scholarly journals Study protocol: effects, costs and distributional impact of digital primary care for infectious diseases—an observational, registry-based study in Sweden

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e038618
Author(s):  
Jens Wilkens ◽  
Hans Thulesius ◽  
Eva Arvidsson ◽  
Anna Lindgren ◽  
Bjorn Ekman
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Health System ◽  
Universal Access ◽  
Research Question ◽  
Ethical Review ◽  
Upper Respiratory Tract ◽  
Research Project ◽  
Lower Urinary Tract Infection ◽  
Distributional Impact

IntroductionThe ability to provide primary care with the help of a digital platform raises both opportunities and risks. While access to primary care improves, overuse of services and medication may occur. The use of digital care technologies is likely to continue to increase and evidence of its effects, costs and distributional impacts is needed to support policy-making. Since 2016, the number of digital primary care consultations for a range of conditions has increased rapidly in Sweden. This research project aims to investigate health system effects of this development. The overall research question is to what extent such care is a cost-effective and equitable alternative to traditional, in-office primary care in the context of a publicly funded health system with universal access. Three specific areas of investigation are identified: clinical effect; cost and distributional impact. This protocol describes the investigative approach of the project in terms of aims, design, materials, methods and expected results.Methods and analysisThe research project adopts a retrospective study design and aims to apply statistical analyses of patient-level register data on key variables from seven regions of Sweden over the years 2017–2018. In addition to data on three common infectious conditions (upper respiratory tract infection; lower urinary tract infection; and skin and soft-tissue infection), information on other healthcare use, socioeconomic status and demography will be collected.Ethics and disseminationThis registry-based study has received ethical approval by the Swedish Ethical Review Authority. Use of data will follow the Swedish legislation and practice with regards to consent. The results will be disseminated both to the research community, healthcare decision makers and to the general public.

Lower urinary tract infection in non-pregnant women under 65

2021 ◽  
Vol 2021 (4) ◽  
pp. 17-22
Author(s):  
Linda Nazarko
Keyword(s):  
Primary Care ◽  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Tract Infection ◽  
Pregnant Women ◽  
Lower Urinary Tract ◽  
Lower Urinary Tract Infection ◽  
Primary Care Settings ◽  
Common Infections ◽  
Lower Urinary

Linda Nazarko details the management of these common infections in primary care settings

‘Unilateral’ decision making and patient participation in primary care

2012 ◽  
Vol 8 (2) ◽  
pp. 145-155 ◽  
Author(s):  
Taru Ijäs-Kallio ◽  
Johanna Ruusuvuori ◽  
Anssi Peräkylä
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Conversation Analysis ◽  
Treatment Decision ◽  
Decision Making Process ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Patients Acceptance

Using conversation analysis as a method, we examine patients’ responses to doctors’ treatment decision deliveries in Finnish primary care consultations for upper respiratory tract infection. We investigate decision-making sequences that are initiated by doctors’ ‘unilateral’ decision delivery (Collins et al. 2005). In line with Collins et al., we see the doctors’ decision deliveries as unilateral when they are offered as suggestions, recommendations or conclusions that make relevant patients’ acceptance of the decision rather than their further contributions to the decision. In contrast, more ‘bilateral’ decision making encourages and is dependent in part on patient’s contributions, too (Collins et al. 2005). We examine how patients respond to unilaterally made decisions and how they participate in and contribute to the outcome of the decision-making process. Within minimal responses patients approve the doctor’s unilateral agency in decision making whereas within two types of extended responses patients voice their own perspectives. 1) In positive responses they appraise the doctor’s decision as appropriate; 2) in other instances, patients may challenge the decision with an extended response that initiates a negotiation on the decision. We suggest that, firstly, unilateral decision making may be collaboratively maintained in consultations and that, secondly, patients have means for challenging it.

Rights of access to healthcare for undocumented migrants: understanding the Italian and British national health systems

2018 ◽  
Vol 11 (4) ◽  
pp. 232-243 ◽  
Author(s):  
Danielle da Costa Leite Borges ◽  
Caterina Francesca Guidi
Keyword(s):  
Health System ◽  
Health Systems ◽  
National Health ◽  
Universal Access ◽  
Research Question ◽  
Access To Healthcare ◽  
Health Policies ◽  
Undocumented Migrants ◽  
Content Type ◽  
British Health

