627. Tele-OPAT Outcomes at Two Community Hospitals

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is well-established for the care of patients requiring IV antibiotics after hospital discharge but little is known about the effectiveness of OPAT delivered through telemedicine.1-3 We therefore investigated outcomes from telemedicine OPAT services (Tele-OPAT) at two community hospitals. Methods Data was collected from two community hospitals in the UPMC system for which both inpatient and outpatient telemedicine ID services (Tele-ID), including Tele-OPAT services, are provided. Tele-ID services at Site 1 (171 beds) began in January 2014 and at Site 2 (133 beds) in January 2018. All patients had inpatient Tele-ID consults via live audio-video (AV) visits or EHR review. After discharge, patients were managed by a Tele-OPAT team consisting of an ID pharmacist, RN and ID physician. Live AV Tele-OPAT outpatient follow-up visits were conducted with the assistance of a tele-presenter at 2 clinic sites. Results A total of 489 unique patients with 536 encounters were evaluated. Site 1 accounted for 284 patients, Site 2 had 252. Demographics are listed in Table 1. 47% of the patients were male with an average age of 65. 51% of the patients were diabetic. Half of the patients were discharged to home. Bacteremia (24.4%) and osteomyelitis (23.3%) were the most frequent diagnoses. Vancomycin was the most commonly used antibiotic (25.6%). Tele-ID Clinic follow up rates varied by year and site between 19 to 26.6% (Figure 1). The choice of follow-up was determined by the primary inpatient physician. 30 Day Readmission Rates were lower for patients that were seen by the Tele-OPAT service (combined rate of 7.4%) vs. no follow up (62%) vs. PCP follow up (22%) vs. follow up with another MD (12.8%) (Figure 2a). Most patients seen by Tele-OPAT were readmitted for reasons not related to their initial infection or their antibiotic course (Figure 2b). Table 1. Patient Demographics Figure 1. Clinic Follow Up Rates Figure 2. Readmission Rates & Reasons for Readmission Conclusion Patients discharged on IV antibiotics who were managed via a Tele-OPAT service in an outpatient clinic had lower readmission rates than those who were seen by non-ID physicians or who had no outpatient follow-up. Tele-OPAT is an important option for patients residing in rural areas who are discharged on parenteral antibiotics. Disclosures Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant)

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592. A Pilot Program to Evaluate Home Telemedicine Visits in an OPAT Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.786 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S359-S360

Author(s):

Kathleen R Sheridan ◽

Josh Wingfield ◽

Natalie Clouse

Keyword(s):

Nurse Practitioners ◽

Retrospective Chart Review ◽

Complication Rates ◽

Pilot Program ◽

Beta Lactam ◽

Readmission Rates ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Patient Demographics ◽

Academic Level

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) is a well-established and effective way of delivering and monitoring patients requiring long-term IV antibiotics1-2. OPAT follow-up appointments are typically in-office appointments. There is limited to no data regarding readmission rates and outcomes of OPAT patients that had home audio-visual (AV) telemedicine (TM) follow-up appointments3. Our OPAT Program began in December 2013 and serves a major academic Level 1 trauma center as well as several smaller community hospitals within our health system. The OPAT team is a multidisciplinary team consisting of ID Physicians, Nurse Practitioners, Pharmacist, Nurses and a Coordinator. Historically, we have evaluated patients in the office within 1-2 weeks of hospital discharge and just prior to antibiotic completion. However, there are several barriers to visit completion including lack of transportation, lack of perceived benefit of appointment by the patient, and other mobility issues. In July 2019, we began a pilot program of offering home AV TM visits. Methods We conducted a retrospective chart review of commercially insured OPAT patients discharged to home from UPMC Presbyterian from July 2019 to February 2020 that had home AV TM visits. We evaluated 30-day readmission rates and complication rates. Results 13 OPAT patients had a telemedicine video visit.. Patient demographics are listed in Table 1. 8 patients were female. The average age of the patients was 54 (range 35-75). 10 of the 13 (77%) patients were treated for osteomyelitis or septic arthritis. 9 of the 13 (69%)patients received a beta-lactam. 4 patients were readmitted, 3 had an ER visit and 1 patient had a PICC line complication (rash). (Figure 1). Half of the readmissions were due to non-infectious causes (OB delivery & pacemaker placement). 2 patients were readmitted due to ongoing infection but only one of these patients had a home TM appointment before their readmission. The other patient’s visit occurred after their readmission. Reasons for ER visits were PICC malfunction, dysuria, and syncope. Patient Demographics Clinical Outcomes Conclusion Home Telemedicine video visits could be an alternative to in-office appointments for OPAT patients. More studies should be done to evaluate this visit modality. Disclosures All Authors: No reported disclosures

