scholarly journals Determinants and pathways of healthcare-seeking behaviours in under-5 children for common childhood illnesses and antibiotic prescribing: a cohort study in rural India

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e052435
Author(s):  
Shweta Khare ◽  
Ashish Pathak ◽  
Manju Raj Purohit ◽  
Megha Sharma ◽  
Gaetano Marrone ◽  
...  
Keyword(s):  
Cohort Study ◽  
Multinomial Logistic Regression ◽  
Healthcare Providers ◽  
Home Treatment ◽  
Secondary Outcome ◽  
Antibiotic Prescribing ◽  
Adjusted Relative Risk ◽  
Healthcare Seeking ◽  
Common Illnesses ◽  
Tract Infections

ObjectivesTo explore the healthcare-seeking pathways, antibiotic prescribing and determine the sociodemographic factors associated with healthcare-seeking behaviour (HSB) of caregivers for common illnesses in under-5 (U-5) children in rural Ujjain, India.Study designProspective cohort study.Study setting and study sampleThe cohort included 270 U-5 children from selected six villages in rural demographic surveillance site, of the R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. A community-based cohort was visited two times weekly for over 113 weeks (August 2014 to October 2016) to record the HSB of caregivers using HSB diaries. Sociodemographic information was also solicited.Primary and secondary outcome measuresPrimary outcomes: first point of care, healthcare-seeking pathway and quantify antibiotic prescribing for the common acute illnesses.Secondary outcomeHSB risk factors were determined using mixed-effects multinomial logistic regression.ResultsA total of 60 228 HSB follow-up time points for 270 children were recorded with a total of 2161 acute illness episodes. The most common illnesses found were respiratory tract infections (RTI) (69%) and gastrointestinal tract infections (8%). No healthcare was sought in 33% of illness episodes, mostly for RTIs. The most common healthcare-seeking pathway was to informal healthcare providers (IHCPs, 49% of illness episodes). The adjusted relative risk for obtaining no treatment, home treatment and treatment by IHCPs was higher for RTIs (aRR=11.54, 1.82 and 1.29, respectively), illiterate mothers (aRR=2.86, 2.38 and 1.93, respectively), and mothers who were homemakers (aRR=2.90, 4.17 and 2.10, respectively). Socioeconomic status was associated with HSB, with the highest aRR for no treatment in the lowest two socioeconomic quintiles (aRR=6.59 and 6.39, respectively). Antibiotics were prescribed in 46% (n=670/1450) illness episodes and the majority (85%, n=572/670) were broad spectrum.ConclusionIn our rural cohort for many acute episodes of illnesses, no treatment or home treatment was done, which resulted in overall reduced antibiotic prescribing. The most common healthcare-seeking pathway was to visit IHCPs, which indicates that they are major healthcare providers in rural areas. Most of the antibiotics were prescribed by IHCPs and were commonly prescribed for illnesses where they were not indicated.

scholarly journals Antibiotic Prescribing by Informal Healthcare Providers for Common Illnesses: A Repeated Cross-Sectional Study in Rural India

Antibiotics ◽  
2019 ◽  
Vol 8 (3) ◽  
pp. 139 ◽  
Author(s):  
Shweta Khare ◽  
Manju Purohit ◽  
Megha Sharma ◽  
Ashok J. Tamhankar ◽  
Cecilia Stalsby Lundborg ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Rural India ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Sectional Study ◽  
Cross Sectional ◽  
Common Illnesses ◽  
Tract Infections

Informal healthcare providers (IHCPs) are predominant healthcare providers in rural India, who prescribe without formal training. Antibiotic prescription by IHCPs could provide crucial information for controlling antibiotic resistance. The aim of this study is to determine the practices and seasonal changes in antibiotic prescribing for common illnesses by IHCPs. A repeated cross-sectional study was conducted over 18 months, covering different seasons in the rural demographic surveillance site, at Ujjain, India. Prescriptions given to outpatients by 12 IHCPs were collected. In total, 15,322 prescriptions for 323 different complaint combinations were analyzed, of which 11,336 (74%) included antibiotics. The results showed that 14,620 (95%) of antibiotics prescribed were broad spectrum and the most commonly prescribed were fluoroquinolones (4771,31%), followed by penicillin with an extended spectrum (4119,27%) and third-generation cephalosporin (3069,20%). Antibiotics were prescribed more frequently in oral and dental problems (1126,88%), fever (3569,87%), and upper respiratory tract infections (3273, 81%); more during the monsoon season (2350,76%); and more frequently to children (3340,81%) than to adults (7996,71%). The study concludes that antibiotics were the more commonly prescribed drugs compared to other medications for common illnesses, most of which are broad-spectrum antibiotics, a situation that warrants further investigations followed by immediate and coordinated efforts to reduce unnecessary antibiotic prescriptions by IHCPs.

