scholarly journals Early primary care physician contact and health service utilisation in a large sample of recently released ex-prisoners in Australia: prospective cohort study

BMJ Open ◽  
2015 ◽  
Vol 5 (6) ◽  
pp. e008021-e008021 ◽  
Author(s):  
J. T. Young ◽  
D. Arnold-Reed ◽  
D. Preen ◽  
M. Bulsara ◽  
N. Lennox ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Health Service ◽  
Primary Care Physician ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Physician ◽  
Service Utilisation ◽  
Physician Contact ◽  
Early Primary

scholarly journals Effects of whole-body MRI on outpatient health service costs: a general-population prospective cohort study in Mecklenburg-Vorpommern, Germany

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e056572
Author(s):  
Carsten Oliver Schmidt ◽  
Elizabeth Sierocinski ◽  
Sebastian Baumeister ◽  
Katrin Hegenscheid ◽  
Henry Völzke ◽  
...  
Keyword(s):  
Cohort Study ◽  
General Population ◽  
Health Service ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Population Based ◽  
Whole Body ◽  
Service Utilisation ◽  
Specialist Care ◽  
Whole Body Mri

ObjectiveWhole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are particularly critical in an observational study. Our principal research question was therefore how participation in a wb-MRI examination with its resemblance to a population-based health screening is associated with outpatient service costs.DesignProspective cohort study.SettingGeneral population Mecklenburg-Vorpommern, Germany.ParticipantsAnalyses included 5019 participants of the Study of Health in Pomerania with statutory health insurance data. 2969 took part in a wb-MRI examination in addition to a clinical examination programme that was administered to all participants. MRI non-participants served as a quasi-experimental control group with propensity score weighting to account for baseline differences.Primary and secondary outcome measuresOutpatient costs (total healthcare usage, primary care, specialist care, laboratory tests, imaging) during 24 months after the examination were retrieved from claims data. Two-part models were used to compute treatment effects.ResultsIn total, 1366 potentially relevant IFs were disclosed to 948 MRI participants (32% of all participants); most concerned masses and lesions (769 participants, 81%). Costs for outpatient care during the 2-year observation period amounted to an average of €2547 (95% CI 2424 to 2671) for MRI non-participants and to €2839 (95% CI 2741 to 2936) for MRI participants, indicating an increase of €295 (95% CI 134 to 456) per participant which corresponds to 11.6% (95% CI 5.2% to 17.9%). The cost increase was sustained rather than being a short-term spike. Imaging and specialist care related costs were the main contributors to the increase in costs.ConclusionsCommunicated findings from population-based wb-MRI substantially impacted health service utilisation and costs. This introduced bias into the natural course of healthcare utilisation and should be taken care for in any longitudinal analyses.

scholarly journals Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients

2013 ◽  
Vol 150 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Sebastian Köhler ◽  
Frans Verhey ◽  
Siegfried Weyerer ◽  
Birgitt Wiese ◽  
Kathrin Heser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Old Age ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Fatal Stroke ◽  
All Cause Mortality ◽  
Primary Care Patients

scholarly journals Incidence of Neuralgic Amyotrophy (Parsonage Turner Syndrome) in a Primary Care Setting - A Prospective Cohort Study

PLoS ONE ◽  
2015 ◽  
Vol 10 (5) ◽  
pp. e0128361 ◽  
Author(s):  
Nens van Alfen ◽  
Jeroen J. J. van Eijk ◽  
Tessa Ennik ◽  
Sean O. Flynn ◽  
Inge E. G. Nobacht ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Turner Syndrome ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Setting ◽  
Primary Care Setting ◽  
Neuralgic Amyotrophy

scholarly journals Impact of antibiotics for children presenting to general practice with cough on adverse outcomes: secondary analysis from a multicentre prospective cohort study

2018 ◽  
Vol 68 (675) ◽  
pp. e682-e693 ◽  
Author(s):  
Niamh M Redmond ◽  
Sophie Turnbull ◽  
Beth Stuart ◽  
Hannah V Thornton ◽  
Hannah Christensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Respiratory Symptoms ◽  
Linear Models ◽  
Secondary Analysis ◽  
Adverse Outcomes ◽  
Antibiotic Prescribing ◽  
Acute Cough

