Identifying COVID-19 cases in primary care settings

Case identification is an ongoing issue for the COVID-19 epidemic, in particular for outpatient care where physicians must decide which patients to prioritise for further testing. This paper reports tools to classify patients based on symptom profiles based on 236 SARS-CoV-2 positive cases and 564 controls, accounting for the time course of illness at point of assessment. Clinical differentiators of cases and controls were used to derive model-based risk scores. Significant symptoms included abdominal pain, cough, diarrhea, fever, headache, muscle ache, runny nose, sore throat, temperature between 37.5{degrees}C and 37.9{degrees}C, and temperature above 38{degrees}C, but their importance varied by day of illness at assessment. With a high percentile threshold for specificity at 0.95, the baseline model had reasonable sensitivity at 0.67. To further evaluate accuracy of model predictions, we firstly used leave-one-out cross-validation, which confirmed high classification accuracy with an area under the receiver operating characteristic curve of 0.92. For the baseline model, sensitivity decreased to 0.56. Secondly, in a separate ongoing prospective study of 237 COVID-19 and 346 primary care patients presenting with symptoms of acute respiratory infection, the baseline model had a sensitivity of 0.57 and specificity of 0.89, and in retrospective notes review of 100 COVID-19 cases diagnosed in primary care, sensitivity was 0.56. A web-app based tool has been developed for easy implementation as an adjunct to laboratory testing to differentiate COVID-19 positive cases among patients presenting in outpatient settings.

Prepared and highly committed despite the risk of COVID-19 infection: A cross-sectional survey of primary care physicians' concerns and coping strategies in Singapore

AbstractO_ST_ABSBACKGROUNDC_ST_ABSPrimary care physicians (PCPs) play a crucial role as first points-of-contact between suspected cases and the healthcare system in the current Coronavirus Disease 2019 (COVID-19) pandemic. An overlooked angle is the potential psychosocial impact on PCPs as they place themselves at increased risk of infection. This study examines PCPs concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. METHODS216 PCPs actively practicing in either a public or private clinic were convenience sampled from three primary care organizations in Singapore. Participants completed an online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. RESULTSA total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection, and a source of risk and concern to loved ones. PCPs reported acceptance of these risks and the need to care for COVID-19 patients. Overall perceived pandemic preparedness was extremely high. PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. CONCLUSIONSPrimary care will continue to be crucial in outbreak management efforts. Healthcare organizations should continue to support PCPs by managing their psychosocial and professional needs.

Ministry of Health Clinical Practice Guidelines: Prevention, Diagnosis and Management of Tuberculosis

The Ministry of Health (MOH) has developed the clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis to provide doctors and patients in Singapore with evidence-based treatment for tuberculosis. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Prevention, Diagnosis and Management of Tuberculosis, for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

Characteristics, and disease control and complications of hypertensive patients in primary-care - a community-based study in Singapore

<p><b>INTRODUCTION</b>Hypertension is a common chronic condition usually managed by primary-care practitioners in Singapore. This study assessed the characteristics, control and complications of non-diabetic hypertensive patients managed at government primary healthcare clinics.</p><p><b>MATERIALS AND METHODS</b>A cross-sectional study involving 9 clinics was conducted over 1-week in 2006. Five hundred and six non-diabetic hypertensive patients were systematically sampled from all clinic attendees. Data relating to socio-demographic, lifestyle factors, treatment and complications were collected by interviewer-administered questionnaires and review of clinic medical records. Blood pressure (BP) measurements were taken with validated automated sets following a standard protocol.</p><p><b>RESULTS</b>The prevalence of good BP control (<140/90 mmHg) was 37.7% (95% CI: 33.6% to 41.8%). Ninety seven percent were on medication with about half on monotherapy. Seventy percent of patients had a body mass index (BMI) of 23.0 kg/m(2) or higher, 64% did not exercise regularly and 8% were current smokers. After adjusting for age and lifestyle factors, male hypertensive patients had poorer BP control compared to females. Nineteen percent of patients reported at least 1 complication of hypertension, especially cardiac disease. After multivariate analysis and duration of disease, age and the male gender were associated with the presence of hypertensive complications.</p><p><b>CONCLUSIONS</b>More than half of the patients were not controlled to target levels. Male patients were more likely to have poorer control of hypertension and significantly higher risks of complications. Control of BP could be further improved by lifestyle modifications - weight reduction, promotion of physical activity, healthier eating habits and smoking cessation.</p>