scholarly journals Healthcare resource utilisation and cost associated with elevated potassium levels: a Danish population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026465 ◽  
Author(s):  
Kun Kim ◽  
Reimar Wernich Thomsen ◽  
Sia Kromann Nicolaisen ◽  
Lars Pål Hasvold ◽  
Eirini Palaka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Healthcare Costs ◽  
Healthcare Providers ◽  
Population Based ◽  
Secondary Outcome ◽  
Resource Utilisation ◽  
Healthcare Resource Utilisation ◽  
Before And After ◽  
Patient Groups ◽  
Diabetes Patients

ObjectivesTo investigate healthcare costs associated with hyperkalaemia (HK) among patients with chronic kidney disease (CKD), heart failure (HF) or diabetes.DesignBefore–after cohort study of patients with HK and matched patients without HK.SettingPopulation-based databases covering primary and secondary care for the entire of Northern Denmark.ParticipantsPatients with a first incident record of CKD (n=78 372), HF (n=14 233) or diabetes (n=37 479) during 2005–2011. Among all patients experiencing a first HK event (potassium level >5.0 mmol/L), healthcare costs were compared during 6 months before and 6 months after the HK event. The same cost assessment was conducted 6 months before and after a matched index date in a comparison cohort of patients without HK.Primary and secondary outcome measuresMean costs of hospital care, general practice and dispensed drugs converted to 2018 Euros.ResultsOverall, 17 747 (23%) CKD patients, 5141 (36%) HF patients and 4183 (11%) diabetes patients with a first HK event were identified. More than 40% of all HK patients across the patient groups had subsequent HK events with successively shorter times between the events. In CKD patients, overall mean costs were €5518 higher 6 months after versus before first HK, while €441 higher in matched CKD patients without HK, yielding HK-associated costs of €5077. Corresponding costs associated with a HK event were €6018 in HF patients, and €4862 in diabetes patients.ConclusionsAmong CKD, HF and diabetes patients, an incident HK event was common, and a large proportion of the patients experienced recurrent HK events. Substantial increase in healthcare costs associated with a HK event was observed in the HK patients compared with non-HK patients. These results are important to better understand the potential economic impact of HK among high-risk comorbid patients in a real-wold setting and help inform decision-making for clinicians and healthcare providers.

scholarly journals Prediction of Mortality in Sepsis using Rapid Emergency Medicine Score: A Cohort Study

2020 ◽  
Author(s):  
Santosh Kumar Swain ◽  
Jeetendra Kumar Patra ◽  
S Rajesh Kumar ◽  
Anurag Choudhury ◽  
Prabhat Kumar Padhi ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Septic Shock ◽  
Cohort Study ◽  
Predictive Value ◽  
Scoring System ◽  
Secondary Outcome ◽  
Prediction Of Mortality ◽  
Significant Difference ◽  
Tract Infections ◽  
Sepsis And Septic Shock

Introduction: Organ dysfunction due to sepsis is manifested as acute rise of 2 points in quick Sequential Organ Failure Assessment (qSOFA) score from baseline, which is assessed by: 1) Systolic Blood Pressure (SBP) ≤100 mmHg; 2) Respiration Rate (RR) ≥22/min; 3) altered mentation, each having one point. For timely and specific management, an early diagnosis and stratification of severity of the sepsis is important. To predict the outcome of sepsis many scoring systems like SOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Mortality Prediction Model (MPM) have been developed. REMS is simple and feasible scoring system comprising of simple variables like, age in years, Pulse Rate (PR), RR, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS) and SpO2 estimation. Aim: The aim of the study was to evaluate the efficacy of REMS score and to validate its utility in patients with sepsis to predict mortality. Materials and Methods: This was an observational, cohort study conducted in the Department of Medicine of SCB Medical College and Hospital, Cuttack. A total of 100 patients of sepsis admitted to medical wards and Intensive Care Unit (ICU) of Medicine department were included in the study. Vital parameters like PR, SBP, RR, GCS, SpO2 were noted. REMS score was calculated for patients with sepsis and septic shock, among survivors and non survivors. Primary outcome was either death or discharged. The observed data was statistically analysed for utility of REMS score in predicting mortality, which is the secondary outcome of the study. Student’s t-test and Mann-Whitney U test were used for comparing normally and non-normally distributed data respectively. Univariate and multivariate logistic regression was done for all parameters in REMS. Results: The average age of the patients was 49 years (SD 14.5) with males and females almost equally distributed. Major source of infection were pneumonia (24%) followed by urinary tract infections (19%). REMS score was calculated on the day of admission of all 100 patients. It clearly distinguished survivors from non survivors (p<0.001). The median value of REMS among non survivors was 9 (7-10), which was highly significant compared to survivors; median value of REMS among survivors was 3.5 (2-5). REMS score was high among patients with septic shock than patients with sepsis {median REMS: 9 (7-10.5) vs. 4 (2-5.75); p<0.001}. All the variables in REMS were significantly associated with mortality, however with multivariate analysis only the RR was independent predictor of mortality. REMS at cut-off score 7 has sensitivity of 87.5%, specificity of 88.2%, Positive Predictive Value (PPV) of 70%, Negative Predictive Value (NPV) of 95.7%, and accuracy of REMS was 88%. Conclusion: REMS score showed a significant difference among survivors and non survivors with higher score predicting higher mortality. Hence, REMS is a valid scoring system that can be used in resource limited emergency departments to predict the mortality in patients with sepsis and septic shock.

