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1.
Open Heart ; 8(2)2021 11.
Article in English | MEDLINE | ID: covidwho-1523054

ABSTRACT

BACKGROUND: Early in the COVID-19 pandemic, the National Health Service (NHS) recommended that appropriate patients anticoagulated with warfarin should be switched to direct-acting oral anticoagulants (DOACs), requiring less frequent blood testing. Subsequently, a national safety alert was issued regarding patients being inappropriately coprescribed two anticoagulants following a medication change and associated monitoring. OBJECTIVE: To describe which people were switched from warfarin to DOACs; identify potentially unsafe coprescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic. METHODS: With the approval of NHS England, we conducted a cohort study using routine clinical data from 24 million NHS patients in England. RESULTS: 20 000 of 164 000 warfarin patients (12.2%) switched to DOACs between March and May 2020, most commonly to edoxaban and apixaban. Factors associated with switching included: older age, recent renal function test, higher number of recent INR tests recorded, atrial fibrillation diagnosis and care home residency. There was a sharp rise in coprescribing of warfarin and DOACs from typically 50-100 per month to 246 in April 2020, 0.06% of all people receiving a DOAC or warfarin. International normalised ratio (INR) testing fell by 14% to 506.8 patients tested per 1000 warfarin patients each month. We observed a very small increase in elevated INRs (n=470) during April compared with January (n=420). CONCLUSIONS: Increased switching of anticoagulants from warfarin to DOACs was observed at the outset of the COVID-19 pandemic in England following national guidance. There was a small but substantial number of people coprescribed warfarin and DOACs during this period. Despite a national safety alert on the issue, a widespread rise in elevated INR test results was not found. Primary care has responded rapidly to changes in patient care during the COVID-19 pandemic.


Subject(s)
Anticoagulants/administration & dosage , Blood Coagulation/drug effects , COVID-19 , Drug Substitution/standards , Factor Xa Inhibitors/administration & dosage , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/standards , State Medicine/standards , Warfarin/administration & dosage , Aged , Anticoagulants/adverse effects , Blood Coagulation Tests , Drug Monitoring , Drug Prescriptions , Drug Substitution/adverse effects , Drug Utilization/standards , England , Factor Xa Inhibitors/adverse effects , Female , Humans , Male , Middle Aged , Patient Safety , Primary Health Care/standards , Retrospective Studies , Risk Assessment , Risk Factors , Warfarin/adverse effects
3.
Clin Pediatr (Phila) ; 61(1): 26-33, 2022 01.
Article in English | MEDLINE | ID: covidwho-1405264

ABSTRACT

The COVID-19 (coronavirus disease 2019) pandemic brought rapid expansion of pediatric telehealth to maintain patient access to care while decreasing COVID-19 community spread. We designed a retrospective, serial, cross-sectional study to investigate if telehealth implementation at an academic pediatric practice led to disparities in health care access. Significant differences were found in pre-COVID-19 versus during COVID-19 patient demographics. Patients seen during COVID-19 were more likely to be younger, White/Caucasian or Asian, English speaking, and have private insurance. They were less likely to be Black/African American or Latinx and request interpreters. Age was the only significant difference in patient demographics between in-person and telehealth visits during COVID-19. A multivariate regression showed older age as a significant positive predictor of having a video visit and public insurance as a significant negative predictor. Our study demonstrates telehealth disparities based on insurance existed at our clinic as did inequities in who was seen before versus during COVID-19.


Subject(s)
Healthcare Disparities/statistics & numerical data , Telemedicine/standards , Urban Population/statistics & numerical data , Ambulatory Care Facilities/organization & administration , Ambulatory Care Facilities/statistics & numerical data , COVID-19/prevention & control , California , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Primary Health Care/methods , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Retrospective Studies , Telemedicine/methods , Telemedicine/statistics & numerical data
7.
Semergen ; 47(4): 248-255, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1157730

ABSTRACT

OBJECTIVES: To assess telemedicine satisfaction of patients from a primary health care center during COVID-19 pandemics. This work could bring information on its acceptance. MATERIALS AND METHODS: Transversal study with 253 individuals. A questionnaire was performed using Likert scale (1-very unsatisfied, 5-very satisfied) on patients with diabetes, hypertension and in subjects with other pathologies, whose consultations occurred between 01/04/2020 and 01/05/2020. Collected data included sociodemographics, previous telemedicine appointments, satisfaction levels of teleconsultation and doubt clarification, and interest in further telemedicine follow-up. In addition, a comparative analysis was performed between the periods January-February and April-May of 2020 in relation to age, sex, hypertension, diabetes and the type of contact (presential or remote). Statistics were performed using SPSS® and Excel®. RESULTS AND DISCUSSION: Diabetes follow-up appointments accounted for 34.4% of total consultations. Globally there was a high level of satisfaction and interest in future telemedicine follow-up. However, diabetic and older patients were less interested in this type of follow-up. Statistically significant differences about satisfaction were found in age, sex and presence/absence of diabetes. 70.6% of healthy patients preferred contact by e-mail over telephone. A selection bias is present because no randomization was made. The higher prevalence of diabetes consultations and the lack of adjustment for confounding factors can also affect results. Number of consults between January-February and April-May was compared and the main result was the significant reduction in the number of face-to-face consultations for diabetes (-50.1%) and hypertension (-94.1%). Presential consultations decreased by 72.6% and non-presential consultations increased by 61.9%. There was a selection bias because the sample was not random. The higher prevalence of diabetes consults and the lack of adjustment for confounders could affect results. CONCLUSIONS: This study allowed us to confirm the importance of telemedicine in primary health care, especially during pandemics. Participants recognized the usefulness of telemedicine and allowed future similar consultations.