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763. 30 Day Readmission Outcomes in Patients Over 80 Years of Age Enrolled in an Outpatient Parenteral Antibiotic Therapy (OPAT) Program

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.831 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S339-S340

Author(s):

Kathleen R Sheridan ◽

Joshua Wingfield ◽

Lauren McKibben ◽

Natalie Clouse

Keyword(s):

Readmission Rate ◽

Chart Review ◽

Age Groups ◽

Retrospective Chart Review ◽

Model Of Care ◽

Readmission Rates ◽

Parenteral Antibiotic ◽

Patient Demographics

Abstract Background OPAT is a well-established model of care for the monitoring of patients requiring long-term IV antibiotics1. We have previously reported a reduction in the 30-day readmission rate to our facility for patients managed in our OPAT program. However, little has been published to date regarding outcomes in OPAT patients over 80 years of age 2–3. Our OPAT program was established in 2013. Patients can be discharged to a facility or home to complete their course of antibiotics. Methods We conducted a retrospective chart review of all OPAT patients discharged from our facility from 2015 to 2018. Patients were divided into two groups based on age, <80 (n = 4618) and >80 (n = 562). Results Patient demographics are listed in Table 1. The overall 30-day readmission rate for patients older than 80 was 27.8%. For patients over 80 that had a follow-up ID clinic appointment, the 30-day readmission rate decreased to 15.7%. For patients younger than 80, the 30-day readmission rate was 36.0% with a decrease to 16.2% if patients were evaluated in the outpatient clinic. Figure 1. Staphylococcus Aureus was the predominant organism in both age categories. Vancomycin was the most common antibiotic used in both age groups followed by β lactams. Conclusion In general, patients aged over 80 years were more likely to be discharged to a facility to complete their antibiotic course than younger patients. These patients also were more likely to have other comorbidities. The 30-day readmission rate in each age group was relatively similar. OPAT in patients over age 80 can have similar 30-day readmission rates as for patients less than 80 years of age Disclosures All authors: No reported disclosures.

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Analyzing 2,589 child neurology telehealth encounters necessitated by the COVID-19 pandemic

Neurology ◽

10.1212/wnl.0000000000010010 ◽

2020 ◽

Vol 95 (9) ◽

pp. e1257-e1266 ◽

Cited By ~ 3

Author(s):

Salvatore C. Rametta ◽

Sara E. Fridinger ◽

Alexander K. Gonzalez ◽

Julie Xian ◽

Peter D. Galer ◽

...

Keyword(s):

Outpatient Care ◽

Minority Groups ◽

Child Neurology ◽

Patient Demographics ◽

Retrospective Comparison ◽

Before And After ◽

Future Care ◽

Icd 10 ◽

Audio Video

ObjectiveTo assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020.MethodsThis was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers.ResultsThere were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups.ConclusionsWe effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.

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604. Factors Associated with Adverse Drug Reactions Leading to Discontinuation of Vancomycin in Outpatient Parenteral Antimicrobial Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.798 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S364-S364

Author(s):

Josh McDonald ◽

Russell J Benefield ◽

Laura Certain

Keyword(s):

