Off-label prescribing to children in primary care: retrospective observational study

Abstract Aim To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. Background Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. Methods This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick–Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. Findings Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

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Profile and outcome of post stroke patients managed at selected public primary care health centres in Peninsular Malaysia: A retrospective observational study

Scientific Reports ◽

10.1038/s41598-018-36154-0 ◽

2018 ◽

Vol 8 (1) ◽

Cited By ~ 1

Author(s):

Aznida Firzah Abdul Aziz ◽

Mohd Fairuz Ali ◽

Mohammad Fhaisol Yusof ◽

Zuraidah Che’ Man ◽

Saperi Sulong ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Peninsular Malaysia ◽

Retrospective Observational Study ◽

Stroke Patients ◽

Post Stroke ◽

Primary Care Health ◽

Health Centres ◽

Care Health

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How sensitive are avoidable emergency department attendances to primary care quality? Retrospective observational study

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-011651 ◽

2020 ◽

pp. bmjqs-2020-011651

Author(s):

Beth Parkinson ◽

Rachel Meacock ◽

Kath Checkland ◽

Matt Sutton

Keyword(s):

Primary Care ◽

Emergency Department ◽

Observational Study ◽

Care Quality ◽

National Average ◽

Retrospective Observational Study ◽

Clinical Quality ◽

Care Access ◽

Primary Care Quality ◽

Rate Ratios

BackgroundImprovements in primary care quality are often proposed as a solution to rises in emergency department (ED) attendances. However, there is little agreement on what constitutes an avoidable attendance, and the relationship between primary care quality and ED demand remains poorly understood.ObjectiveTo estimate the size of the associations between primary care quality and volumes of ED attendances classified as avoidable.MethodsRetrospective observational study of all attendances at EDs in England during 2015/2016, applying three definitions of avoidable attendance. We linked practice-level counts of attendances to seven measures of primary care access, patient experience and clinical quality for 7521 practices. We used count data regressions to associate attendance counts with levels of quality. We then calculated proportions of attendances associated with levels of primary care quality below the national average.ResultsAttendance volumes were negatively related to three of the seven quality measures. Incidence rate ratios (IRRs) for all attendances associated with 10 percentage-point differences in quality were 0.987 for clinical quality and 0.987 for easy telephone access and 0.978 for ability to get an appointment. These associations were relatively stronger for narrower definitions of avoidable attendances (for the narrowest definition, IRRs=0.966, 0.976 and 0.934, respectively) but represented fewer attendances in absolute terms. 341 000 (2.4%) attendances were associated with levels of primary care quality below the national average in 2015/2016.ConclusionED attendances are sensitive to primary care quality, but magnitudes of these associations are small. Attendances are much less responsive to differences in primary care quality than indicated by estimates of the prevalence of avoidable attendances. This may explain the failure of initiatives to reduce attendances through primary care improvements.

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Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study

BMJ Open ◽

10.1136/bmjopen-2018-024970 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024970 ◽

Cited By ~ 1

Author(s):

Michelle Greiver ◽

Sumeet Kalia ◽

Teja Voruganti ◽

Babak Aliarzadeh ◽

Rahim Moineddin ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Observational Study ◽

Diastolic Pressure ◽

Cardiovascular Outcomes ◽

Retrospective Observational Study ◽

Digit Preference ◽

The Mean ◽

The Uk ◽

Primary Care Practices

ObjectivesTo study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes.DesignRetrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017.SettingPrimary care practices in Canada and the UK.ParticipantsAdults aged 18 years or more.Main outcome measuresMean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes.Results707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP.ConclusionsAcquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.

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Common step-wise interventions improved primary care clinic visits and reduced emergency department discharge failures: a large-scale retrospective observational study

BMC Health Services Research ◽

10.1186/s12913-019-4300-1 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Chet D. Schrader ◽

Richard D. Robinson ◽

Somer Blair ◽

Sajid Shaikh ◽

Amy F. Ho ◽

...

Keyword(s):

Primary Care ◽

Emergency Department ◽

Observational Study ◽

Large Scale ◽

Primary Care Clinic ◽

Retrospective Observational Study ◽

Care Clinic ◽

Emergency Department Discharge ◽

Clinic Visits

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Does refugee status matter? Medical needs of newly arrived asylum seekers and resettlement refugees - a retrospective observational study of diagnoses in a primary care setting

Conflict and Health ◽

10.1186/s13031-019-0223-z ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Evelyn Kleinert ◽

Frank Müller ◽

Ghefar Furaijat ◽

Nele Hillermann ◽

Alexandra Jablonka ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Asylum Seekers ◽

Care Setting ◽

Primary Care Setting ◽

Retrospective Observational Study ◽

Refugee Status ◽

Medical Needs

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Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records

BMJ Open ◽

10.1136/bmjopen-2017-019233 ◽

2018 ◽

Vol 8 (1) ◽

pp. e019233 ◽

Cited By ~ 8

Author(s):

Martine W J Huygens ◽

Ilse C S Swinkels ◽

Robert A Verheij ◽

Roland D Friele ◽

Onno C P van Schayck ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Observational Study ◽

Patient Characteristics ◽

Retrospective Observational Study ◽

Electronic Health Record Data ◽

Face To Face ◽

Patients With Diabetes ◽

General Practices ◽

Electronic Health

ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

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High-risk basal cell carcinoma excision in primary care: a retrospective observational study of compliance with NICE guidance

BMJ Open ◽

10.1136/bmjopen-2018-023299 ◽

2018 ◽

Vol 8 (11) ◽

pp. e023299

Author(s):

Simon John Cole ◽

Rachel Howes ◽

Chris Meehan ◽

Richard Cole

Keyword(s):

Primary Care ◽

High Risk ◽

Observational Study ◽

Basal Cell ◽

Retrospective Observational Study ◽

Anatomical Site ◽

Complete Excision ◽

Close Supervision ◽

Nice Guidance ◽

Future Revision

ObjectivesTo assess compliance with 2010 National Institute for Health and Care Excellence (NICE) guidance on cancer services relating to the management of basal cell carcinomas (BCC) in the community, where except in specific circumstances it is recommended that only low-risk BCCs should be excised routinely.Design and settingA retrospective observational study of the histopathology reports of BCC excisions received from primary care in two district general hospitals in the South of England. One hundred consecutive BCC excisions were analysed from each hospital.Outcome measuresThe numbers of high-risk BCCs excised in primary care according to histological subtype, anatomical site and age and if these excisions were compliant with NICE 2010 guidance. Completeness of excision and mention of BCC on histology request were secondary outcomes.ResultsHistologically high-risk subtypes were present in 32% (64/200) of BCCs excised in the community. Only 17/64 were excised by general practitioners (GPs) who were accredited to do so. Non-compliance regarding anatomical site occurred in 16% of samples; only one was non-compliant regarding patient age. There was a high overall rate of complete excision (94.5%) with variation in presence of the term BCC on histology request forms.ConclusionsNICE 2010 guidance relating to BCC excision in primary care was not followed in a considerable number of cases. Compliance with NICE 2010 guidance depends on the ability to recognise high-risk BCCs clinically and manage appropriately. It also shows that despite close supervision by secondary care, there are still failures of compliance.GP training in identification of subtypes of BCC might be improved, as well as an increase in numbers of GPs accredited to carry out high-risk BCC excisions. Difficulty in diagnosing high-risk histological subtypes of BCC preoperatively should be considered in any future revision of NICE guidance.

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