The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

BACKGROUND AND CONTEXT: Giving Asthma Support to Patients (GASP) is a unique online tool developed to provide asthma education at point of care, and to provide health care professionals in primary care with skills and knowledge to undertake a structured asthma assessment. ASSESSMENT OF PROBLEM: A retrospective cohort study was undertaken to evaluate the effectiveness of GASP. Data for patients aged 564 years seen in primary care (Waitemata region of Auckland) with uncontrolled asthma who had completed a minimum of two GASP assessments between 1 November 2008 and 17 April 2011 were extracted from a secure, self-populating database. Outcome measures were compared between each patients visit 1 and 2 assessments. RESULTS: A total of 761 patients provided data using GASP. There was a significant reduction between GASP assessments in the risk of exacerbations, hospital admissions, emergency department presentations, requirement for corticosteroids, and bronchodilator reliance. STRATEGIES FOR IMPROVEMENT: Results from this retrospective cohort study are promising. A randomised controlled trial of the use of GASP in primary care is warranted to confirm these findings. The effectiveness of the GASP tool also needs to be further investigated in Maori and Pacific populations. LESSONS: The findings of this study of GASP show its potential and support its use in the primary care setting. KEYWORDS: Asthma; decision support techniques; primary health care, retrospective study

Download Full-text

Referral rates for children with acute gastroenteritis: a retrospective cohort study

BJGP Open ◽

10.3399/bjgpopen20x101053 ◽

2020 ◽

Vol 4 (3) ◽

pp. bjgpopen20X101053

Author(s):

Pien Ingrid Wolters ◽

Gea Holtman ◽

Freek Fickweiler ◽

Irma Bonvanie ◽

Anouk Weghorst ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Acute Gastroenteritis ◽

Retrospective Cohort ◽

Incidence Rates ◽

Referral Rates ◽

Face To Face ◽

Contact Rates ◽

The Impact

BackgroundHospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care out-of-hours (OOH) services.AimTo assess trends in referral rates from primary care OOH services to specialist emergency care for children presenting with acute gastroenteritis.Design & settingThis retrospective cohort study covered a period from September 2007–September 2014. Children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care OOH service were included.MethodPseudonymised data were obtained, and children were analysed overall and by age category. Χ2 trend tests were used to assess rates of acute gastroenteritis, referrals, face-to-face contacts, and oral rehydration therapy (ORT) prescriptions.ResultsThe data included 12 455 children (6517 boys), with a median age of 20.2 months (interquartile range [IQR] 11.6 to 36.0 months). Over 7 years, incidence rates of acute gastroenteritis decreased significantly, and face-to-face contact rates increased significantly (both, P<0.01). However, there was no significant trend for referral rates (P = 0.87) or prescription rates for ORT (P = 0.82). Subgroup analyses produced comparable results, although there was an increase in face-to-face contact rates for the older children.ConclusionIncidence rates for childhood acute gastroenteritis presenting in OOH services decreased and referral rates did not increase significantly. These findings may be useful as a reference for the impact of new interventions for childhood acute gastroenteritis.

Download Full-text

The impact of comprehensive air purification on patient duration of stay, discharge outcomes, and health care economics: A retrospective cohort study

Surgery ◽

10.1016/j.surg.2020.07.021 ◽

2020 ◽

Vol 168 (5) ◽

pp. 968-974

Author(s):

Stanislaw P. Stawicki ◽

Samantha Wolfe ◽

Chad Brisendine ◽

Sherrine Eid ◽

Matthew Zangari ◽

...

Keyword(s):

Health Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Air Purification ◽

Health Care Economics ◽

Duration Of Stay ◽

Discharge Outcomes ◽

The Impact

Download Full-text

Overall survival based on oncologist density in the United States: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0250894 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0250894

Author(s):

Sudeep K. Siddappa Malleshappa ◽

Smith Giri ◽

Smit Patel ◽

Tapan Mehta ◽

Leonard Appleman ◽

...

Keyword(s):

Primary Care ◽

Overall Survival ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Care Services ◽

The United States ◽

Rank Test ◽

Care Services ◽

The Impact

Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists’ recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9–6.5, 6.5–8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients’ median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97–1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.

Download Full-text

The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care

Journal of Primary Care & Community Health ◽

10.1177/21501327211051930 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110519

Author(s):

Thuraiya Al Harthi ◽

Huda Anwar ◽

Anwaar Al Lawati ◽

Fathyia Al Shuriqi ◽

Fakhria Al Rashdi ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Glycated Hemoglobin ◽

Telephone Consultation ◽

Face To Face ◽

Before And After ◽

Patients With Diabetes ◽

The Impact

Background COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients’ and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients’ glycemic outcome in Oman. Aim and Objectives To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients’ glycemic outcome. Methods Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients’ glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients’ HbA1c and mode of consultation was measured using multivariable regression analysis. Results A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was −0.3 (−2.3 to 1.5), P = .734 for telephone consultation alone, −0.5 (−2.4 to 1.4), P = .613 for face-to-face alone, and −0.5 (−2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation. Conclusion Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

Download Full-text

Effect of the 2016 Kumamoto earthquakes on preventable hospital admissions: a retrospective cohort study in Japan

BMJ Open ◽

10.1136/bmjopen-2017-021294 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021294 ◽

Cited By ~ 1

Author(s):

Yusuke Sasabuchi ◽

Hiroki Matsui ◽

Kazuhiko Kotani ◽

Alan Kawarai Lefor ◽

Hideo Yasunaga

Keyword(s):

Primary Care ◽

Cohort Study ◽

Health Insurance ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Admissions ◽

The 2016 Kumamoto Earthquakes ◽

Access To Primary Care ◽

The Impact ◽

2016 Kumamoto Earthquakes

Background and objectivesThe Kumamoto earthquakes struck Kumamoto prefecture, in the southwest part of Japan in April 2016. Physical and mental disorders presenting to hospital increased after the 2016 Kumamoto earthquakes. Impaired access to primary care due to the earthquakes may have contributed to this increase. However, it is not known whether the 2016 Kumamoto earthquakes affected access to primary care. The objective of the present study was to investigate the impact of the 2016 Kumamoto earthquakes on short-term health conditions by analysing ambulatory care sensitive conditions (ACSCs), using administrative data from Kumamoto prefecture.DesignA retrospective cohort study.SettingResidents enrolled in National Health Insurance or Late Elders’ Health Insurance from Kumamoto prefecture, Japan.ParticipantsAll hospital admissions due to ACSCs between 15 March and 16 May in each year from 2013 to 2016.Outcome measuresACSCs are defined as conditions for which appropriate primary care interventions could prevent admission to the hospital.ResultsWe identified a total of 7921, 18 763 and 85 436 admissions for vaccine, acute and chronic preventable ACSCs, respectively, during the study period. Admissions within 7 days after the 2016 Kumamoto earthquakes increased to 32.6% (10.2, 59.5), 44.1% (27.0, 63.5) and 27.7% (20.2, 35.6) for vaccine-preventable, acute and chronic ACSCs, respectively. However, admissions for ACSCs did not change significantly 30 days after the earthquakes.ConclusionThe 2016 Kumamoto earthquakes were associated with increased hospital admissions for ACSCs. The impact of the earthquakes on admissions for ACSCs did not persist for more than 7 days.

Download Full-text