scholarly journals Primary care consultations for respiratory tract symptoms during the COVID-19 pandemic: a cohort study including 70,000 people in South West England

2021 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Hilda O Hounkpatin ◽  
Jeffrey Morgan-Harrisskitt ◽  
Beth Stuart ◽  
Simon D S Fraser ◽  
...  
Keyword(s):  
Primary Care ◽  
Respiratory Tract ◽  
Cohort Analysis ◽  
Home Visits ◽  
Descriptive Statistics ◽  
Out Of Hours ◽  
Face To Face ◽  
South West ◽  
Retrospective Cohort Analysis ◽  
South West England

Abstract Background Primary care consultations for respiratory tract symptoms including identifying and managing COVID-19 during the pandemic have not been characterized. Methods A retrospective cohort analysis using routinely collected records from 70,431 adults aged 18+ in South England within the Electronic Care and Health Information Analytics (CHIA) database. Total volume and type of consultations (face-to-face, home visits, telephone, email/video, or out of hours) for respiratory tract symptoms between 1 January and 31 July 2020 (during the first wave of the pandemic) were compared with the equivalent period in 2019 for the same cohort. Descriptive statistics were used to summarize consultations by sociodemographic and clinical characteristics, and by COVID-19 diagnosis and outcomes (death, hospitalization, and pneumonia). Results Overall consultations for respiratory tract symptoms increased by 229% during the pandemic compared with the preceding year. This included significant increases in telephone consultations by 250%, a 1,574% increase in video/email consultations, 105% increase in home visits, and 92% increase in face-to-face consultations. Nearly 60% of people who presented with respiratory symptoms were tested for COVID-19 and 16% confirmed or clinically suspected to have the virus. Those with complications including pneumonia, requiring hospitalization, and who died were more likely to be seen in-person. Conclusion During the pandemic, primary care substantially increased consultations for respiratory tract symptoms to identify and manage people with COVID-19. These findings should be balanced against national reports of reduced GP workload for non-COVID care.

scholarly journals Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016901 ◽  
Author(s):  
Hannah B Edwards ◽  
Elsa Marques ◽  
William Hollingworth ◽  
Jeremy Horwood ◽  
Michelle Farr ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Waiting Times ◽  
Telephone Consultation ◽  
Face To Face ◽  
Online Consultation ◽  
South West ◽  
Consultation System ◽  
General Practices ◽  
South West England

ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

scholarly journals Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study

2019 ◽  
Vol 7 (14) ◽  
pp. 1-288 ◽  
Author(s):  
John L Campbell ◽  
Emily Fletcher ◽  
Gary Abel ◽  
Rob Anderson ◽  
Rupatharshini Chilvers ◽  
...  
Keyword(s):  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Mixed Methods ◽  
Patient Care ◽  
Mixed Methods Study ◽  
Direct Patient Care ◽  
South West ◽  
Career Break ◽  
South West England

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) To identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) To consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals Primary care for patients with respiratory tract infection before and early on in the COVID-19 pandemic: an observational study in 16 European countries

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e049257
Author(s):  
Alike W van der Velden ◽  
Eva A Bax ◽  
Emily Bongard ◽  
Rune Munck Aabenhus ◽  
Marilena Anastasaki ◽  
...  
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Laboratory Testing ◽  
Diagnostic Testing ◽  
European Countries ◽  
Fine Tuning ◽  
Face To Face ◽  
Degree Of Confidence