Purpose The purpose of this paper is to analyse the levels of access to healthcare available to undocumented migrants in the Italian and British health systems through a comparative analysis of health policies for this population in these two national health systems. Design/methodology/approach It builds on textual and legal analysis to explore the different meanings that the principle of universal access to healthcare might have according to literature and legal documents in the field, especially those from the human rights domain. Then, the concept of universal access, in theory, is contrasted with actual health policies in each of the selected countries to establish its meaning in practice and according to the social context. The analysis relies on policy papers, data on health expenditure, legal statutes and administrative regulations and is informed by one research question: What background conditions better explain more universal and comprehensive health systems for undocumented migrants? Findings By answering this research question the paper concludes that the Italian health system is more comprehensive than the British health system insofar it guarantees access free of charge to different levels of care, including primary, emergency, preventive and maternity care, while the rule in the British health system is the recovering of charges for the provision of services, with few exceptions. One possible legal explanation for the differences in access between Italy and UK is the fact that the right to health is not recognised as a fundamental constitutional right in the latter as it is in the former. Originality/value The paper contributes to ongoing debates on Universal Health Coverage and migration, and dialogues with recent discussions on social justice and welfare state typologies.

scholarly journals African primary care research: Choosing a topic and developing a proposal

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Bob Mash
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Ethical Issues ◽  
Research Question ◽  
Research Proposal ◽  
Research Project ◽  
Primary Care Research ◽  
Care Research ◽  
African Context ◽  
Research Studies

This is the first in a series of articles on primary care research in the African context. The aim of the series is to help build capacity for primary care research amongst the emerging departments of family medicine and primary care on the continent. Many of the departments are developing Masters of Medicine programmes in Family Medicine and their students will all be required to complete research studies as part of their degree. This series is being written with this audience in particular in mind – both the students who must conceptualise and implement a research project as well as their supervisors who must assist them.This article gives an overview of the African primary care context, followed by a typology of primary care research. The article then goes on to assist the reader with choosing a topic and defining their research question. Finally the article addresses the structure and contents of a  research proposal and the ethical issues that should be considered.

scholarly journals Self-medication with antibiotics among patients attending a Malaysian primary care clinic: a preliminary study

2021 ◽  
Vol 8 (2) ◽  
pp. 542
Author(s):  
Zati Sabrina Ahmad Zubaidi
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Self Medication ◽  
Care Clinic ◽  
Upper Respiratory ◽  
At Home

Background: Research on self-medication with antibiotic in Malaysian primary care clinics are limited. This study aimed to assess the practice of self-medication with antibiotic, self-recognized complaints to self-medicate, antibiotic knowledge, attitudes towards antibiotic and potential association to self-medicate in a primary care clinic.Methods: This was a community-based pilot study using a self-administered questionnaire among 281 respondents. Chi square test and independent T test were performed to identify potential associations to self-medication.Results: The prevalence of self-medication with antibiotic was 13.3%. The most common complain to self-medicate was for upper respiratory tract infection (58.8%). Majority of them were able to self-purchased antibiotics (55.9%). 70.6% of respondents who SMA understood that overuse of antibiotic results in antibiotic resistance. Interestingly, antibiotic knowledge among respondents who self-medicate was higher (6.50±1.93) compared to those who did not (5.85±2.46) albeit not statistically significant. However, respondents who self-medicate had poorer attitude towards antibiotic compared to those who did not and this was statistically significant, t (254)=0-4.25, p=0.0001. 95% CI (-4.653, 1.709). This includes keeping antibiotics at home and using leftover antibiotics for respiratory illness.Conclusions: Self-medication with antibiotic in this population is low. Inappropriate attitude towards antibiotic is associated with self-medication with antibiotic. Antibiotic campaigns should focus on improving the community’s attitude towards antibiotic especially pertaining to educating the public against keeping antibiotic at home and using leftover antibiotics for upper respiratory tract infection. The findings demonstrated the need and feasibility of the study protocol for future research. 

scholarly journals Reducing inappropriate antibiotic prescribing in upper respiratory tract infection in a primary care setting in Kolkata, India

2018 ◽  
Vol 7 (4) ◽  
pp. e000217 ◽  
Author(s):  
Amy Dehn Lunn
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Antibiotic Use ◽  
Multifaceted Intervention ◽  
Upper Respiratory Tract Infection ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Upper Respiratory

Inappropriate antibiotic use is a key factor in the emergence of antibiotic resistance. The majority of antibiotics are prescribed in primary care, where upper respiratory tract infection (URTI) is a common presentation. Inappropriate antibiotic prescribing in URTI is common globally and has increased markedly in developing and transitional countries. Antibiotic stewardship is crucial to prevent the emergence and spread of resistant microbes. This project aimed to reduce inappropriate antibiotic prescribing in URTI in a non-governmental organisation’s primary care outreach clinics in Kolkata, India, from 62.6% to 30% over 4 months. A multifaceted intervention to reduce inappropriate antibiotic use in non-specific URTI was implemented. This consisted of a repeated process of audit and feedback, interactive training sessions, one-to-one case-based discussion, antibiotic guideline development and coding updates. The primary outcome measure was antibiotic prescribing rates. A baseline audit of all patients presenting with non-specific URTI over 8 weeks in November and December 2016 (n=222) found that 62.6% were prescribed antibiotics. Postintervention audit over 4 weeks in April 2017 (n=69) showed a marked reduction in antibiotic prescribing to 7.2%. An increase in documentation of examination findings was also observed, from 52.7% to 95.6%. This multifaceted intervention was successful at reducing inappropriate antibiotic prescribing, with sustained reductions demonstrated over the 4 months of the project. This suggests that approaches previously used in Europe can successfully be applied to different settings.

