scholarly journals Remote Covid Assessment in Primary Care (RECAP) risk prediction tool: derivation and real-world validation studies.

2021 ◽  
Author(s):  
Ana B Espinosa-Gonzalez ◽  
Denys Prociuk ◽  
Francesca Fiorentino ◽  
Christian Ramtale ◽  
Ella Mi ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Prediction ◽  
Model Development ◽  
Area Under The Curve ◽  
Community Setting ◽  
Signs And Symptoms ◽  
Low Risk ◽  
Peripheral Oxygen Saturation ◽  
Care Practices ◽  
Primary Care Practices

Background Accurate assessment of COVID-19 severity in the community is essential for best patient care and efficient use of services and requires a risk prediction score that is COVID-19 specific and adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms and risk factors, we sought to develop and validate two COVID-19-specific risk prediction scores RECAP-GP (without peripheral oxygen saturation (SpO2)) and RECAP-O2 (with SpO2). Methods Prospective cohort study using multivariable logistic regression for model development. Data on signs and symptoms (model predictors) were collected on community-based patients with suspected COVID-19 via primary care electronic health records systems and linked with secondary data on hospital admission (primary outcome) within 28 days of symptom onset. Data sources: RECAP-GP: Oxford-Royal College of General Practitioners Research and Surveillance Centre (RSC) primary care practices (development), Northwest London (NWL) primary care practices, NHS COVID-19 Clinical Assessment Service (CCAS) (validation). RECAP-O2: Doctaly Assist platform (development, and validation in subsequent sample). Estimated sample size was 2,880 per model. Findings Data were available from 8,311 individuals. Observations, such SpO2, were mostly missing in NWL, RSC, and CCAS data; however, SpO2 was available for around 70% of Doctaly patients. In the final predictive models, RECAP-GP included sex, age, degree of breathlessness, temperature symptoms, and presence of hypertension (Area Under the Curve (AUC): 0.802, Validation Negative Predictive Value (NPV) of low risk 98.8%. RECAP-O2 included age, degree of breathlessness, fatigue, and SpO2 at rest (AUC: 0.843), Validation NPV of low risk 99.4%. Interpretation Both RECAP models are a valid tool in the assessment of COVID-19 patients in the community. RECAP-GP can be used initially, without need for observations, to identify patients who require monitoring. If the patient is monitored at home and SpO2 is available, RECAP-O2 is useful to assess the need for further treatment escalation.

scholarly journals Predicting risk of hospital admission in patients with suspected COVID-19 in a community setting : protocol for development and validation of a multivariate risk prediction tool (RECAP) (Preprint)

2021 ◽  
Author(s):  
Ana B Espinosa-Gonzalez ◽  
Ana Luisa Neves ◽  
Francesca Fiorentino ◽  
Denys Prociuk ◽  
Laiba Husain ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Prediction ◽  
Patient Outcomes ◽  
Model Development ◽  
Community Setting ◽  
Signs And Symptoms ◽  
Multivariate Risk ◽  
Primary Care Clinicians ◽  
Development And Validation ◽  
Remote Consultations

BACKGROUND During the pandemic, remote consultations have become the norm for the assessment of patients with signs and symptoms of COVID-19 in order to decrease the risk of transmission. This has added to the already existing challenges experienced by primary care clinicians when assessing suspected COVID-19 patients due to the uncertainty around disease progression (e.g., risk of deterioration around the 8th day of disease) and has prompted the use of risk prediction scores, such as NEWS2, to assess severity and guide treatment. However, the risk prediction tools available have not been validated in a community setting and have not been designed to capture the idiosyncrasy of COVID-19 infection. OBJECTIVE The objective of this study is to produce a multivariate risk prediction tool (RECAP–V1) to support primary care clinicians in the identification of those COVID-19 patients that are at higher risk of deterioration and facilitate the early escalation of their treatment with the aim of improving patient outcomes. METHODS The study follows a prospective cohort observational design, whereby patients presenting in primary or community care with signs and symptoms suggestive of COVID-19 will be followed and their data linked with hospital outcomes (hospital admission, intensive care unit admission and death). The collection of the primary data for the model will be carried out by primary care clinicians in four arms, i.e., North West London Clinical Commissioning Groups (NWL CCG), Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC), Covid Clinical Assessment Service (CCAS) and South East London CCGs (Doctaly platform), and will involve the use of an electronic template that incorporates a list of items (known as RECAP-V0) thought to be associated with worse disease outcome according to previous qualitative work.. This data will be linked to patient outcomes in highly secure environments (iCARE and ORCHID secure environments). We will then use multivariate logistic regression analyses for model development and validation. RESULTS Recruitment of participants started in October 2021. Initially, only NWL CCGs and RCGP RSC arms were active. As of 24th of March 2021, we have recruited a combined sample of 3,827 participants in these two arms. CCAS and Doctaly joined the study in February 2021, with CCAS starting recruitment process on the 15th of March 2021. The first part of the analysis (RECAP-V1 model development) is planned to start in April 2021 using the first half of the NWL CCG and RCGP RSC combined datasets. Posteriorly, the model will be validated with the rest of NWL CCG and RCGP RSC data as well as CCAS and Doctaly datasets. The study was approved by the Research Ethics Committee on the 27th of May 2020 (IRAS number 283024, REC reference number: 20/NW/0266) and badged as NIHR Urgent Public Health Study on 14th of October 2020. CONCLUSIONS We believe the validated RECAP-V1 early warning score will be a valuable tool for the assessment of suspected COVID-19 patients’ severity in the community, either in face-to-face or remote consultations, and will facilitate the timely escalation of treatment with the potential to improve patient outcomes. CLINICALTRIAL ISRCTN registry (ISRCTN13953727)

scholarly journals Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e042052
Author(s):  
Jean-Baptiste Woods ◽  
Geva Greenfield ◽  
Azeem Majeed ◽  
Benedict Hayhoe
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Cost Effectiveness ◽  
Health Worker ◽  
Health Workers ◽  
Risk Of Bias ◽  
Mental Health Workers ◽  
Mental Health Worker ◽  
Care Practices ◽  
Primary Care Practices

ObjectivesMental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.DesignSystematic literature review.Data sourcesWe searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteriaAll quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesisData were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.ResultsFifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.ConclusionsWhile there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.

scholarly journals Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

2021 ◽  
Vol 9 (2) ◽  
pp. e000780
Author(s):  
Lisanne Andra Gitsels ◽  
Ilyas Bakbergenuly ◽  
Nicholas Steel ◽  
Elena Kulinskaya
Keyword(s):  
Primary Care ◽  
Older People ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Health Improvement ◽  
Network Database ◽  
Statin Prescription ◽  
The Health Improvement Network ◽  
Care Practices ◽  
Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

scholarly journals Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Grace Warner ◽  
Lisa Garland Baird ◽  
Brendan McCormack ◽  
Robin Urquhart ◽  
Beverley Lawson ◽  
...  
Keyword(s):  
Primary Care ◽  
Case Management ◽  
End Of Life ◽  
End Of Life Care ◽  
Realist Synthesis ◽  
Multi Level ◽  
Care Practices ◽  
Primary Care Practitioners ◽  
Management Functions ◽  
Primary Care Practices

Abstract Background An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. Methods A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. Results Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. Conclusions Primary care practitioners’ use of tools to assess patients/families’ needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families’ outcomes.

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