ObjectiveTo describe primary health care (consultation characteristics and management) for patients contacting their general practitioner (GP) with a respiratory tract infection (RTI) early on in the COVID-19 pandemic in contrasting European countries, with comparison to prepandemic findings.SettingPrimary care in 16 countries (79 practices), when no routine SARS-CoV-2 testing was generally available.Design and participantsBefore (n=4376) and early in the pandemic (n=3301), patients with RTI symptoms were registered in this prospective audit study.Outcome measuresConsultation characteristics (type of contact and use of PPE) and management characteristics (clinical assessments, diagnostic testing, prescribing, advice and referral) were registered. Differences in these characteristics between countries and between pandemic and prepandemic care are described.ResultsCare for patients with RTIs rapidly switched to telephone/video consultations (10% in Armenia, 91% in Denmark), and when consultations were face-to-face, GPs used PPE during 97% (95% CI 96% to 98%) of contacts. Laboratory testing for SARS-CoV-2 in primary care patients with RTIs was rapidly implemented in Denmark (59%) and Germany (31%), while overall testing for C reactive protein decreased. The proportion of patients prescribed antibiotics varied considerably between countries (3% in Belgium, 48% in UK) and was lower during the pandemic compared with the months before, except for Greece, Poland and UK. GPs provided frequent and varied COVID-related advice and more frequently scheduled a follow-up contact (50%, 95% CI 48% to 52%). GPs reported a slightly higher degree of confidence in the likely effectiveness of their management in face-to-face (73% (very) confident, 95% CI 71% to 76%) than in virtual consultations (69%, 95% CI 67% to 71%).ConclusionsDespite between-country variation in consultation characteristics, access to SARS-CoV-2 laboratory testing and medication prescribing, GPs reported a high degree of confidence in managing their patients with RTIs in the emerging pandemic. Insight in the highly variable pandemic responses, as measured in this multicountry audit, can aid in fine-tuning national action and in coordinating a pan-European response during future pandemic threats.

scholarly journals Preschool children in Danish out-of-hours primary care: a one-year descriptive study of face-to-face consultations

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jørgen Lous ◽  
Grete Moth ◽  
Linda Huibers ◽  
Peter Vedsted ◽  
Morten Bondo Christensen
Keyword(s):  
Primary Care ◽  
Preschool Children ◽  
Descriptive Study ◽  
Out Of Hours ◽  
Face To Face ◽  
One Year

scholarly journals Triage response by two different out-of-hours healthcare services: an observational cohort study

2019 ◽  
Vol 2 (3) ◽  
pp. 32
Author(s):  
Morten Breinholt Søvsø ◽  
Hejdi Gamst-Jensen ◽  
Morten Bondo Christensen ◽  
Linda Huibers ◽  
Freddy Lippert ◽  
...  
Keyword(s):  
Cohort Study ◽  
Home Visits ◽  
Healthcare Services ◽  
Observational Cohort Study ◽  
Out Of Hours ◽  
Telephone Consultation ◽  
Face To Face ◽  
The North ◽  
Entry Points ◽  
Observational Cohort

Background: The entry points to Danish acute care are the out-of-hours health care services (OOH) and emergency medical services (EMS). Where EMS is organized in a similar manner throughout Denmark, the OOH is not. Four regions (including the North Denmark Region) have a general practitioner operated service (OOH-GP), whereas the Capital Region of Copenhagen, (Copenhagen) Denmark has the Medical Helpline 1813, (OOH-1813) which is staffed by nurses and physicians. Nationally, access to out-of-hours healthcare and emergency departments requires referral by one of the healthcare services. The OOH services in the North Denmark Region and Copenhagen handle similar patients and health problems; however, no published research has compared the type of actions performed in response to patient calls.   We investigated and compared the type of triage response given by OOH-GP and OOH-1813 to patient contacts in the study period and the proportion of subsequent hospitalization. Methods: Observational cohort study of patients contacting OOH-GP and OOH-1813 from January 24th to February 9th, 2017. Patients with valid personal identification numbers were included. Primary outcomes were action performed by the call-handler i.e. telephone consultation, face-to-face consultation, home visit and hospitalization within 24 hours. Hospitalization was defined as a hospital stay of ≥24 hours. Results: We included 32,489 contacts (OOH-GP: 21,149 and OOH-1813: 11,340 (representative sample)). Calls to the OOH-GP were handled as follows: 67.2% (n=14,214) telephone consultation only, 32.8% (n=6,935) face-to-face consultations including 1,089 home visits (5.1%). In comparison, at OOH-1813, 51% (n=5,763) were handled by telephone consultation only, 49% (n=5,575) were triaged to face-to-face consultation including 38 home visits (0.44%). The differences in triage were statistically significant (p<0.05). Subsequent admissions occurred after 524 (4.6%) OOH-1813 contacts and 798 (3.8%) OOH-GP contacts (OR = 1.22 (1.01;1.27)). Conclusions: This comparison of OOH-1813 and OOH-GP shows significant differences in the triage responses, among these, notably more face-to-face consultations at OOH-1813. Subsequent hospitalizations were comparable with a small, but statistically significant, overrepresentation among the OOH-1813 cohort. These results could be due to the differences in organizational structure of the OOH or demographics in the two regions (capital vs city-rural), however further research is needed to determine this.

