scholarly journals Impact of COVID-19 on psychiatric services and presentations in north-west Edinburgh

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S74-S75
Author(s):  
Ritika Devadas ◽  
Douglas Murdie ◽  
Idris Thomas ◽  
Rhona Hannah ◽  
Wiktoria Karbowniczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Hospital Admissions ◽  
Early Recognition ◽  
Psychiatric Services ◽  
Severe Illness ◽  
Healthcare Provision ◽  
North West ◽  
The North ◽  
The Impact

AimsCOVID-19 has had a significant impact on healthcare provision, accessibility and psychiatric presentations. We aim to investigate the impact of the pandemic on psychiatric services and the severity of presentations in Edinburgh, with a particular focus on the North-West Edinburgh Community Mental Health Team (NW CMHT).MethodMeasures of the impact of the pandemic on NW CMHT were identified as referral numbers from primary care and Did Not Attend (DNA) rates. Royal Edinburgh Hospital admissions, detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 (MHA) and Out of Hours (OOH) contacts were used as proxy measures to explore the severity and urgency of presentations.Quantitative data focussing on these parameters for patients aged 18–65 years in NW CMHT in 2019 and 2020 were collected from NHS Lothian Analytical Services. OOH data were only available Edinburgh-wide. All data were anonymised in line with NHS Lothian Information Governance Policy.In order to assess the impact on staff, a questionnaire was created and disseminated, with qualitative data returned anonymously.ResultReferrals to NW CMHT decreased by 9.3% in 2020 (n = 2164) compared to 2019 (n = 2366). Referrals in April (n = 81) and May (n = 102) 2020 were far below the monthly average across the two years (n = 188).Appointment numbers were very similar in 2019 (n = 3542) and 2020 (n = 3514). Despite this, DNA and cancellation rates decreased by 3.94% in 2020. Questionnaire results illustrated some of the challenges for staff of working during a pandemic.Admissions to hospital reduced by 6.8% in 2020 (n = 219 vs n = 235). While MHA detentions in NW Edinburgh increased by only 1.8% (n = 173 vs n = 170), new Compulsory Treatment Orders (CTO) increased by 60%. Furthermore, OOH contacts across Edinburgh increased by 45.2% when compared to 2019.ConclusionThe COVID-19 pandemic altered the way patients accessed healthcare. Uncertainty of the public in accessing primary care services early in the pandemic may have contributed to reduced referral numbers.The increase in CTOs is suggestive of severe relapses in previously stable patients or new episodes of illness. The pandemic may have contributed to a reduction in early recognition, and referral, of those with major mental disorders resulting in more protracted or severe illness episodes. The increase in OOH crisis contacts supports such a hypothesis.Despite what would be expected, DNA and cancellation rates in NW CMHT reduced. The contribution of telemedicine to this warrants further exploration as a means of delivering healthcare in an efficient and accessible way.

scholarly journals Evaluating the Effectiveness of a Local Primary Care Incentive Scheme: A Difference-in-Differences Study

2021 ◽  
pp. 107755872110352
Author(s):  
Esmaeil Khedmati Morasae ◽  
Tanith C. Rose ◽  
Mark Gabbay ◽  
Laura Buckels ◽  
Colette Morris ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admissions ◽  
Financial Incentive ◽  
Emergency Admission ◽  
Difference In Differences ◽  
Emergency Admissions ◽  
North West ◽  
Admission Rates ◽  
The North ◽  
Improvement Scheme

National financial incentive schemes for improving the quality of primary care have come under criticism in the United Kingdom, leading to calls for localized alternatives. This study investigated whether a local general practice incentive-based quality improvement scheme launched in 2011 in a city in the North West of England was associated with a reduction in all-cause emergency hospital admissions. Difference-in-differences analysis was used to compare the change in emergency admission rates in the intervention city, to the change in a matched comparison population. Emergency admissions rates fell by 19 per 1,000 people in the years following the intervention (95% confidence interval [17, 21]) in the intervention city, relative to the comparison population. This effect was greater among more disadvantaged populations, narrowing socioeconomic inequalities in emergency admissions. The findings suggest that similar approaches could be an effective component of strategies to reduce unplanned hospital admissions elsewhere.

scholarly journals ‘Do I, don’t I?’ A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic

2021 ◽  
pp. archdischild-2020-321260
Author(s):  
Gabriella Watson ◽  
Lucy Pickard ◽  
Bhanu Williams ◽  
Dougal Hargreaves ◽  
Mitch Blair
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Recovery Period ◽  
Severe Illness ◽  
Care Seeking ◽  
Community Perception ◽  
Healthcare Provision ◽  
North West ◽  
Care Experience

BackgroundPaediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care.MethodsSemistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach.ResultsFrom interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them.ConclusionA pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.

Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England

2018 ◽  
Vol 94 (1114) ◽  
pp. 463-468 ◽  
Author(s):  
Emmanuel Fru Nsutebu ◽  
Ana Belén Ibarz-Pavón ◽  
Elizabeth Kanwar ◽  
Nancy Prospero ◽  
Neil French ◽  
...  
Keyword(s):  
Fluid Balance ◽  
Large Scale ◽  
Early Recognition ◽  
Serum Lactate ◽  
Care Bundle ◽  
Sepsis Management ◽  
North West ◽  
The North ◽  
Senior Clinician ◽  
The Impact

ObjectiveTo evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England.Setting14 hospitals in the northwest of England.InterventionA quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review.Main outcome measuresInpatient mortality, 30-day readmission rates and duration of hospital ≥10 days.ResultsData for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69–0.95)) and hospital stays over 10 days (OR 0.69 (0.60–0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59–0.81), OR 0.77 (0.67–0.89) and OR 0.64 (0.54–0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49–0.69), OR0.81 (0.70–0.94) and OR 0.54 (0.45–0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days.ConclusionsThe AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.

scholarly journals The impact of brief quality improvement (QI) projects by medical students in primary care in Gauteng or the North West Province, South Africa

2012 ◽  
Vol 4 (1) ◽  
Author(s):  
Claire Van Deventer ◽  
Nontsikelelo Sondzaba
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Medical Students ◽  
Clinical Skills ◽  
Theory And Practice ◽  
North West ◽  
The North ◽  
North West Province ◽  
The University ◽  
The Impact

Background: The Integrated Primary Care (IPC) rotation is undertaken over six weeks by final year medical students at the University of Witwatersrand. Students are placed in either rural or urban primary health care centres based in Gauteng or the North West Province. As part of the IPC rotation, students undertake short quality improvement (QI) projects. The purpose of this study is to evaluate the impact of the QI projects undertaken over the period stretching from 2006 to 2010. Methods: An observational study of QI reports done by students. Project reports assessed and compared to site marks, indicators of learning assessed and individual and group marks compared.Results: Of 274 projects undertaken, 223 (81.4%) were available for evaluation. Geographical placements and QI themes were categorised. Management issues were most frequently identified as being problematic followed by chronic illnesses. Understanding and applying the principles of QI was partially achieved and gaps were identified for future projects. The most common intervention was training of personnel and design and distribution of posters or pamphlets.Conclusions: Most QI projects were well thought out and relevant to the chosen setting. In the majority of cases, a great deal of effort and creativity went into the process and skills other than clinical skills were employed such as writing, presentation of data in graphs and tables. Integration of theory and practice was achieved only partially.

scholarly journals Retrospective analysis of North West London healthcare utilisation by children during the COVID-19 pandemic

2022 ◽  
Vol 6 (1) ◽  
pp. e001363
Author(s):  
Rohan Mongru ◽  
Danielle F Rose ◽  
Ceire Costelloe ◽  
Aubrey Cunnington ◽  
Ruud G Nijman
Keyword(s):  
Primary Care ◽  
Retrospective Analysis ◽  
Hospital Admissions ◽  
Healthcare Utilisation ◽  
Care Practice ◽  
North West ◽  
Classification Of Diseases ◽  
International Statistical Classification ◽  
The Impact

ObjectiveTo explore the impact of the measures taken to combat COVID-19 on the patterns of acute illness in children presenting to primary and secondary care for North West London.Design/setting/participantsRetrospective analysis of 8 309 358 primary and secondary healthcare episodes of children <16 years registered with a North West London primary care practice between 2015 and 2021.Main outcome measuresNumbers of primary care consultations, emergency department (ED) attendances and emergency admissions during the pandemic were compared with those in the preceding 5 years. Trends were examined by age and for International Statistical Classification of Diseases and Related Health Problems 10th Revision-coded diagnoses of: infectious diseases, and injuries and poisonings for admitted children.ResultsComparing 2020 to the 2015–2019 mean, primary care consultations were 22% lower, ED attendances were 38% lower and admissions 35% lower. Following the first national lockdown in April 2020, primary care consultations were 39% lower compared with the April 2015–2019 mean, ED attendances were 72% lower and unscheduled hospital admissions were 63% lower. Admissions >48 hours were on average 13% lower overall during 2020, and 36% lower during April 2020. The reduction in admissions for infections (61% lower than 2015–2019 mean) between April and August 2020 was greater than for injuries (31% lower).ConclusionThe COVID-19 pandemic was associated with an overall reduction in childhood illness presentations to health services in North West London, most prominent during periods of national lockdown, and with a greater impact on infections than injuries. These reductions demonstrate the impact on children of measures taken to combat COVID-19 across the health system.