Subject(s)
COVID-19/psychology , Patient Satisfaction/statistics & numerical data , Primary Health Care/methods , Primary Health Care/standards , Telemedicine/standards , Adult , Aftercare/methods , Aftercare/psychology , Age Factors , Aged , Diabetes Mellitus/psychology , Female , Humans , Male , Middle Aged , Sex Factors , Surveys and Questionnaires
8.
BMC Pregnancy Childbirth ; 21(1): 208, 2021 Mar 15.
Article in English | MEDLINE | ID: covidwho-1136217

ABSTRACT

BACKGROUND: Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic. METHODS: This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21). RESULTS: Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%. CONCLUSION: Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic.


Subject(s)
Anxiety , COVID-19 , Pregnancy Complications , Primary Health Care , Social Support , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Anxiety/prevention & control , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Cross-Sectional Studies , Depression/diagnosis , Depression/epidemiology , Female , Humans , Iran/epidemiology , Needs Assessment , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/epidemiology , Pregnancy Complications/prevention & control , Pregnancy Complications/psychology , Pregnant Women/psychology , Primary Health Care/methods , Primary Health Care/standards , Primary Health Care/trends , Risk Factors , SARS-CoV-2 , Stress, Psychological/diagnosis , Stress, Psychological/epidemiology
9.
J Diabetes Sci Technol ; 15(5): 986-992, 2021 09.
Article in English | MEDLINE | ID: covidwho-1133531

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. METHODS: We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. RESULTS: Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. CONCLUSIONS: Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.


Subject(s)
COVID-19/prevention & control , Communicable Disease Control , Diabetes Mellitus/therapy , Healthcare Disparities , Telemedicine , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , California/epidemiology , Child , Child, Preschool , Communicable Disease Control/methods , Delivery of Health Care/methods , Delivery of Health Care/organization & administration , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Diabetes Mellitus/epidemiology , Diabetes Mellitus, Type 1/epidemiology , Diabetes Mellitus, Type 1/therapy , Diabetes Mellitus, Type 2/epidemiology , Diabetes Mellitus, Type 2/therapy , Endocrinology/methods , Endocrinology/organization & administration , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Humans , Infant , Male , Middle Aged , Pandemics , Primary Health Care/organization & administration , Primary Health Care/standards , Primary Health Care/statistics & numerical data , Quarantine , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/statistics & numerical data , Young Adult
10.
J Am Board Fam Med ; 34(Suppl): S203-S209, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1100014

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , Primary Health Care/standards , Public Health/standards , COVID-19/epidemiology , Cooperative Behavior , Delivery of Health Care, Integrated/trends , Humans , Pandemics , Primary Health Care/economics , Primary Health Care/trends , Public Health/economics , Public Health/trends , SARS-CoV-2 , United States/epidemiology
11.
Aten Primaria ; 52 Suppl 2: 70-92, 2020 11.
Article in Spanish | MEDLINE | ID: covidwho-1064818

ABSTRACT

Vaccine development is one of the fastest growing sectors in medicine now and in the future, as we are living with the emergency health care for the SARS-CoV-2 coronavirus. The semFYC PAPPS program biannually publishes the recommendations of the group and, in this edition, special emphasis is placed on the common vaccination proposed by the Ministry of Health, where, at last, it no longer discriminates between paediatrics and adults, and proposes a calendar throughout life. The main novelties in the field of vaccinology today are focused on the consolidation of the nonavalent vaccine against the human papilloma virus and in the change of the dose of monovalent meningitis vaccine C for the tetravalent one, ACWY, at age 12. The pandemic we are experiencing has led to the postponement of most preventive activities. On the return to «normality¼, the vaccination calendar must be examined, and completed if necessary.


Subject(s)
Immunization Schedule , Primary Health Care/standards , Vaccination/standards , Vaccines/standards , Virus Diseases/prevention & control , Adult , COVID-19/prevention & control , Child , Humans , Primary Health Care/methods , Vaccination/methods , Vaccines/administration & dosage
14.
Am Fam Physician ; 102(11): 673-678, 2020 12 01.
Article in English | MEDLINE | ID: covidwho-1001150

ABSTRACT

In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2019 judged to be most consistent with the principles of Choosing Wisely, an international campaign to reduce unnecessary testing and treatments. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for the Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to encourage or consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., do not recommend platelet-rich plasma injections for rotator cuff disease or knee osteoarthritis), respiratory disease (e.g., in clinically stable patients with community-acquired pneumonia, antibiotics can be stopped after five days), screening or preventive care (e.g., patients who take their blood pressure at home or in a pharmacy should know what to do when they have an elevated reading), and miscellaneous topics (e.g., in healthy adults treated for dermatophyte infection, do not obtain baseline or follow-up alanine transaminase level, aspartate transaminase level, or complete blood count). These POEMs describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Knowing more about these POEMs and their connection with the Choosing Wisely campaign will help clinicians and patients engage in conversations better informed by high-quality evidence.


Subject(s)
COVID-19/therapy , Evidence-Based Medicine/methods , Primary Health Care/standards , Unnecessary Procedures/statistics & numerical data , Crowdsourcing , Humans , Physician's Role , Physician-Patient Relations , Quality Improvement/organization & administration
15.
Front Public Health ; 8: 572042, 2020.
Article in English | MEDLINE | ID: covidwho-983741

ABSTRACT

An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 started in China's Hubei province at the end of 2019 has rapidly become a pandemic. In Italy, a great number of patients was managed in primary care setting and the role of general practitioners and physicians working in the first-aid emergency medical service has become of utmost importance to coordinate the network between the territory and hospitals during the pandemic. Aim of this manuscript is to provide a guidance model for the management of suspected, probable, or confirmed cases of SARS-CoV-2 infection in the primary care setting, from diagnosis to treatment, applying also the recommendations of the Italian Society of General Medicine. Moreover, this multidisciplinary contribution would analyze and synthetize the preventive measures to limit the spread of SARS-CoV-2 infection in the general population as well as the perspective for vaccines.


Subject(s)
COVID-19/prevention & control , Disease Outbreaks/prevention & control , Pandemics/prevention & control , Practice Guidelines as Topic , Preventive Medicine/standards , Primary Health Care/standards , Humans , Italy
17.
Intern Emerg Med ; 16(2): 255-258, 2021 03.
Article in English | MEDLINE | ID: covidwho-942608

ABSTRACT

The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.


Subject(s)
COVID-19/epidemiology , Health Policy/trends , Primary Health Care/standards , Quality Improvement , Telemedicine , Europe/epidemiology , Humans , Pandemics , SARS-CoV-2
18.
Aust J Gen Pract ; 49(11): 728-732, 2020 11.
Article in English | MEDLINE | ID: covidwho-895901

ABSTRACT

BACKGROUND: General practitioners (GPs) have some of the highest rates of mortality from COVID-19 among healthcare workers. SARS-CoV-2 has unique properties that place GPs at particular risk. OBJECTIVE: The aim of this article is to discuss the nose-related features of SARS-CoV-2 that place GPs at risk, and to make recommendations pertinent to the safety and protection of primary healthcare physicians. DISCUSSION: The highest viral load of SARS-CoV-2 is in the nose and nasopharynx. It is often highest early in the illness, before the development of symptoms. Further, SARS-CoV-2 replicates and continues to shed in the nasopharynx long after the virus is no longer detectable in the lower respiratory tract. This places any physician performing examinations on, or procedures involving, the upper respiratory tract at risk for contracting COVID-19. New-onset hyposmia and dysgeusia are indicators for COVID-19 and should be included in screening protocols.


Subject(s)
Betacoronavirus , Coronavirus Infections , General Practitioners/statistics & numerical data , Infection Control , Nasal Cavity/virology , Nasopharynx/virology , Olfaction Disorders/virology , Pandemics , Pneumonia, Viral , Australia , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , COVID-19 , Coronavirus Infections/mortality , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Coronavirus Infections/virology , Disease Transmission, Infectious/prevention & control , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/standards , Nasal Mucosa/metabolism , Occupational Exposure/prevention & control , Occupational Exposure/statistics & numerical data , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/mortality , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , Primary Health Care/standards , Risk Management , SARS-CoV-2 , Viral Load
19.
J Med Internet Res ; 22(11): e19375, 2020 11 12.
Article in English | MEDLINE | ID: covidwho-840883

ABSTRACT

BACKGROUND: Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. OBJECTIVE: With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. METHODS: In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). RESULTS: In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. CONCLUSIONS: This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care.


Subject(s)
Patient Participation/methods , Primary Health Care/standards , Referral and Consultation/organization & administration , Humans
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