scholarly journals Respiratory tract infection-related healthcare utilisation in children with Down’s syndrome

Infection ◽  
2020 ◽  
Vol 48 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Logan Manikam ◽  
Anne G. M. Schilder ◽  
Monica Lakhanpaul ◽  
Peter Littlejohns ◽  
Emma C. Alexander ◽  
...  
Keyword(s):  
Cohort Study ◽  
Respiratory Tract ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Anatomical Variation ◽  
Down's Syndrome ◽  
Down’S Syndrome ◽  
Healthcare Utilisation ◽  
Antibiotic Prescribing ◽  
Tract Infections

Abstract Purpose Children with Down’s syndrome (DS) are prone to respiratory tract infections (RTIs) due to anatomical variation, immune system immaturity and comorbidities. However, evidence on RTI-related healthcare utilisation, especially in primary care, is incomplete. In this retrospective cohort study, we use routinely collected primary and secondary care data to quantify RTI-related healthcare utilisation in children with DS and matched controls without DS. Methods Retrospective cohort study of 992 children with DS and 4874 matched controls attending English general practices and hospitals as identified in Clinical disease research using LInked Bespoke studies and Electronic health Records (CALIBER) from 1997 to 2010. Poisson regression was used to calculate consultation, hospitalisation and prescription rates, and rate ratios. Wald test was used to compare risk of admission following consultation. The Wilcoxon rank–sum test was used to compare length of stay by RTI type and time-to-hospitalisation. Results RTI-related healthcare utilisation is significantly higher in children with DS than in controls in terms of GP consultations (adjusted RR 1.73; 95% CI 1.62–1.84), hospitalisations (adjusted RR 5.70; 95% CI 4.82–6.73), and antibiotic prescribing (adjusted RR 2.34; 95% CI 2.19–2.49). Two percent of children with DS presenting for an RTI-related GP consultation were subsequently admitted for an RTI-related hospitalisation, compared to 0.7% in controls. Conclusions Children with DS have higher rates of GP consultations, hospitalisations and antibiotic prescribing compared to controls. This poses a significant burden on families. Further research is recommended to characterise healthcare behaviours and clinical decision-making, to optimise care for this at risk group.

scholarly journals Comparison of antibiotic prescribing records in two UK primary care electronic health record systems: cohort study using CPRD GOLD and CPRD Aurum databases

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e038767
Author(s):  
Martin C Gulliford ◽  
Xiaohui Sun ◽  
Thamina Anjuman ◽  
Eleanor Yelland ◽  
Tarita Murray-Thomas
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Record ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
Health Record ◽  
Medical Diagnoses ◽  
General Practices ◽  
Electronic Health ◽  
Tract Infections

ObjectivesWe aimed to evaluate recording of antibiotic prescribing from two primary care electronic health record systems.DesignCohort study.SettingUK general practices contributing to the Clinical Practice Research Datalink (CPRD) databases: CPRD GOLD (Vision data) and CPRD Aurum (EMIS data). English CPRD GOLD general practices were analysed as a subgroup, as all CPRD Aurum practices were located in England.Participants158 305 patients were randomly sampled from CPRD Aurum and 160 394 from CPRD GOLD.Outcome measuresAntibiotic prescriptions in 2017 were identified. Age-standardised and sex-standardised antibiotic prescribing rates per 1000 person years were calculated. Prescribing of individual antibiotic products and associated medical diagnoses was evaluated.ResultsThere were 101 360 antibiotic prescriptions at 883 CPRD Aurum practices and 112 931 prescriptions at 290 CPRD GOLD practices, including 112 general practices in England. The age-standardised and sex-standardised antibiotic prescribing rate in 2017 was 512.6 (95% CI 510.4 to 514.9) per 1000 person years in CPRD Aurum and 584.3 (582.1 to 586.5) per 1000 person years in CPRD GOLD (505.2 (501.6 to 508.9) per 1000 person years if restricted to practices in England). The 25 most frequently prescribed antibiotic products were similar in both databases. One or more medical codes were recorded on the same date as an antibiotic prescription for 72 989 (74%) prescriptions in CPRD Aurum, 84 756 (78%) in CPRD GOLD and 28 471 (78%) for CPRD GOLD in England. Skin, respiratory and genitourinary tract infections were recorded for 39 035 (40%) prescriptions in CPRD Aurum, 41 326 (38%) in CPRD GOLD, with 15 481 (42%) in English CPRD GOLD practices only.ConclusionEstimates for antibiotic prescribing and infection recording were broadly similar in both databases suggesting similar recording across EMIS and Vision systems. Future research on antimicrobial stewardship can also be conducted using primary care data in CPRD Aurum.

scholarly journals Healthcare Seeking Behaviour of Pregnant Women in rural Amhara, Ethiopia: Perception of Healthcare Providers

2020 ◽  
Author(s):  
Fisseha Shiferie ◽  
Yemane Berhane ◽  
Firehiwot Workneh
Keyword(s):  
Antenatal Care ◽  
Pregnant Women ◽  
Health Beliefs ◽  
Family Income ◽  
Care Service ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Good Relationship ◽  
Healthcare Seeking ◽  
Tract Infections

Abstract Background Healthcare services utilization by pregnant women helps to improve the health of women during pregnancy, childbirth and even after delivery. Various literatures show the strong association between women’s utilization of antenatal care services and factors such as urban residence, partners’ educational status, quality and cost of services, health beliefs, exposure to mass media, family income and service accessibility. Methods The study was conducted in South Gondar and West Gojjam zones in Amhara region of Ethiopia. A qualitative research design using in-depth interviews was employed to explore perceptions and experiences of healthcare providers with healthcare seeking behaviour of pregnant women. Tape recordings were transcribed verbatim in Amharic (the local language in the study area) and translated back to English. Transcripts were coded and data was analyzed manually using thematic content analysis approach. Results Pregnant women were found to have a good relationship with healthcare providers. In spite of their good relationship with healthcare providers, pregnant women were not using healthcare services per Ministry of Health recommendation. Although counseling was part of the routine antenatal care service, food taboos, those foods which are strictly forbidden for health, cultural, and religious reasons, has affected women from getting the recommended nutritional requirements during pregnancy. According to the data generated from this study, screening for routine laboratory services such as sexually transmitted infections and Urinary tract infections was performed in health centers. This study has also revealed that women preferred individual antenatal care service over group antenatal care or any form of gatherings like monthly conferences. Conclusion The trust built between healthcare providers and pregnant women has impacted the healthcare seeking behaviour of women positively. Healthcare seeking behaviour of women during pregnancy, birth and postpartum was highly influenced by religious and cultural factors. The healthcare seeking behaviour of pregnant women was also highly influenced by lack of transport access to healthcare facilities.

scholarly journals Antibiotic prophylaxis and clinical outcomes among older adults with recurrent urinary tract infection: cohort study

2018 ◽  
Vol 48 (2) ◽  
pp. 228-234 ◽  
Author(s):  
Haroon Ahmed ◽  
Daniel Farewell ◽  
Hywel M Jones ◽  
Nick A Francis ◽  
Shantini Paranjothy ◽  
...  
Keyword(s):  
Older Adults ◽  
Cohort Study ◽  
Urinary Tract ◽  
Antibiotic Prophylaxis ◽  
Antibiotic Prescribing ◽  
Clinical Recurrence ◽  
Recurrent Utis ◽  
Related Hospitalisation ◽  
Tract Infections ◽  
Reduced Risk

Abstract Background clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults. Methods this was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertain ≥3 months’ prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation. Results of 4,043 men and 15,653 women aged ≥65 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45–0.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51–0.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64–0.94). In women, prophylaxis was also associated with a reduced risk of clinical recurrence (HR, 0.57; 95% CI, 0.55–0.59) and acute antibiotic prescribing (HR, 0.61; 95% CI, 0.59–0.62), but estimates of the risk of UTI-related hospitalisation were inconsistent between our main analysis (HR, 1.16; 95% CI, 1.05–1.28) and sensitivity analysis (HR, 0.82; 95% CI, 0.72–0.94). Conclusions antibiotic prophylaxis was associated with lower rates of UTI recurrence and acute antibiotic prescribing in older adults. To fully understand the benefits and harms of prophylaxis, further research should determine the frequency of antibiotic-related adverse events and the impact on antimicrobial resistance and quality of life.

