scholarly journals Health care for undocumented immigrants during the early phase of the Covid-19 pandemic in Lombardy, Italy

2020 ◽  
Vol 30 (6) ◽  
pp. 1186-1188
Author(s):  
Carlo Devillanova ◽  
Cinzia Colombo ◽  
Primo Garofolo ◽  
Anna Spada
Keyword(s):  
Primary Care ◽  
Undocumented Immigrants ◽  
Respiratory Infections ◽  
Housing Conditions ◽  
Quantitative Evidence ◽  
Health Measures ◽  
Clinical Burden ◽  
Access To Primary Care ◽  
The Impact ◽  
Visit Number

Abstract Despite concern on the impact of coronavirus disease 2019 (COVID-19) pandemic on undocumented immigrants, quantitative evidence on the issue is scant. We analyze socioeconomic and health conditions of 1590 undocumented immigrants in Milan, Lombardy, one of the regions with the highest COVID-19 clinical burden in the world that does not guarantee access to primary care for these individuals. We document a sharp reduction in visit number after lockdown, with 16% frequency of acute respiratory infections, compatible with COVID-19. Moreover, housing conditions make it difficult to implement public health measures. Results suggest the need to foster primary care by undocumented immigrants to face COVID-19 emergency.

scholarly journals Correction to: Measuring the impact of the Afordable Care Act Medicaid expansion on access to primary care using an interrupted time series approach

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Elizabeth A. Brown ◽  
Brandi M. White ◽  
Walter J. Jones ◽  
Mulugeta Gebregziabher ◽  
Kit N. Simpson
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Interrupted Time Series ◽  
Medicaid Expansion ◽  
Time Series Approach ◽  
Access To Primary Care ◽  
The Impact

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals The Effects of Heatwaves on Human Morbidity in Primary Care Settings: A Case-Crossover Study

2022 ◽  
Vol 19 (2) ◽  
pp. 832
Author(s):  
Mahmoud Alsaiqali ◽  
Katrien De Troeyer ◽  
Lidia Casas ◽  
Rafiq Hamdi ◽  
Christel Faes ◽  
...  
Keyword(s):  
Primary Care ◽  
Crossover Study ◽  
Respiratory Infection ◽  
Respiratory Infections ◽  
Infection Risk ◽  
Incidence Density ◽  
Acute Effects ◽  
Primary Care Settings ◽  
Case Crossover ◽  
The Impact

Purpose: This study assesses the potential acute effects of heatwaves on human morbidities in primary care settings. Methods: We performed a time-stratified case-crossover study to assess the acute effects of heatwaves on selected morbidities in primary care settings in Flanders, Belgium, between 2000 and 2015. We used conditional logistic regression models. We assessed the effect of heatwaves on the day of the event (lag 0) and X days earlier (lags 1 to X). The associations are presented as Incidence Density Ratios (IDR). Results: We included 22,344 events. Heatwaves are associated with increased heat-related morbidities such as heat stroke IDR 3.93 [2.94–5.26] at lag 0, dehydration IDR 3.93 [2.94–5.26] at lag 1, and orthostatic hypotension IDR 2.06 [1.37–3.10] at lag 1. For cardiovascular morbidities studied, there was only an increased risk of stroke at lag 3 IDR 1.45 [1.04–2.03]. There is no significant association with myocardial ischemia/infarction or arrhythmia. Heatwaves are associated with decreased respiratory infection risk. The IDR for upper respiratory infections is 0.82 [0.78–0.87] lag 1 and lower respiratory infections (LRI) is 0.82 [0.74–0.91] at lag 1. There was no significant effect modification by age or premorbid chronic disease (diabetes, hypertesnsion). Conclusion: Heatwaves are associated with increased heat-related morbidities and decreased respiratory infection risk. The study of heatwaves’ effects in primary care settings helps evaluate the impact of heatwaves on the general population. Primary care settings might be not suitable to study acute life-threatening morbidities.

scholarly journals Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jen Murphy ◽  
William Whittaker ◽  
Mark Elliot ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Unmet Need ◽  
Negative Binomial Regression ◽  
City Region ◽  
Hub Location ◽  
Barriers To Access ◽  
Access To Primary Care ◽  
The Right ◽  
The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

scholarly journals A tool to identify potential primary care presentations in the hospital emergency department

