scholarly journals Time trends in contraceptive prescribing in UK primary care 2000–2018: a repeated cross-sectional study

2021 ◽  
pp. bmjsrh-2021-201260
Author(s):  
Thomas Joshua Pasvol ◽  
E Anne Macgregor ◽  
Greta Rait ◽  
Laura Horsfall
Keyword(s):  
Primary Care ◽  
Social Deprivation ◽  
Pay For Performance ◽  
Temporal Trends ◽  
Hormonal Contraception ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Performance Incentive ◽  
Deprived Areas

BackgroundOver the last 20 years, new contraceptive methods became available and incentives to increase contraceptive uptake were introduced. We aimed to describe temporal trends in non-barrier contraceptive prescribing in UK primary care for the period 2000–2018.MethodsA repeated cross-sectional study using patient data from the IQVIA Medical Research Data (IMRD) database. The proportion (95% CI) of women prescribed non-barrier contraception per year was captured.ResultsA total of 2 705 638 women aged 15–49 years were included. Between 2000 and 2018, the proportion of women prescribed combined hormonal contraception (CHC) fell from 26.2% (26.0%–26.3%) to 14.3% (14.2%–14.3%). Prescriptions for progestogen-only pills (POPs) and long-acting reversible contraception (LARC) rose from 4.3% (4.3%–4.4%) to 10.8% (10.7%–10.9%) and 4.2% (4.1%–4.2%) to 6.5% (6.5%–6.6%), respectively. Comparing 2018 data for most deprived versus least deprived areas, women from the most deprived areas were more likely to be prescribed LARC (7.7% (7.5%–7.9%) vs 5.6% (5.4%–5.8%)) while women from the least deprived areas were more likely to be prescribed contraceptive pills (20.8% (21.1%–21.5%) vs 26.2% (26.5%–26.9%)). In 2009, LARC prescriptions increased irrespective of age and social deprivation in line with a pay-for-performance incentive. However, following the incentive's withdrawal in 2014, LARC prescriptions for adolescents aged 15–19 years fell from 6.8% (6.6%–7.0%) in 2013 to 5.6% (5.4%–5.8%) in 2018.ConclusionsCHC prescribing fell by 46% while POP prescribing more than doubled. The type of contraception prescribed was influenced by social deprivation. Withdrawal of a pay-for-performance incentive may have adversely affected adolescent LARC uptake, highlighting the need for further intervention to target this at-risk group.

scholarly journals Prevalence of suspected COVID-19 infection in patients from ethnic minority populations: a cross-sectional study in primary care

2020 ◽  
Vol 70 (699) ◽  
pp. e696-e704
Author(s):  
Sally A Hull ◽  
Crystal Williams ◽  
Mark Ashworth ◽  
Chris Carvalho ◽  
Kambiz Boomla
Keyword(s):  
Primary Care ◽  
South Asian ◽  
Time Course ◽  
Social Deprivation ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Clinical Factors ◽  
Cross Sectional ◽  
Long Term Conditions

BackgroundThe first wave of the London COVID-19 epidemic peaked in April 2020. Attention initially focused on severe presentations, intensive care capacity, and the timely supply of equipment. While general practice has seen a rapid uptake of technology to allow for virtual consultations, little is known about the pattern of suspected COVID-19 presentations in primary care.AimTo quantify the prevalence and time course of clinically suspected COVID-19 presenting to general practices, to report the risk of suspected COVID-19 by ethnic group, and to identify whether differences by ethnicity can be explained by clinical data in the GP record.Design and settingCross-sectional study using anonymised data from the primary care records of approximately 1.2 million adults registered with 157 practices in four adjacent east London clinical commissioning groups. The study population includes 55% of people from ethnic minorities and is in the top decile of social deprivation in England.MethodSuspected COVID-19 cases were identified clinically and recorded using SNOMED codes. Explanatory variables included age, sex, self-reported ethnicity, and measures of social deprivation. Clinical factors included data on 16 long-term conditions, body mass index, and smoking status.ResultsGPs recorded 8985 suspected COVID-19 cases between 10 February and 30 April 2020.Univariate analysis showed a two-fold increase in the odds of suspected COVID-19 for South Asian and black adults compared with white adults. In a fully adjusted analysis that included clinical factors, South Asian patients had nearly twice the odds of suspected infection (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.83 to 2.04). The OR for black patients was 1.47 (95% CI = 1.38 to 1.57).ConclusionUsing data from GP records, black and South Asian ethnicity remain as predictors of suspected COVID-19, with levels of risk similar to hospital admission reports. Further understanding of these differences requires social and occupational data.