BackgroundClinicians commonly prescribe antibiotics to prevent major adverse outcomes in children presenting in primary care with cough and respiratory symptoms, despite limited meaningful evidence of impact on these outcomes.AimTo estimate the effect of children’s antibiotic prescribing on adverse outcomes within 30 days of initial consultation.Design and settingSecondary analysis of 8320 children in a multicentre prospective cohort study, aged 3 months to <16 years, presenting in primary care across England with acute cough and other respiratory symptoms.MethodBaseline clinical characteristics and antibiotic prescribing data were collected, and generalised linear models were used to estimate the effect of antibiotic prescribing on adverse outcomes within 30 days (subsequent hospitalisations and reconsultation for deterioration), controlling for clustering and clinicians’ propensity to prescribe antibiotics.ResultsSixty-five (0.8%) children were hospitalised and 350 (4%) reconsulted for deterioration. Clinicians prescribed immediate and delayed antibiotics to 2313 (28%) and 771 (9%), respectively. Compared with no antibiotics, there was no clear evidence that antibiotics reduced hospitalisations (immediate antibiotic risk ratio [RR] 0.83, 95% confidence interval [CI] = 0.47 to 1.45; delayed RR 0.70, 95% CI = 0.26 to 1.90, overall P = 0.44). There was evidence that delayed (rather than immediate) antibiotics reduced reconsultations for deterioration (immediate RR 0.82, 95% CI = 0.65 to 1.07; delayed RR 0.55, 95% CI = 0.34 to 0.88, overall P = 0.024).ConclusionMost children presenting with acute cough and respiratory symptoms in primary care are not at risk of hospitalisation, and antibiotics may not reduce the risk. If an antibiotic is considered, a delayed antibiotic prescription may be preferable as it is likely to reduce reconsultation for deterioration.

scholarly journals Assessing and predicting adolescent and early adulthood common mental disorders using electronic primary care data: analysis of a prospective cohort study (ALSPAC) in Southwest England

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e053624
Author(s):  
Daniel Smith ◽  
Kathryn Willan ◽  
Stephanie L Prady ◽  
Josie Dickerson ◽  
Gillian Santorelli ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Mental Disorders ◽  
Outcome Measures ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Common Mental Disorders ◽  
Free Text ◽  
Primary Care Data ◽  
Time Point

ObjectivesWe aimed to examine agreement between common mental disorders (CMDs) from primary care records and repeated CMD questionnaire data from ALSPAC (the Avon Longitudinal Study of Parents and Children) over adolescence and young adulthood, explore factors affecting CMD identification in primary care records, and construct models predicting ALSPAC-derived CMDs using only primary care data.Design and settingProspective cohort study (ALSPAC) in Southwest England with linkage to electronic primary care records.ParticipantsPrimary care records were extracted for 11 807 participants (80% of 14 731 eligible). Between 31% (3633; age 15/16) and 11% (1298; age 21/22) of participants had both primary care and ALSPAC CMD data.Outcome measuresALSPAC outcome measures were diagnoses of suspected depression and/or CMDs. Primary care outcome measure were Read codes for diagnosis, symptoms and treatment of depression/CMDs. For each time point, sensitivities and specificities for primary care CMD diagnoses were calculated for predicting ALSPAC-derived measures of CMDs, and the factors associated with identification of primary care-based CMDs in those with suspected ALSPAC-derived CMDs explored. Lasso (least absolute selection and shrinkage operator) models were used at each time point to predict ALSPAC-derived CMDs using only primary care data, with internal validation by randomly splitting data into 60% training and 40% validation samples.ResultsSensitivities for primary care diagnoses were low for CMDs (range: 3.5%–19.1%) and depression (range: 1.6%–34.0%), while specificities were high (nearly all >95%). The strongest predictors of identification in the primary care data for those with ALSPAC-derived CMDs were symptom severity indices. The lasso models had relatively low prediction rates, especially in the validation sample (deviance ratio range: −1.3 to 12.6%), but improved with age.ConclusionsPrimary care data underestimate CMDs compared to population-based studies. Improving general practitioner identification, and using free-text or secondary care data, is needed to improve the accuracy of models using clinical data.

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