Risk of COVID-19 Disease, Dialysis Unit Attributes, and Infection Control Strategy among London In-Center Hemodialysis Patients.

BACKGROUND AND OBJECTIVES: Patients receiving in-center hemodialysis treatment face unique challenges during the coronavirus disease 2019 (COVID-19) pandemic, specifically the need to attend for treatment that prevents self-isolation. Dialysis unit attributes and isolation strategies that might reduce dialysis center COVID-19 infection rates have not been previously examined. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We explored the role of variables, including community disease burden, dialysis unit attributes (size and layout), and infection control strategies, on rates of COVID-19 among patients receiving in-center hemodialysis in London, United Kingdom, between March 2, 2020 and May 31, 2020. The two outcomes were defined as (1) a positive test for infection or admission with suspected COVID-19 and (2) admission to the hospital with suspected infection. Associations were examined using a discrete time multilevel time-to-event analysis. RESULTS: Data on 5755 patients dialyzing in 51 units were analyzed; 990 (17%) tested positive and 465 (8%) were admitted with suspected COVID-19 between March 2 and May 31, 2020. Outcomes were associated with age, diabetes, local community COVID-19 rates, and dialysis unit size. A greater number of available side rooms and the introduction of mask policies for asymptomatic patients were inversely associated with outcomes. No association was seen with sex, ethnicity, or deprivation indices, nor with any of the different isolation strategies. CONCLUSIONS: Rates of COVID-19 in the in-center hemodialysis population relate to individual factors, underlying community transmission, unit size, and layout.

Implementation of a team model for RACF care by a general practice.

OBJECTIVE: Many general practitioners (GPs) struggle to meet the demand for their services at residential aged care facilities (RACFs). The aim of this study was to describe and examine the effect on service provision and GPs of a new model of RACF care in a rural general practice. METHODS: A mixed-method case study was used to examine the practice nurse-led team model of RACF care. In-depth, semi-structured interviews with GPs and other staff were analysed using a thematic approach. Medicare Benefits Schedule (MBS) item analysis examined service provision in the two years pre- and post-implementation of the new model. RESULTS: Key themes that emerged were access to care, GP satisfaction, the role of the practice nurse, the model's financial viability and lessons for other practices. Under the new model of care, residents' access to standard general practice consultations increased from 6.69 to 14.09/resident/year. At the same time, after-hours consultations were reduced from 0.16 to 0.10/resident/year. There were also significant increases in provision of Medicare quality improvement services. GPs reported that their workload and stress decreased, while their levels of professional satisfaction increased. DISCUSSION: This service model has much to offer GPs who are willing to engage in team care. It is an efficient model of high-quality care that overcomes key barriers associated with providing sustainable general practice services to RACF residents.