Adverse Drug Reactions ◽

Antimicrobial Therapy ◽

Plasma Concentrations ◽

The United States ◽

High Rate ◽

Unplanned Readmission ◽

Drug Reactions ◽

Research Support ◽

Outpatient Parenteral Antimicrobial Therapy

Abstract Background Over 250,000 patients receive outpatient parenteral antimicrobial therapy (OPAT) in the United States each year. Vancomycin is commonly used in OPAT but has a high rate of discontinuations due to adverse drug reactions (ADRs). Being able to predict the occurrence of these ADRs and assess their impact could improve the overall quality of OPAT services when utilizing vancomycin. Methods This was a retrospective chart review of all adult University of Utah Health (UUH) patients who received vancomycin OPAT and had planned follow-up with UUH infectious disease (ID) providers between October 25, 2018 and July 31, 2019. Patients were excluded if they were less than 18 years of age, pregnant, did not have planned follow up with UUH ID physicians, or were on any form of renal replacement therapy. The primary outcome assessed was discontinuation of vancomycin due to ADR, as documented by the ID provider. Type of ADR leading to discontinuation and 30-day unplanned readmission were also assessed. Results One hundred fifty-eight patients met inclusion criteria (n=158). The mean age of patients was 55 years with a median Charlson comorbidity score of 3. Most patients utilized a non-UUH infusion service (116, 73% vs 42, 27%) and utilized vancomycin as their sole antibiotic (83, 53%). The majority of patients were being treated for orthopedic infections (78, 49%). Twenty-eight patients discontinued vancomycin OPAT due to an ADR (18%). The most common ADR leading to discontinuation was acute kidney injury (10, 36%). Variables associated with ADRs leading to discontinuation included utilization of UUH home infusion services (54% vs 21%, P < 0.001) and initial vancomycin plasma concentrations obtained less than 7 days after discharge (92% vs 71%, P < 0.001). The overall 30 day readmission rate was 10% and the rate among patients who experienced an ADR leading to discontinuation was higher than those who did not (25% vs 8%, P < 0.001). Conclusion The overall rate of discontinuation of vancomycin OPAT due to ADR in the UUH population is similar to what has been described in previous literature. The higher rate of unplanned readmission in the population of patients who experienced ADRs warrants further study. The results of this study will be utilized for future quality improvement interventions at our institution. Disclosures Russell J. Benefield, PharmD, Merck and Co (Grant/Research Support)Paratek Pharmaceuticals (Grant/Research Support)Rempex Pharmaceuticals (Grant/Research Support)

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Early ID Outpatient Follow-up of OPAT Patients Reduces 30-day Readmission

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.787 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S332-S332

Author(s):

Ena Saini ◽

Mohammad Ali ◽

Ping Du ◽

Tonya Crook ◽

John Zurlo

Keyword(s):

Medical Center ◽

Univariate Analysis ◽

Tertiary Care ◽

Post Discharge ◽

Outpatient Parenteral Antimicrobial Therapy ◽

Patient Demographics ◽

Tertiary Care Medical Center ◽

The Relationship ◽

Multiple Antibiotics

Abstract Background Although weekly outpatient follow-up for patients discharged on outpatient parenteral antimicrobial therapy (OPAT) has been recommended, few practitioners follow this recommendation. No studies have examined the relationship between outpatient follow-up and patient outcomes for this population. We examined the association between outpatient ID follow-up and the risk for 30-day readmission for patients discharged on OPAT. Methods We conducted a retrospective cohort study using EMR data comprising 1102 OPAT patients treated between January 2012 and December 2014 at a major tertiary care medical center. We sought to determine whether ID outpatient follow-up was associated with a lower risk of 30-day readmission, after adjusting for patient demographics, infection diagnosis, outpatient antibiotics, and comorbidities (mainly diabetes mellitus, renal failure and immunosuppression). Results Of 1102 cases, 201 of 1102 (18%, 95 females, 106 males) were readmitted within 30 days, of whom 133 (66%) were re-admitted in the first 2 weeks post discharge. 837 (76%) were seen in ID outpatient follow-up within 30 days of discharge, of whom 396 (47%) were seen in first 2 weeks. By univariate analysis OPAT patients seen in ID outpatient follow-up within 2 weeks of discharge were less likely to get readmitted within 30 days of hospital discharge (OR: 0.6, CI: 0.4–0.9, P < 0.02). Patients with immunosuppression (OR: 1.9, 95% CI: 1.3–2.7, P < 0.0001) or discharged on 3 or more antimicrobials (OR: 2.1, 95% CI:1.4–3.2, P < 0.0001) were more likely to have 30-day readmission. By multivariate analysis patients seen in outpatient ID follow-up within 2 weeks (OR: 0.6, CI: 0.4–0.9, P < 0.006) or those receiving ceftriaxone alone (OR: 0.6, CI: 0.3–0.9, P < 0.015) were less likely to have 30-day readmission. Patients who were immunosuppressed (OR: 1.9, CI: 1.3–3.0, P < 0.003) or those discharged on 3 or more antimicrobials (OR: 2.1, CI: 1.4–3.2, P < 0.001) were more likely to have 30-day readmission. Conclusion Infectious disease outpatient follow-up within 2 weeks for patients discharged on OPAT reduces all-cause 30-day readmission. Early outpatient follow-up is especially important for patients who are immunosuppressed and those receiving multiple antibiotics. Disclosures All authors: No reported disclosures.