scholarly journals The provision of additional services in primary care: a cross-sectional study of incentivised additional services, social deprivation, and ethnic group

BJGP Open ◽  
2020 ◽  
pp. bjgpopen20X101141
Author(s):  
Veline L'Esperance ◽  
Peter Schofield ◽  
Mark Ashworth
Keyword(s):  
Primary Care ◽  
Ethnic Group ◽  
Social Deprivation ◽  
Cross Sectional Study ◽  
Activity Level ◽  
Population Characteristics ◽  
Urgent Care ◽  
Cross Sectional ◽  
Practice Nurses ◽  
Deprived Areas

BackgroundPrimary care in England is contracted to provide essential services. Many practices also provide additional services, termed ‘directed enhanced services’ (DES), for extra income. The optional nature of DES may result in inequitable service delivery.AimTo determine the range of DES activity and equity of service provision.Design & settingA cross-sectional analysis of data from general practices in England took place from 2018–2019.MethodDES were defined in terms of activity level and measured as total DES funding per registered patient. Linear regression modelling was used to explore the relationship between DES activity, practice, and population characteristics.ResultsData were available for 6873 practices providing up to 10 DES in the initial sample. Due to negative funding amounts and a list size of ≤750 registered patients, 24 practices were excluded. Of the final sample (n = 6849), highest DES provision was for influenza and pneumococcal immunisation (99.9%), pertussis immunisation (97.9%), rotavirus and shingles immunisation (99.9%), meningitis immunisation (99.7%), and childhood immunisation (99.6%); lowest provision was for extended hours access (72.4%), violent patient services (2.0%), and out-of-area urgent care (1.3%). Mean DES funding was £6.25 per patient. In deprived areas, DES funding was £0.35 lower (95% confidence interval [CI] = £0.60 to £0.10) per patient (most versus least deprived quintiles); ethnic group-related differences were not significant. DES funding was higher in practices with more GPs or practice nurses per patient. In deprived communities, there was less immunisation activity (including influenza, pneumococcal, meningitis, childhood, and rotavirus and shingles immunisation) and provision of extended hours access; however, learning disability checks provision was greater in these communities.ConclusionDES provision is lower in deprived areas (notably for immunisations and some aspects of access) but higher in better staffed practices. Voluntary quality schemes may contribute to widening health inequalities.

scholarly journals Association between community-based self-reported COVID-19 symptoms and social deprivation explored using symptom tracker apps: a repeated cross-sectional study in Northern Ireland

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e048333
Author(s):  
Jennifer M McKinley ◽  
David Cutting ◽  
Neil Anderson ◽  
Conor Graham ◽  
Brian Johnston ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Urban Areas ◽  
Social Deprivation ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Housing Density ◽  
Cross Sectional ◽  
Pharmaceutical Interventions ◽  
Deprived Areas

