OP321 The Scale And Variation Of The Impact Of COVID-19 On Prescribing Of Medicines In Primary Care In Wales

2021 ◽  
Vol 37 (S1) ◽  
pp. 13-14
Author(s):  
Will Hardy ◽  
Dan McManus ◽  
Susan Murphy ◽  
Dyfrig Hughes
Keyword(s):  
Primary Care ◽  
Oral Contraceptives ◽  
Oral Anticoagulants ◽  
Access To Medicines ◽  
Unintended Consequences ◽  
Stock Management ◽  
Novel Approach ◽  
Time Series Modelling ◽  
Additional Support ◽  
The Impact

IntroductionPrescribing of medicines in primary care in Wales has been exceptional in 2020 due to COVID-19 and the associated changes to the delivery of health services. The changes are likely to have harmful, albeit unintended, consequences, including disruption of pharmacy stock management; unpredictable changes in prescribing; and interruption to patients’ supply of medicines and reduced medication adherence. Changes in prescribing are unlikely to be distributed evenly across the country or population. Therefore, this study aimed to identify changes in GP prescribing compared with previous years, the variation of these changes, and factors related to the variation in changes, to identify patient subgroups for whom the impact is disproportionate.MethodsWe identified medicines of interest where concerns around prescribing have been raised and, for each of these medicines, retrieved monthly prescribing data for each GP practice in Wales (N = 492). We then linked these data with other publicly available data (for example, practice size, indices of multiple deprivation, disease prevalence).We developed a novel approach to measure the impact of COVID-19 on GP prescribing. We compared observed with expected prescribing volume projected via time series modelling and differences were related to patient and practice characteristics using general estimating equations.ResultsThere was evidence of stockpiling of medicines during March 2020 (for example, oral-contraceptives and oral-anticoagulants with 11.6 and 18.5 percent increases from March 2019), followed by a short-term reduction in prescribing for oral-contraceptives (a reduction of 12.9 percent), but not oral-anticoagulants (an increase of 6.5 percent). However, GP level data show considerable deviation from the national trend for several GPs, which may be due to health and socio-demographic factors.ConclusionsCOVID-19 has had a major impact on primary care prescribing in Wales. The distribution of changes in prescribing will not be even across the country or the population. Identification of systematic variation in impacts on prescribing could identify geographical areas or patients in need of additional support to ensure uninterrupted and appropriate access to medicines.

Conundrums in merging public policy into private dentistry: experiences from Australia’s recent past

2015 ◽  
Vol 39 (2) ◽  
pp. 169
Author(s):  
Raymond Lam ◽  
Estie Kruger ◽  
Marc Tennant
Keyword(s):  
Primary Care ◽  
Service Provision ◽  
Dental Treatment ◽  
Dental Service ◽  
Unintended Consequences ◽  
Government Support ◽  
Oral Disease ◽  
Oral Diseases ◽  
Access To Primary Care ◽  
The Impact

Oral disease continues to be a major problem in Australia impacting quality of life, the economy and broader health system. Although the understanding of caries and periodontal disease has improved along with increased government support, oral diseases continue to be the most prevalent among all health conditions. This is despite unprecedented levels of funding in the Chronic Disease Dental Scheme and the Teen Dental Plan. Access to primary care dentistry in the private sector, where the majority of dental services are provided, remains a critical issue. Under the current system of dentistry, it cannot be assumed that the practice of dentistry represents a prioritised approach to combat disease patterns based on scientific evidence in primary health and prevention. Drawing on data in relation to these two programs, the present study highlights issues impacting dental service provision. This includes issues such as access and affordability to dental care, sustainability of policy and its unintended consequences, private practice pressures and the impact of remuneration on treatment. This paper argues that without structural reform there will continue to be barriers in implementing policies capable of improving oral health. What is known about the topic? The burden of oral diseases remains high and there continue to be problems in accessing and affording dental treatment. What does this paper add? This paper highlights factors impacting dental service provision and offers potential solutions to improve access to primary care dentistry. What are the implications for practitioners? A consideration of these factors may assist policy makers and governments in formulating effective policies.

scholarly journals The impact of occupational risk from COVID on GP supply in England: A cross-sectional study

2020 ◽  
Author(s):  
Miqdad Asaria ◽  
Rebecca Fisher
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Significant Proportion ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Deprived Neighbourhoods ◽  
Additional Support ◽  
The Impact ◽  
Very High

Objectives: To identify the risk of general practitioner mortality from COVID and the impact of measures to mitigate this risk on the level and socioeconomic distribution of primary care provision in the English NHS Design: Cross sectional study Setting: All GP practices providing primary care under the NHS in England Participants: 45,858 GPs and 6,771 GP practices in the English NHS Main outcome measures: Numbers of high-risk GPs, high-risk single-handed GP practices, patients associated with these high-risk single-handed practices and the regional and socioeconomic distribution of each. Mortality rates from COVID by age, sex and ethnicity were used to attribute risk to GPs and the Index of Multiple Deprivation was used to determine socioeconomic distributions of the outcomes. Results: Of 45,858 GPs in our sample 3,632 (7.9%) were classified as high risk or very high risk. Of 6,771 GP practices in our sample 639 (9.4%) were identified as single-handed practices and of these 209 (32.7%) were run by a GP at high or very high risk. These 209 single-handed practices care for 710,043 patients. GPs at the highest levels of risk from COVID, and single-handed practices run by high-risk GPs were concentrated in the most deprived neighbourhoods in the country. London had the highest proportion of both GPs and single-handed GP practices at very high risk of COVID mortality with 1,160 patients per 100,000 population registered to these practices. Conclusions: A significant proportion of GPs working in England, particularly those serving patients in the most deprived neighbourhoods, are at high risk of dying from COVID. Many of these GPs run single-handed practices. These GPs are particularly concentrated in London. There is an opportunity to provide additional support to mitigate COVID risk for GPs, GP practices and their patients. Failure to do so will likely exacerbate existing health inequalities.

scholarly journals How Much Health Promotion and Disease Prevention Is Enough? Should Chiropractic Colleges Focus on Efficacy Training in Screening for Family Violence?

2006 ◽  
Vol 20 (2) ◽  
pp. 128-137 ◽  
Author(s):  
Lisa Terre ◽  
Gary Globe ◽  
Mark T. Pfefer
Keyword(s):  
Primary Care ◽  
Professional Identity ◽  
Family Violence ◽  
Professional Education ◽  
Primary Care Providers ◽  
Unintended Consequences ◽  
Empirical Literature ◽  
Care Providers ◽  
Developmental Approach ◽  
The Impact

Introduction: Although family violence has been identified as a major public health issue, it has received little attention in the chiropractic literature. Accordingly, this article provides a conceptual overview on family violence, discusses the role of chiropractors in its detection, and raises several issues germane to chiropractic education that deserve further attention in future chiropractic publications. Methods: A selective review of the empirical literature on family violence was conducted with a focus on issues relevant to chiropractic training and professional identity. Results: Extrapolating from the research, several models for medical training and continuing education have been proposed that emphasize a multidisciplinary, developmental approach to infusing knowledge, skill building, and mentored practice experiences into professional education experiences. Conclusion: As chiropractors become more mainstream portal-of-entry providers, there is a clear need to translate the didactics of family violence into the clinical setting. Clinical education may provide students the opportunity to master basic competencies for managing challenging family violence problems. The clinical environment may be appropriate for inculcating skills commensurate with those of other primary care providers. Yet, the extent to which training priorities and approaches extrapolated from other health care disciplines should be accepted wholesale by the chiropractic profession merits further discussion, including issues around the professional identity of chiropractic, the impact of accreditation standards and practice guidelines on actual professional practice behaviors, and the possible limits and unintended consequences associated with expanding the traditional chiropractic scope of practice from a specialty to a primary care profession.