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
H Schütze ◽  
R Rees ◽  
S Asha ◽  
K Eagar
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Public Health Issue ◽  
Accurate Data ◽  
Hospital Emergency ◽  
Targeted Interventions ◽  
International Trends ◽  
Significant Public Health ◽  
Access To Primary Care ◽  
The Impact

Abstract Background Access to primary care has an impact on health outcomes and is a significant public health issue. Limited access to primary care has seen non-urgent presentations to hospital emergency departments continue to rise globally. A lack of a universal workable definition of what a primary care presentation is has impeded national and international estimations of the true burden. Our aim was to develop a standardised code frame to identify potential primary care patients in the emergency department to allow accurate data estimations to be made, and help inform future interventions. Methods An audit of medical records was conducted in two major hospitals in Sydney, Australia. A code frame was developed, tested and applied retrospectively to five years of data. Results Of 601,168 presentations to the emergency department, 171,906 (29%) were deemed to be potential primary care presentations. The code frame had a sensitivity of 99.9% and a specificity of 49.0%. Conclusions This standardised code frame enables accurate retrospective local and national data estimations of the impact of primary care presentations in the emergency department, which was previously not available. The code frame could be used prospectively to evaluate interventions such as diverting patients to primary care settings, and to identify populations for specifically targeted interventions. The conservative nature of the code frame ensures that only those that can safely receive care in a primary care setting are identified as potential primary care. Key messages This robust tool will enable more accurate data estimations of primary care appropriate presentations in the emergency department, which can assist planning and policy efforts. It can be easily adapted to incorporate triage codes in international settings and provides a useful tool for comparing international trends.

scholarly journals Emergency care access to primary care records: an observational study

2020 ◽  
Vol 27 (3) ◽  
pp. e100153
Author(s):  
Thomas Bowden ◽  
David Lyell ◽  
Enrico Coiera
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Hospital Admission ◽  
Emergency Care ◽  
Patient Characteristics ◽  
Care Access ◽  
Process Outcomes ◽  
Primary Care Record ◽  
Access To Primary Care ◽  
The Impact

ObjectiveTo measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access.MeasuresRates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission.DesignA retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients’ primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories.Results6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=−9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=−36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081).DiscussionEmergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories.ConclusionFurther studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.

Improving access to primary care: the impact of a quality-improvement strategy

2010 ◽  
Vol 19 (3) ◽  
pp. 248-251 ◽  
Author(s):  
K. Kirschner ◽  
J. Braspenning ◽  
I. Maassen ◽  
A. Bonte ◽  
J. Burgers ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Improvement Strategy ◽  
Quality Improvement Strategy ◽  
Access To Primary Care ◽  
The Impact

Accountable Care in Transitions (ACTion): A Team-Based Approach to Reducing Hospital Utilization in a Patient-Centered Medical Home

2017 ◽  
Vol 31 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Emily M. Hawes ◽  
Jennifer N. Smith ◽  
Nicole R. Pinelli ◽  
Rayhaan Adams ◽  
Gretchen Tong ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Medical Provider ◽  
Care Needs ◽  
Patient Centered ◽  
Access To Primary Care ◽  
Transition Points ◽  
The Impact

Background: There is limited data describing the role of the patient-centered medical home (PCMH) in successful transitions programs and more information is needed to determine the transition points where pharmacist involvement is most impactful. Methods: A family medicine center developed a multidisciplinary outpatient-based transitions program focused on reducing emergency department (ED) and hospital use in medically complex patients. Key team members were a medical provider, clinical pharmacist practitioner (CPP), and care manager. The objective was to evaluate the impact of the program by comparing utilization before and after the intervention and to identify patient and process characteristic predictors of 30-day rehospitalizations. Results: Of the 268 patients included, the mean time to follow-up appointment attended was 11.6 (11.8) days after discharge. The majority of patients (72%) saw their primary care provider at follow-up. Patients experiencing the multidisciplinary intervention had lower 30-day rehospitalizations at 7, 14, and 30 days postdischarge with significance achieved at 14 and 30 days. Compared to before the intervention, reductions in both ED visits and hospitalizations as well as increases in clinic visits were seen at 1, 3, and 6 months. CPP involvement was associated with lower rehospitalizations (7.7% vs 18.8%; P = .04). Conclusion: A multidisciplinary outpatient-based transitions program embedded in the PCMH increased access to primary care and reduced hospital and ED utilization. Face-to-face CPP involvement significantly lowered rehospitalizations. This program describes a standardized approach to complex care needs with defined roles, a model that may be generalizable and reproduced in other medical homes.

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.

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