ObjectivesThe aim of the study was to investigate the spatial and temporal relationships between the prevalence of COVID-19 symptoms in the community-level and area-level social deprivation.DesignSpatial mapping, generalised linear models, using time as a factor and spatial-lag models were used to explore the relationship between self-reported COVID-19 symptom prevalence as recorded through two smartphone symptom tracker apps and a range of socioeconomic factors using a repeated cross-sectional study design.SettingIn the community in Northern Ireland, UK. The analysis period included the earliest stages of non-pharmaceutical interventions and societal restrictions or ‘lockdown’ in 2020.ParticipantsUsers of two smartphone symptom tracker apps recording self-reported health information who recorded their location as Northern Ireland, UK.Primary outcome measuresPopulation standardised self-reported COVID-19 symptoms and correlation between population standardised self-reported COVID-19 symptoms and area-level characteristics from measures of multiple deprivation including employment levels and population housing density, derived as the mean number of residents per household for each census super output area.ResultsHigher self-reported prevalence of COVID-19 symptoms was associated with the most deprived areas (p<0.001) and with those areas with the lowest employment levels (p<0.001). Higher rates of self-reported COVID-19 symptoms within the age groups, 18–24 and 25–34 years were found within the most deprived areas during the earliest stages of non-pharmaceutical interventions and societal restrictions (‘lockdown’).ConclusionsThrough spatial regression of self-reporting COVID-19 smartphone data in the community, this research shows how a lens of social deprivation can deepen our understanding of COVID-19 transmission and prevention. Our findings indicate that social inequality, as measured by area-level deprivation, is associated with disparities in potential COVID-19 infection, with higher prevalence of self-reported COVID-19 symptoms in urban areas associated with area-level social deprivation, housing density and age.

Portuguese Patient Dignity Question: A cross-sectional study of palliative patients cared for in primary care

2020 ◽  
Vol 18 (6) ◽  
pp. 658-661
Author(s):  
Mafalda Lemos Caldas ◽  
Miguel Julião ◽  
Ana João Santos ◽  
Harvey Max Chochinov
Keyword(s):  
Primary Care ◽  
Health Care Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Sectional Study ◽  
Clinical Tool ◽  
Cross Sectional ◽  
Old Patients ◽  
Promising Tool ◽  
Palliative Patients

AbstractIntroductionThe Patient Dignity Question (PDQ) is a clinical tool developed with the aim of reinforcing the sense of personhood and dignity, enabling health care providers (HCPs) to see patients as people and not solely based on their illness.ObjectiveTo study the acceptability and feasibility of the Portuguese version of the PDQ (PDQ-PT) in a sample of palliative care patients cared for in primary care (PC).MethodA cross-sectional study using 20 palliative patients cared for in a PC unit. A post-PDQ satisfaction questionnaire was developed.ResultsTwenty participants were included, 75% were male; average age was 70 years old. Patients found the summary accurate, precise, and complete; all said that they would recommend the PDQ to others and want a copy of the summary placed on their family physician's medical chart. They felt the summary heightened their sense of dignity, considered it important that HCPs have access to the summary and indicated that this information could affect the way HCPs see and care for them. The PDQ-PT's took 7 min on average to answer, and 10 min to complete the summary.Significance of resultsThe PDQ-PT is well accepted and feasible to use with palliative patients in the context of PC and seems to be a promising tool to be implemented. Future trials are now warranted.

scholarly journals Knowledge, attitude and practice of evidence-based medicine among primary care practitioners in Malaysia: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044372
Author(s):  
Mat Nawi Zanaridah ◽  
Mohd Noor Norhayati ◽  
Zakaria Rosnani
Keyword(s):  
Primary Care ◽  
Evidence Based Medicine ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Evidence Based ◽  
Sectional Study ◽  
Primary Care Practitioner ◽  
Cross Sectional ◽  
Primary Care Practitioners ◽  
Based Medicine

ObjectivesTo determine the level of knowledge and practice of evidence-based medicine (EBM) and the attitudes towards it and to identify the factors associated with its practice among primary care practitioners in Selangor, Malaysia.SettingThis cross-sectional study was conducted in randomly selected health clinics in Selangor. Data were collected from primary care physicians using self-administered questionnaires on knowledge, practice and attitudes regarding EBM.ParticipantsThe study included 225 respondents working in either government or private clinics. It excluded house officers and those working in public and private universities or who were retired from practice.ResultsA total of 32.9% had a high level of EBM knowledge, 12% had a positive attitude towards EBM and 0.4% had a good level of its practice. The factors significantly associated with EBM practice were ethnicity, attitude, length of work experience as a primary care practitioner and quick access to online reference applications on mobile phones.ConclusionsAlthough many physicians have suboptimal knowledge of EBM and low levels of practising it, majority of them have a neutral attitude towards EBM practice. Extensive experience as a primary care practitioner, quick access to online references on a mobile phone and good attitude towards EBM were associated with its practice.

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