scholarly journals Changes in potential cancer indicator reporting in primary-care during the COVID-19 pandemic

2020 ◽  
Author(s):  
Lauren J Scott ◽  
Mairead Murphy ◽  
Sarah Price ◽  
Rhys Lewis ◽  
Rachel Denholm ◽  
...  
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Patient Characteristics ◽  
World Health Organisation ◽  
World Health ◽  
Face To Face ◽  
Rate Ratios ◽  
Potential Cancer ◽  
Remote Consultations

Abstract Background In March 2020, the World Health Organisation declared COVID-19 a pandemic.Aim To investigate how the pandemic affected presentation to primary-care with features potentially indicating cancer, and explore how reporting differed by patient characteristics and in face-to-face vs. remote consultations.Design and setting Retrospective cohort study in 21 practices in South-West England.Methods Potential cancer indicators were identified using pre-defined code lists for symptoms, signs, test results and diagnoses. Negative binomial regression models compared reporting of potential cancer indicators in April-July 2020 to April-July 2019. Incidence rate ratios (IRRs), 95% confidence intervals (CIs) and p-values are reported.Results During April-July 2019 and 2020, respectively, 152,447/344,184 (44%) and 123,775/350,966 (35%) patients consulted, with 44,662/344,184 (13%) and 29,150/350,966 (8%) reporting a potential cancer indicator (IRR=0.65, 95%CI 0.62-0.68, p<0.001). Reduced indicator reporting was stable across ethnicity, deprivation and shielding status, was greater in children (0-4 years IRR=0.50, 95%CI 0.46-0.55, p<0.001; 5-17 years IRR=0.45, 95%CI 0.41-0.49, p<0.001) and males (IRR=0.61, 95%CI 0.58-0.64), and less marked in patients with mental health conditions (IRR=0.75, 95%CI 0.72-0.79, p<0.001). Indicator reporting dropped for GP face-to-face consultations (IRR=0.88, 95%CI 0.80-0.97, p=0.011) and increased for remote consultations (IRR=1.22, 95%CI 1.11-1.34, p<0.001), but despite this, remained lower in remote consulting than face-to-face in April-July 2020.Conclusion Patient consulting in general, and for potential cancer indicators specifically, reduced during the first-wave of the COVID-19 pandemic. Remote consulting may be part of the reason for the reduction in reporting of potential cancer indicators, along with the reduced spreading of viral (non-cancer) infections.

scholarly journals Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e050131
Author(s):  
Lauren J Scott ◽  
Mairead Murphy ◽  
Sarah Price ◽  
Rhys Lewis ◽  
Rachel Denholm ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
Face To Face ◽  
Number Of Patients ◽  
Potential Cancer ◽  
Remote Consultations

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

scholarly journals Mobility and social deprivation on primary care utilisation among paediatric patients with asthma

2021 ◽  
Vol 9 (3) ◽  
pp. e001085
Author(s):  
Jennifer A Lucas ◽  
Miguel Marino ