scholarly journals A Multidisciplinary NHS COVID-19 Service to Manage Post-COVID-19 Syndrome in the Community

2021 ◽  
Vol 12 ◽  
pp. 215013272110109
Author(s):  
Amy Parkin ◽  
Jennifer Davison ◽  
Rachel Tarrant ◽  
Denise Ross ◽  
Stephen Halpin ◽  
...  
Keyword(s):  
Primary Care ◽  
Psychological Symptoms ◽  
Service Level ◽  
Community Healthcare ◽  
Skill Sets ◽  
Care Services ◽  
Primary Care Services ◽  
Level 3 ◽  
Set Up ◽  
The Uk

The National Institute for Health and Care Excellence (NICE) describe “ post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.

scholarly journals Evaluation of primary care services in Hungary

2020 ◽  
Author(s):  
Imre Rurik ◽  
Zoltán Jancsó ◽  
László Kalabay ◽  
Levente Lánczi ◽  
Lajos Mester ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Level ◽  
Comprehensive Overview ◽  
Process Indicators ◽  
Community Orientation ◽  
Care Services ◽  
Primary Care Services ◽  
Burn Out ◽  
Gate Keeping ◽  
Almost All

Abstract Background. It is a major challenge to show what configurations of primary care(PC) is associated with better outcomes, in terms of quality, equity and costs. The QUALICOPC Study tried to analyse and compare them within 35 countries, using validated questionnaires filled by family physicians/general practitioners (GPs). This paper aims to provide data of the Hungarian-arm of the QUALICOPC Study; to compare some findings to that of other participating countries; to give a comprehensive overview about the recent Hungarian PC system. Methods. Altogether 222 questionnaires were completed by Hungarian GPs, delivered by fieldworkers, in a geographically representative distribution. Results . Financing are based mostly on capitation, with smaller additional compensatory elements and minor quality incentives. The gate-keeping function is weak, although by referrals, the preference of patients is mostly considered. Communication between PC and specialists is often insufficient. Variety of available devices and equipment’s are appropriate. Single handed practices were 87%. Appointment instead of queuing is a new option and become more popular, mainly among better educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Half of them estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is not sufficient, therefore many GPs are involved in other earning activities. The increasing shortage of manpower is a major challenge. Conclusions. In the past 2 decades, there was visible improvement at service level and in economic circumstances. Cooperation and communication between different levels of health care provision should be improved, focusing better to community orientation and to preventive services. There is a need for specific primary care oriented guidelines to define the expected tasks of GPs.

scholarly journals 736. Delays in Malaria Recognition and Door to Anti-malarial Time in a South London Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S466-S466
Author(s):  
Nisha Patel ◽  
Tomasz Materski ◽  
Elisa Gonzalez ◽  
Solomon Russom ◽  
Gurjinder Sandhu
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Physician ◽  
African Countries ◽  
College Hospital ◽  
Travel History ◽  
Care Services ◽  
Primary Care Services ◽  
Sub Saharan ◽  
The Uk

Abstract Background The prompt recognition and treatment of Plasmodium falciparum is necessary to prevent death. We reviewed data from a cohort of patients presenting with malaria to Kings College Hospital NHS Trust, London. Methods Retrospective review of electronic records and drug charts of patients diagnosed with malaria from Jan 2019- March 2021. Results 109 cases of malaria were identified representing travellers from 11 Sub-Saharan African countries: Nigeria(38%), Sierra Leone(33%), Ivory Coast(10%). The age range varied from 4 to 76 years with a mean of 44, 66% of the cohort was male. 22 cases occurred during the COVID-19 Pandemic. The commonest symptoms were Fever (97%), Headache (92%) and malaise (72%). P. falciparum was present in 99% cases. A travel history was taken in 94% of cases. Malaria was considered by the first clinician in 82% of cases with the second highest differential being a viral illness. In 6 cases, it took 4 to 11 medical reviews before malaria was considered. 29 patients met the UK criteria for severe malaria. Door to antimalarial time varied from 1 to 128 hours, with a median of 7.4 hours. 46% of the cohort received intravenous Artesunate as their first antimalarial. Extreme delays occurred were clinicians did not consider malaria, patients had negative films or a patient did not declare a travel history when asked. 1 patient died of cerebral malaria with a door to needle time of 2hr 3min. Where a reason for delay is documented, drug availability represented the highest cause with mean delay from prescribing antimalarial to giving antimalarial of 2.7 hours. There was no difference in door to antimalarial administration during the COVID-19 Pandemic, but patients did have a delay in presentation to hospital from onset of symptoms, mean 6.2 days pre-pandemic, 10.5 days during pandemic, this was not statistically significant (P= 0.198). 3 patients presenting during the Pandemic had covid-19 swabs prior to admission and 10 had attended primary care services. Number of days between onset of malaria symptoms and presentation to the Emergency Department Box plot demonstrating that patients were waiting longer post symptom onset to access care in the Emergency Department. 3 patients had covid swabs in the community and 10 accessed care through their primary care physician. Conclusion Our data show that malaria is being considered early in the emergency department however there remain significant delays in administration of treatment. In 6 cases where malaria was not considered early there were delays in diagnosis of up to 5 days. An audit cycle will be completed with the aim of reducing door to antimalarial time. Disclosures All Authors: No reported disclosures