An initiative in primary care psychiatry in South Australia

2002 ◽  
Vol 10 (3) ◽  
pp. 259-264
Author(s):  
Tom Paterson ◽  
Christopher Seiboth ◽  
Barbara Magin ◽  
Rajan Nagesh ◽  
Cyndy Lloyd ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
General Practitioner ◽  
Care Setting ◽  
Primary Care Setting ◽  
South Australia ◽  
North West ◽  
The North ◽  
Health Project ◽  
Ongoing Development

Objective: To describe a joint mental health project involving the Adelaide Northern Division of General Practice (ANDGP) and the North West Adelaide Mental Health Service (NWAMHS). Conclusions: This project has been developed to explore alternative strategies to facilitate the identification and management of patients with mental illness in the primary care setting. The project has also endeavoured to explore alternative types of psychiatrist/general practitioner interactions other than the conventional ‘general practitioner referred psychiatrist consultation’. The development of adequate and clinically relevant evaluation methods, both quantitative and qualitative, has also been an explicit objective of the project. While the project provides an exciting stimulus for ongoing development of models of Primary Psychiatric Care, it is evident that such models can only evolve in the context of significant service and systemic change. It is hoped that the experiences in the northern suburbs of Adelaide can stimulate others to explore the ongoing collaborations between psychiatric services and general practitioners in ways that can produce better mental health outcomes in our patients.

scholarly journals Primary care teams’ experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachelle Ashcroft ◽  
Catherine Donnelly ◽  
Maya Dancey ◽  
Sandeep Gill ◽  
Simon Lam ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Focus Groups ◽  
Care Delivery ◽  
Virtual Care ◽  
Primary Care Teams ◽  
The Impact

Abstract Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond.

scholarly journals Effect of tropical cyclones on the Stratosphere-Troposphere Exchange observed using satellite observations over north Indian Ocean

2016 ◽  
Author(s):  
M. Venkat Ratnam ◽  
S. Ravindra Babu ◽  
S. S. Das ◽  
Ghouse Basha ◽  
B. V. Krishnamurthy ◽  
...  
Keyword(s):  
Water Vapor ◽  
Indian Ocean ◽  
Tropical Cyclones ◽  
Lower Stratosphere ◽  
North Indian Ocean ◽  
Satellite Observations ◽  
Upper Troposphere ◽  
North West ◽  
The North ◽  
The Impact

Abstract. Tropical cyclones play an important role in modifying the tropopause structure and dynamics as well as stratosphere-troposphere exchange (STE) process in the Upper Troposphere and Lower Stratosphere (UTLS) region. In the present study, the impact of cyclones that occurred over the North Indian Ocean during 2007–2013 on the STE process is quantified using satellite observations. Tropopause characteristics during cyclones are obtained from the Global Positioning System (GPS) Radio Occultation (RO) measurements and ozone and water vapor concentrations in UTLS region are obtained from Aura-Microwave Limb Sounder (MLS) satellite observations. The effect of cyclones on the tropopause parameters is observed to be more prominent within 500 km from the centre of cyclone. In our earlier study we have observed decrease (increase) in the tropopause altitude (temperature) up to 0.6 km (3 K) and the convective outflow level increased up to 2 km. This change leads to a total increase in the tropical tropopause layer (TTL) thickness of 3 km within the 500 km from the centre of cyclone. Interestingly, an enhancement in the ozone mixing ratio in the upper troposphere is clearly noticed within 500 km from cyclone centre whereas the enhancement in the water vapor in the lower stratosphere is more significant on south-east side extending from 500–1000 km away from the cyclone centre. We estimated the cross-tropopause mass flux for different intensities of cyclones and found that the mean flux from stratosphere to troposphere for cyclonic stroms is 0.05 ± 0.29 × 10−3 kg m−2 and for very severe cyclonic stroms it is 0.5 ± 1.07 × 10−3 kg m−2. More downward flux is noticed in the north-west and south-west side of the cyclone centre. These results indicate that the cyclones have significant impact in effecting the tropopause structure, ozone and water vapour budget and consequentially the STE in the UTLS region.

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