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Evaluation of the Accero Stent for Stent-Assisted Coiling of Unruptured Wide-Necked Intracranial Aneurysm Treatment with Short-Term Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm9092808 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2808

Author(s):

Wojciech Poncyljusz ◽

Kinga Kubiak ◽

Leszek Sagan ◽

Bartosz Limanówka ◽

Katarzyna Kołaczyk

Keyword(s):

Subarachnoid Hemorrhage ◽

Intracranial Aneurysms ◽

Clinical Results ◽

Class I ◽

Unruptured Aneurysms ◽

Patient Demographics ◽

Stent Deformation ◽

Unruptured Intracranial Aneurysms ◽

Occlusion Rate

Background: Stent-assisted coiling is an effective method of treating intracranial aneurysms. The aim of the study was to assess the safety and efficacy of the new Accero stent for the treatment of intracranial aneurysms. Materials and Methods: It was a retrospective, single-center study. Eighteen unruptured intracranial aneurysms were treated using the stent-assisted coiling method with the Accero stent. Patient demographics, aneurysm characteristics, procedural parameters, grade of occlusion, complications, and clinical results were analyzed. Follow-up magnetic resonance (MR) was performed 6 months after intervention. Results: Seventeen patients with 18 incidental unruptured aneurysms were electively treated with coiling and the Accero stent. The aneurysms were located on internal carotid artery (ICA), middle cerebral artery (MCA) and basilar artery (BA). All stents were deployed successfully. Immediate complete occlusion rate Raymond-Roy occlusion classification (RROC) class I was achieved in 13 cases and class II in 4 cases. Complications occurred in 2/17 treatments and included guidewire stent perforation with subarachnoid hemorrhage (SAH) and stent deformation. Vascular spasm in the subarachnoid hemorrhage (SAH) patient subsided before discharge. Ninety days after intervention, the modified Rankin Scale (mRS) value was 0. RROC class I was observed in 88.23% of cases in follow-up. Conclusion: The Accero stent provides excellent support for coil mass. It constitutes an efficacious device with good initial occlusion rate for treating wide-necked unruptured intracranial aneurysms.

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P014: Incidental findings in trauma whole-body CT scans: a systematic review

CJEM ◽

10.1017/cem.2020.222 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S69-S69

Author(s):

V. Tsang ◽

K. Bao ◽

J. Taylor

Keyword(s):

Systematic Review ◽

Incidental Findings ◽

Traffic Accidents ◽

Road Traffic ◽

Subsequent Treatment ◽

Whole Body ◽

Trauma Patients ◽

Patient Demographics ◽

Study Results

Introduction: Whole-body computed tomography scans (WBCT) are a mainstay in the work-up of polytrauma or multiple trauma patients in the emergency department. While incredibly useful for identifying traumatic injuries, WBCTs also reveal incidental findings in patients, some of which require further diagnostic testing and subsequent treatment. Although the presence of incidental findings in WBCTs have been well documented, there has been no systematic review conducted to organize and interpret findings, determine IF prevalence, and document strategies for best management. Methods: A systematic review was conducted using MEDLINE, PUBMED, and EMBASE. Specific journals and reference lists were hand-mined, and Google Scholar was used to find any additional papers. Data synthesis was performed to gather information on patient demographics, prevalence and type of incidental findings (IFs), and follow-up management was collected. All documents were independently assessed by the two reviewers for inclusion and any disagreements were resolved by consensus. Results: 1231 study results were identified, 59 abstracts, and 12 included in final review. A mean of 53.9% of patients had at least one IF identified, 31.5% had major findings, and 68.5% had minor findings. A mean of 2.7 IFs per patient was reported for articles that included number of total IFs. The mean age of patients included in the studies were 44 years old with IFs more common in older patients and men with more IFs than women. IFs were most commonly found in the abdominal/pelvic region followed by kidneys. Frequency of follow-up documentation was poor. The most common reported mechanisms of injury for patients included in the study were MVA and road traffic accidents (60.0%) followed by falls from >3m (23.2%). Conclusion: Although there is good documentation on the mechanism of injury, patient demographics, and type of IF, follow-up for IFs following acute trauma admission lacks documentation and follow-up and is an identified issue in patient management. There is great need for systematic protocols to address management of IFs in polytrauma patients.

