants living with obesity with or without type 2 diabetes were enrolled and randomized via an automated computer algorithm to an intervention group (n = 200) or to a control group (n = 140). The telehealth lifestyle-coaching program comprised of an initial one-hour face-to-face motivational interview followed by asynchronous telehealth coaching. The behavioural change techniques used were enabled by individual live monitoring. The primary outcome was a change in body weight from baseline to 24 months. Data were assessed for n = 136 participants (40%), n = 81 from the intervention group and n = 55 from the control group, who completed the 24-month follow-up. After 24 months mean body weight and body mass index were reduced significantly for completers in both groups, but almost twice as much was registered for those in the intervention group which was not significant between groups -4.4 (CI -6.1; -2.8) kg versus -2.5 (CI -3.9; -1.1) kg, P = 0.101. Haemoglobin A1c was significantly reduced in the intervention group -3.1 (CI -5.0; -1.2) mmol/mol, but not in the control group -0.2 (CI -2.4; -2.0) mmol/mol without a significant between group difference (P = 0.223). Low completion was partly due to coronavirus disease 2019. Telehealth lifestyle coaching improve long-term weight loss (> 24 months) for obese people with and without type 2 diabetes compared to usual care.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Mentoring , Telemedicine , Humans , Diabetes Mellitus, Type 2/prevention & control , Weight Loss , Telemedicine/methods , Life Style , Obesity/therapy , Primary Health Care
16.
BMJ Open ; 12(11): e066868, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137796

ABSTRACT

OBJECTIVES: The North East of England, ranked as having the highest poverty levels and the lowest health outcomes, has the highest cardiovascular disease (CVD) premature mortality. This study aimed to compare CVD-related conditions and risk factors for deprived practice populations with other general practice (GP) populations in Northern England to England overall, before and during COVID-19 to identify changes in recorded CVD-related risk factors and conditions and evidence-based lipid prescribing behaviour. DESIGN: A population-based observational study of aggregated practice-level data obtained from publicly accessible data sets. SETTING: 34 practices that fall into the 15% most deprived practice populations in England were identified as the most deprived communities in the North East and North Cumbria (Deep End). PARTICIPANTS: Patients aged ≥16 registered with GP and diagnosed with any form of CVD. PRIMARY AND SECONDARY OUTCOME MEASURES: CVD-related conditions and risk factors, statin prescribing. RESULTS: Deep End (n=263 830) had a smaller, younger and more deprived population with lower levels of employment and full-time education and higher smoking prevalence. They had some higher recorded CVD-related conditions than England but lower than the non-Deep End. Atrial fibrillation (-0.9, -0.5), hypertension (-3.7, -1.3) and stroke and transient ischaemic attack rates (-0.5, -0.1) appeared to be lower in the Deep End than in the non-Deep End but the optimal statin prescribing rate was higher (3.1, 8.2) than in England. CONCLUSION: Recorded CVD-related risk factors and conditions remained comparable before and during COVID-19. These are higher in the Deep End than in England and similar or lower than the non-Deep End, with a higher optimal statin prescribing rate. However, it was not possible to control for age and sex. More work is needed to estimate the consequences of the pandemic on disadvantaged communities and to compare whether the findings are replicated in other areas of deprivation.


Subject(s)
COVID-19 , Cardiovascular Diseases , Hydroxymethylglutaryl-CoA Reductase Inhibitors , Humans , Cardiovascular Diseases/epidemiology , COVID-19/epidemiology , Risk Factors , England/epidemiology , Primary Health Care
17.
Fam Pract ; 38(Suppl 1): i37-i44, 2021 Aug 27.
Article in English | MEDLINE | ID: covidwho-2115231