scholarly journals Insertion of a Clinical Pathway Pop-Up Window into a Computer-Based Prescription System: A Method to Promote Antibiotic Stewardship in Upper Respiratory Tract Infection

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1479
Author(s):  
Wantin Sribenjalux ◽  
Nattawat Larbsida ◽  
Sittichai Khamsai ◽  
Benjaphol Panyapornsakul ◽  
Phitphiboon Deawtrakulchai ◽  
...  
Keyword(s):  
Primary Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Clinical Pathway ◽  
Antibiotic Prescription ◽  
The Other ◽  
Upper Respiratory Tract ◽  
Post Intervention ◽  
Computer Based ◽  
Upper Respiratory

Outpatient antibiotics are most frequently prescribed for upper respiratory tract infection (URI); however, most such prescriptions are inappropriate. We aimed to determine the effect of an electronic clinical pathway on the rates of overall and rational prescription of antibiotics in patients with URI. A pilot quasi-experimental study was conducted in a university hospital and two of its nearby primary care units (PCU) in northeast Thailand from June to September 2020. Clinical pathway pop-up windows were inserted into the hospital’s computer-based prescription system. Care providers were required to check the appropriate boxes before they were able to prescribe amoxicillin or co-amoxiclav. We examined a total of 675 visits to the outpatient department due to URI at three points in time: pre-intervention, immediately post-intervention, and 6 weeks post-intervention. Patients in the latter group tended to be younger and visits were more likely to be general practitioner-related and to the student PCU than in the other two groups. In addition, the rate of antibiotic prescription was significantly lower at 6 weeks after intervention than at either of the other time periods (32.0% vs 53.8% pre-intervention and 46.2% immediately post-intervention; p < 0.001), and the proportion of rational antibiotic prescriptions increased significantly after implementation. Antibiotic prescription rates were lower at the community primary care unit and higher when the physician was a resident or a family doctor. The deployment of an electronic clinical pathway reduced the rate of unnecessary antibiotic prescriptions. The effect was greater at 6 weeks post-implementation. However, discrepancy of patients’ baseline characteristics may have skewed the findings.

scholarly journals Introducing antimicrobial stewardship to the outpatient clinics of a suburban academic health system

2022 ◽  
Vol 2 (1) ◽  
Author(s):  
Travis B. Nielsen ◽  
Maressa Santarossa ◽  
Beatrice Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Antimicrobial Stewardship ◽  
Acute Bronchitis ◽  
Urgent Care ◽  
Upper Respiratory Tract ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Appropriate Prescribing ◽  
Tract Infections

Abstract Objective: To establish an antimicrobial stewardship program in the outpatient setting. Design: Prescribers of antimicrobials were asked to complete a survey regarding antimicrobial stewardship. We also monitored their compliance with appropriate prescribing practices, which were shared in monthly quality improvement reports. Setting: The study was performed at Loyola University Health System, an academic teaching healthcare system in a metropolitan suburban environment. Participants: Prescribers of antimicrobials across 19 primary care and 3 immediate- and urgent-care clinics. Methods: The voluntary survey was developed using SurveyMonkeyand was distributed via e-mail. Data were collected anonymously. Rates of compliance with appropriate prescribing practices were abstracted from electronic health records and assessed by 3 metrics: (1) avoidance of antibiotics in adult acute bronchitis and appropriate antibiotic treatment in (2) patients tested for pharyngitis and (3) children with upper respiratory tract infections. Results: Prescribers were highly knowledgeable about what constitutes appropriate prescribing; verified compliance rates were highly concordant with self-reported rates. Nearly all prescribers were concerned about resistance, but fewer than half believed antibiotics were overprescribed in their office. Among respondents, 74% reported intense pressure from patients to prescribe antimicrobials inappropriately. Immediate- and urgent-care prescribers had higher rates of compliance than primary-care prescribers, and the latter group responded well to monthly reports and online educational resources. Conclusions: Intense pressure from patients to prescribe antimicrobials when they are not indicated leads to overprescribing, an effect compounded by the importance of patient satisfaction scores. Compliance reporting improved the number of appropriate antibiotics prescribed in the primary care setting.

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