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63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.222 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

E Lau ◽

Z Arshad ◽

A Aslam ◽

A Thahir ◽

M Krkovic

Keyword(s):

Economic Impact ◽

Treatment Protocol ◽

Case Series ◽

Consecutive Series ◽

Financial Loss ◽

Patient Demographics ◽

Tertiary Centre ◽

The Mean ◽

Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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O06 Baseline predictors of methotrexate-related adverse events in methotrexate-naïve patients with RA

Rheumatology ◽

10.1093/rheumatology/keab246.005 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Ahmad A Sherbini ◽

James M Gwinnutt ◽

Kimme L Hyrich ◽

Suzanne M M Verstappen ◽

Keyword(s):

Rheumatoid Arthritis ◽

Adverse Events ◽

Health Assessment ◽

Prevalence Rates ◽

Clinical Predictors ◽

Research Support ◽

Related Data ◽

Increased Risk ◽

One Year

Abstract Background/Aims Methotrexate (MTX) is the most common treatment for rheumatoid arthritis (RA). The prevalence of adverse events (AEs) associated with MTX treatment for RA have been studied extensively, but there are limited data on the predictors of these AEs. This study aims to summarise the prevalence rates of MTX AEs, including gastrointestinal (GI), neurological, mucocutaneous, and elevated alanine transaminase (ALT) enzyme, and to identify baseline demographic and clinical predictors of these AEs. Methods The Rheumatoid Arthritis Medication Study (RAMS) is a UK multi-centre prospective cohort study of patients with RA starting MTX for the first time. Relevant demographic, medication, clinical and disease related data were collected at baseline. AEs were reported at six and twelve months follow-ups. The prevalence rates of AEs were calculated based on the proportions of patients who reported having had an AE within one year of follow-up. The associations between candidate baseline predictors and AEs were assessed using multivariable logistic regression. Results A total of 2,089 patients were included with a mean age of 58.4 (standard deviation: 13.5) years, 1390 (66.5%) were women. 1,814 and 1,579 patients completed the 6 and 12 months follow-up visits, respectively. The prevalence rates of the AEs within one year of follow-up were: GI = 777 (40.6%), mucocutaneous = 441 (23.1%), neurological = 487 (25.5%), elevated ALT (> upper limit of normal [ULN]) = 286 (15.5%). Younger age and being a woman were associated with increased risk of GI AEs, (age: OR 0.97 per year increase in age, 95% CI 0.98, 1.00; male sex: OR 0.58 vs female, 95% CI 0.46, 0.74) (Table 1). Higher baseline Health Assessment Questionnaire (HAQ) score was an independent predictor of GI, mucocutaneous, and neurological AEs. Furthermore, having ALT >1xULN at baseline or history of diabetes was associated with increased risk of subsequent ALT elevation during the study follow-up. Conclusion In patients with RA starting MTX, GI AEs were the most commonly reported AEs during the first year of follow-up. The identified predictors of AEs may facilitate discussions between clinicians and patients prior to commencing MTX, and may lead to increased adherence and consequently improved effectiveness. Disclosure A.A. Sherbini: None. J.M. Gwinnutt: Grants/research support; BMS. K.L. Hyrich: Member of speakers’ bureau; Abbvie. Grants/research support; Pfizer, UCB, BMS. S.M.M. Verstappen: Consultancies; Celltrion. Member of speakers’ bureau; Pfizer. Grants/research support; BMS.

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The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

BMC Family Practice ◽

10.1186/s12875-021-01471-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Ingmar Schäfer ◽

Heike Hansen ◽

Agata Menzel ◽

Marion Eisele ◽

Daniel Tajdar ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Rural Areas ◽

Longitudinal Observational Study ◽

Multivariable Analyses ◽

Gastrointestinal Complaints ◽

Urban And Rural Areas ◽

Quota Sampling ◽

Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

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