ABSTRACT

INTRODUCTION: The early identification of COVID-19 patients is of outmost importance in the current pandemic. As with other pathogens, presenting symptoms of SARS-CoV-2 may vary, depending on sociodemographic factors. We aimed to describe the clinical characteristics of COVID-19 patients by age/gender and to assess whether the diagnostic performance of these symptoms varied according to these variables. METHODS: We analysed data from a cross-sectional study involving primary care patients undergoing RT-PCR testing in Lyon, France. Among patients who tested positive, we examined whether there was an association between age/gender and various symptoms. In addition, we calculated the diagnostic performance of the most specific symptoms (smell/taste disorder). RESULTS: Among 1543 consecutive patients, 253 tested positive (16%). There were significant age/gender-related differences in symptoms. In middle-aged women, the diagnostic performance of smell/taste disorders were AUC = 0.65 [95%CI 0.59-0.71] and PPV = 72% [95%CI 53-87%], that is higher than in the entire sample (smell/taste disorders: AUC = 0.59 [95%CI 0.57-0.62] and PPV = 57% [95%CI 47-67%]. In contrast, the negative predictive values of smell/taste disorders were similar in both groups (85% [95%CI 81-89%] for middle-age women and 86% [95%CI 85-88%] for the entire sample). CONCLUSION: We found significant age/gender-related differences in the clinical characteristics of COVID-19 patients. Screening strategies based on smell/taste disorders performed better in middle-aged women, but could not ensure a diagnosis of COVID-19 in any subgroup of patients. Future diagnostic strategies should use age/gender differentiated approaches.


Subject(s)
COVID-19/epidemiology , Olfaction Disorders/epidemiology , Primary Health Care , Self Report , Taste Disorders/epidemiology , Adult , Age Factors , Aged , Cross-Sectional Studies , Female , France/epidemiology , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Sex Factors
18.
Prim Care Diabetes ; 16(6): 753-759, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2113826

ABSTRACT

AIMS: To analyse if antidiabetic treatment was associated with better COVID-19 outcomes in type 2 diabetic patients, measured by hospital admission and mortality rates as severe outcomes. METHODS: Cohort study including COVID-19 patients registered in the Primary Care electronic records, in March-June 2020, comparing exposed to metformin in monotherapy with exposed to any other antidiabetic. DATA SOURCE: SIDIAP (Information System for Research in Primary Care), which captures clinical information of 5,8 million people from Catalonia, Spain. RESULTS: We included 31,006 diabetic patients infected with COVID-19, 43.7% previously exposed to metformin, 45.5% of them in monotherapy. 16.4% were admitted to hospital and 15.1% died. Users of insulin in monotherapy (OR 1.29, 95% CI 1.11-1.50), combined with metformin (OR 1.38, 1.13-1.69) or IDPP4 alone (OR 1.29, 1.03-1.63) had higher risk of severe outcomes than those in metformin monotherapy. Users of any insulin (OR 1.61, 1.32-1.97) or combined with metformin (OR 1.69, 1.30-2.20) had a higher risk of mortality. CONCLUSIONS: Patients receiving metformin monotherapy in our study showed a lower risk of hospitalization and death in comparison to those treated with other frequent antidiabetic agents. We cannot distinguish if better outcomes are related with the antidiabetic therapy or with other factors, such as metabolic control or interventions applied during the hospital admission.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Metformin , Humans , Hypoglycemic Agents/adverse effects , Spain/epidemiology , Pandemics , Cohort Studies , COVID-19/drug therapy , COVID-19/epidemiology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/drug therapy , Diabetes Mellitus, Type 2/epidemiology , Metformin/adverse effects , Insulin/adverse effects , Primary Health Care
19.
Prim Care Diabetes ; 16(6): 768-774, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2113810

ABSTRACT

AIM: To examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not. METHODS: This retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws). RESULTS: No differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64-47%, P < 0.001), eye fundus check-ups (39-37%, P = NS), neurologist check-ups (28-25%, P = NS) and FMP check-ups (382-321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7-2.4 mmol/L, P < 0.001) and eGFR (83-80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period. CONCLUSION: According to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Humans , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , COVID-19/epidemiology , Glycated Hemoglobin A , Croatia/epidemiology , Retrospective Studies , RNA, Viral , SARS-CoV-2 , Primary Health Care , Continuity of Patient Care
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