scholarly journals Adapting primary care for new migrants: a formative assessment

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100701 ◽  
Author(s):  
Elizabeth Such ◽  
Elizabeth Walton ◽  
Brigitte Delaney ◽  
Janet Harris ◽  
Sarah Salway
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Online Survey ◽  
Resource Constraints ◽  
Sample Survey ◽  
Service Development ◽  
Care Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

BackgroundImmigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands.AimTo formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need.Design & settingOnline survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector.MethodNon-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care.ResultsSurvey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care.ConclusionDespite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.

Sexually transmitted infections in primary care

2021 ◽  
Vol 14 (3) ◽  
pp. 168-174
Author(s):  
Harsha Dhokia
Keyword(s):  
Primary Care ◽  
Sexually Transmitted Infections ◽  
Sexually Transmitted ◽  
Care Services ◽  
Primary Care Services ◽  
Genitourinary Medicine ◽  
The Uk

Sexually transmitted infections (STIs) have often been managed in genitourinary medicine clinics. However, with increasing rates of STIs, more patients are now presenting to primary care services. It can be a sensitive subject for patients, who may be embarrassed to attend. A non-judgemental approach and knowledge about STIs are important in easing patients’ anxieties. This article provides an overview of the most common STIs in the UK, including presenting features and primary care investigation and management.

scholarly journals Patient and public perception and experience of community pharmacy services post-discharge in the UK: a rapid review and qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e043344
Author(s):  
Sarah Khayyat ◽  
Philippa Walters ◽  
Cate Whittlesea ◽  
Hamde Nazar
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Community Pharmacy ◽  
Healthcare Providers ◽  
Pharmacy Practice ◽  
Rapid Review ◽  
Post Discharge ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

ObjectivesTo investigate the perception and experience of patients and the public (PP) about community pharmacy (CP) services and other primary care services after hospital discharge back home.Design and settingA rapid review and qualitative study exploring PP perceptions of primary care, focusing on CP services in the UK.MethodsA mixed-methods approach was adopted including a rapid review undertaken between 24 April and 8 May 2019 across four databases (MEDLINE, EMBASE, PsycINFO and CINAHL). Semistructured interviews were then conducted investigating for shifts in current PP perception, but also nuanced opinion pertaining to CP services. A convenience sampling technique was used through two online PP groups for recruitment. Thematic framework analysis was applied to interview transcripts.ParticipantsAny consenting adults ≥18 years old were invited regardless of their medical condition, and whether they had used post-discharge services or not.ResultsTwenty-five studies met the inclusion criteria. Patients were generally supportive and satisfied with primary care services. However, some barriers to the use of these services included: resource limitations; poor communication between healthcare providers or between patient and healthcare providers; and patients’ lack of awareness of available services. From the 11 interviewees, there was a lack of awareness of CP post-discharge services. Nevertheless, there was general appreciation of the benefit of CP services to patients, professionals and wider healthcare system. Potential barriers to uptake and use included: accessibility, resource availability, lack of awareness, and privacy and confidentiality issues related to information-sharing. Several participants felt the uptake of such services should be improved.ConclusionThere was alignment between the review and qualitative study about high patient acceptance, appreciation and satisfaction with primary care services post-discharge. Barriers to the use of CP post-discharge services identified from interviews resonated with the existing literature; this is despite developments in pharmacy practice in recent times towards clinical and public health services.

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