General practitioners: Between integration and co-location. The case of primary care centers in Tuscany, Italy

2018 ◽  
Vol 32 (1) ◽  
pp. 2-15 ◽  
Author(s):  
Sara Barsanti ◽  
Manila Bonciani
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
System Integration ◽  
Positive Impact ◽  
Unintended Consequences ◽  
Care Services ◽  
Primary Care Services ◽  
The Usa ◽  
Italian Model ◽  
The Impact

Healthcare systems have followed several strategies aimed at integrating primary care services and professionals. Medical homes in the USA and Canada, and primary care centres across Europe have collocated general practitioners and other health and social professionals in the same building in order to boost coordination among services and the continuity of care for patients. However, in the literature, the impact of co-location on primary care has led to controversial results. This article analyses the possible benefits of the co-location of services in primary care focusing on the Italian model of primary care centres (Case della Salute) in terms of general practitioners’ perception. We used the results of a web survey of general practitioners in Tuscany to compare the experiences and satisfaction of those general practitioners involved and not involved in a primary care centre, performed a MONAVA and ANOVA analysis. Our case study highlights the positive impact of co-location on the integration of professionals, especially with nurses and social workers, and on organizational integration, in terms of frequency of meeting to discuss about quality of care. Conversely, no significant differences were found in terms of either clinical or system integration. Furthermore, the collaboration with specialists is still weak. Considering the general practitioners’ perspective in terms of experience and satisfaction towards primary care, co-location strategies is a necessary step in order to facilitate the collaboration among professionals and to prevent unintended consequences in terms of an even possible isolation of primary care as an involuntary ‘disintegration of the integration’.

scholarly journals Evaluating the intended and unintended consequences of opioid-prescribing interventions on primary care in British Columbia, Canada: protocol for a retrospective population-based cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038724
Author(s):  
Dimitra Panagiotoglou ◽  
Rita McCracken ◽  
M Ruth Lavergne ◽  
Erin C Strumpf ◽  
Tara Gomes ◽  
...  
Keyword(s):  
Primary Care ◽  
British Columbia ◽  
Cohort Study ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Unintended Consequences ◽  
Mortality Data ◽  
Policy Changes ◽  
Opioid Agonist ◽  
The Impact

IntroductionBetween 2015 and 2018, there were over 40 000 opioid-related overdose events and 4551 deaths among residents in British Columbia (BC). During this time the province mobilised a variety of policy levers to encourage physicians to expand access to opioid agonist treatment and the College of Physicians and Surgeons of British Columbia (CPSBC) released a practice standard establishing legally enforceable minimum thresholds of professional behaviour in the hopes of curtailing overdose events. Our goal is to conduct a comprehensive investigation of the intended and unintended consequences of these policy changes. Specifically, we aim to understand the effects of these measures on physician prescribing behaviours, identify physician characteristics associated with uptake of the new measures, and measure the effects of the policy changes on patients’ access to quality primary care.Methods and analysisThis is a population-level, retrospective cohort study of all BC primary care physicians who prescribed any opioid medication for opioid-use disorder or chronic non-cancer pain during the study period, and their patients. The study period is 1 January 2013–31 December 2018, with a 1-year wash-in period (1 January 2012–31 December 2012) to exclude patients who initiated long-term opioid treatment prior to our study period or whose pain type (ie, ‘chronic non-cancer’, ‘acute’, ‘cancer or palliative’, or ‘other’) cannot be confirmed. The project combines five administrative health datasets under the authority of the BC Ministry of Health, with the CPSBC’s Physician Registry, BC Cancer Agency’s Cancer Registry and Vital Statistics’ Mortality data. We will create measures of prescribing concordance, access, continuity, and comprehensiveness to assess primary care delivery and quality at both the physician and patient level. We will use generalised estimating equations, interrupted time series, mixed effects models, and funnel plots to identify factors related to changes in prescribing and evaluate the impact of the changes to prescribing policies. Results will be reported using appropriate Enhancing the QUAlity and Transparency Of health Research guidelines (eg, STrengthening the Reporting of OBservational studies in Epidemiology).Ethics and disseminationThis study has been approved by McGill University’s Institutional Review Board (#A11-M55-19A), and the University of British Columbia’s Research Ethics Board (#H19-03537). We will disseminate results via a combination of open access peer-reviewed journal publications, conferences, lay summaries and OpEds.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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