scholarly journals Antimicrobial stewardship during the COVID-19 epidemic: population-based cohort study and interrupted time series analysis in the United Kingdom

2021 ◽  
pp. BJGP.2020.1051
Author(s):  
Emma Rezel-Potts ◽  
Veline L'Esperance ◽  
Martin Gullifiord
Keyword(s):  
Time Series ◽  
Cohort Study ◽  
Time Series Analysis ◽  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Population Based ◽  
Antibiotic Prescribing ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Tract Infections

Background. The COVID-19 pandemic has altered the context for antimicrobial stewardship in primary care. Aim: To assess the effect of the pandemic on antibiotic prescribing, accounting for changes in consultations for respiratory and urinary tract infections (RTIs/UTIs). Design and Setting: Population-based cohort study using the UK Clinical Practice Research Datalink (CPRD) (January 2017 to September 2020). Method: Interrupted time series analysis evaluated changes in antibiotic prescribing and RTI/UTI consultations adjusting for age, gender, season and secular trends. We assessed the proportion of COVID-19 episodes associated with antibiotic prescribing. Results: There were 253,655 registered patients in 2017 and 232,218 in 2020 with 559,461 antibiotic prescriptions, 216,110 RTI consultations and 36,402 UTI consultations. Compared to pre-pandemic months, March 2020 was associated with higher prescribing (adjusted rate ratio 1.13; 95% confidence interval 1.11 to 1.16). Prescribing fell below predicted rates between April and August 2020, reaching a minimum in May (0.73, 0.71 to 0.75). Pandemic months were associated with lower rates of RTI/UTI consultations, particularly in April for RTIs (0.23; 0.22 to 0.25). There were small reductions in the proportion of RTI consultations with antibiotic prescribed and no reduction for UTIs. Among 25,889 COVID-19 patients, 2,942 (11%) had antibiotics within a COVID-19 episode. Conclusion: Pandemic months were initially associated with increased antibiotic prescribing which then fell below expected levels during the national lockdown. Findings are reassuring that antibiotic stewardship priorities have not been neglected due to COVID-19. Research is required into the effects of reduced RTI/UTI consultations on incidence of serious bacterial infection.

scholarly journals Immediate and delayed antibiotic prescribing strategies used by Australian early-career general practitioners.

2021 ◽  
pp. BJGP.2021.0026
Author(s):  
Andrew Davey ◽  
Amanda Tapley ◽  
Katie June Mulquiney ◽  
Mieke van Driel ◽  
Alison Fielding ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Multinomial Logistic Regression ◽  
Acute Bronchitis ◽  
Early Career ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
Cross Sectional ◽  
Diagnostic Uncertainty ◽  
Prescribing Behaviour ◽  
Tract Infections

Background: Antibiotics are overused for non-pneumonia acute respiratory tract infections (ARTIs). Aim: To establish prevalence and explore associations of antibiotic prescribing strategies used by Australian early-career GPs for non-pneumonia ARTIs. Design and Setting: Cross-sectional analysis of data, September 2016 to December 2017, from the Registrar Clinical Encounters in Training cohort study. Method: Multinomial logistic regression of antibiotic prescribing (“no prescribing”, “immediate prescribing”, or “delayed prescribing”) to manage an ARTI. Results: Of 7,156 new ARTI problems, no antibiotics were prescribed for 4,892 problems (68%), antibiotics were prescribed for immediate use for 1,614 problems (23%) and delayed antibiotics were used for 650 problems (9%). “Delayed prescribing” was used in 22% of otitis media, 16% of sinusitis, 13% of sore throat, 11% of acute bronchitis/bronchiolitis, and 5% of upper respiratory tract infection (URTI). “Delayed prescribing” was used for 29% of all prescriptions written. “Delayed prescribing” and “immediate prescribing” were associated with markers of clinical concern. “Delayed prescribing” was associated with longer duration of consultation and with fewer problems dealt with in the consultation. Conclusion: Australian early-career GPs use “no prescribing” for ARTIs substantially more than established GPs, but, except for URTIs, still prescribe antibiotics in excess of validated benchmarks. They may use “delayed prescribing” more often than European GPs. They may use “delayed prescribing” to manage diagnostic uncertainty and, possibly, conflicting influences on prescribing behaviour. Consequently, the use of “delayed prescribing” may enable a transition to an environment of more rational antibiotic prescribing for ARTIs.

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