scholarly journals Identifying patients at risk of psychosis: a qualitative study of GP views in South West England

2020 ◽  
pp. bjgp20X713969
Author(s):  
Daniela Strelchuk ◽  
Nicola Wiles ◽  
Catherine Derrick ◽  
Stanley Zammit ◽  
Katrina Turner
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Patient Group ◽  
Continuity Of Care ◽  
Mental State ◽  
Psychotic Symptoms ◽  
Structured Interviews ◽  
South West ◽  
South West England ◽  
At Risk Mental State

BackgroundEarly intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs’ awareness of patients who are at risk of psychosis.AimTo explore GPs’ views and experiences of identifying patients with an at-risk mental state for psychosis, and the barriers and facilitators to identification.Design and settingIn-depth semi-structured interviews were held with GPs working in South West England primary care. The interviews were conducted between March and July 2019.MethodA topic guide was used to ensure consistency across interviews. This guide was revised to incorporate a definition of the at-risk mental state for psychosis, as after conducting a few interviews it became clear that some GPs were not familiar with this construct. Interviews were audiorecorded and analysed thematically.ResultsA total of 20 GPs were interviewed. Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services.ConclusionIdentifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.

scholarly journals Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033428
Author(s):  
Gail Hayward ◽  
Sharon Dixon ◽  
Sophie Garland ◽  
Margaret Glogowska ◽  
Helen Hunt ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Point Of Care ◽  
Home Visits ◽  
Total Carbon ◽  
Secondary Outcome ◽  
Service Improvement ◽  
Team Approach ◽  
Out Of Hours ◽  
Blood Tests

ObjectivesWe aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service.DesignA mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews.SettingOut-of-hours primary care.ParticipantsAll patients requiring home visits from the service during the implementation period.InterventionsThe i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation.Primary and secondary outcome measuresThe proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests.Resultsi-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage.ConclusionsPOC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.

Local implementation of AMS initiatives: a mixed-methods study

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697025 ◽  
Author(s):  
Rosalie Allison ◽  
Donna Lecky ◽  
Elizabeth Beech ◽  
Ceire Costelloe ◽  
Diane Ashiru-Oredope ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Interviews ◽  
Antibiotic Prescribing ◽  
Out Of Hours ◽  
Face To Face ◽  
E Learning ◽  
General Practices ◽  
Primary Care Practitioners ◽  
Future Work ◽  
Common Infections

BackgroundThe NHS English Quality Premium recommends that inappropriate antibiotic prescribing is reduced; there are a range of national antimicrobial stewardship (AMS) initiatives to support this.AimThe aim of this study is to assess AMS activities in primary care across England. The findings will be used to inform how the RCGP, PHE and NHS can help optimise stewardship activities.MethodQualitative interviews: with AMS leads within Clinical Commissioning Groups’ (CCGs) and Commissioning Support Units’ (CSUs) medicines management teams. Questionnaire: informed by the qualitative data, sent to all 209 CCGs in England in 2017.ResultsIn total, 89% (187/209) of CCGs returned a questionnaire; 82% of AMS leads reported spending only 0.1 whole-time equivalent on AMS activities, as it was only one role within a wider remit, so dedicating time is challenging. 99% (167/169) of CCGs had delivered AMS education in the last 2 years: 140 face-to-face; 121 via e-learning. 99% (184/186) actively promoted the TARGET Antibiotics Toolkit; 94% (175/187) actively promoted TARGET patient leaflets: 92% The Treating Your Infection (TYI) leaflet. 90% (166/185) used the PHE managing common infections guidance: 81% (149/185) modify or localise; 41/185 (22%) signpost directly to it. Eighty-six CCGs reported using CCG audit tools and 82 CCGs reported using TARGET’s audit tools. 85% (142/168) fed back antimicrobial prescribing data to the CCG/CSU board; 100% (169/169) to general practices and 33% (56/169) to out-of-hours providers.ConclusionAlthough CCGs reported promoting these AMS activities, there was little evaluation of uptake by primary care practitioners. Future work should focus on measuring AMS uptake; having staff dedicated solely to AMS could facilitate this.

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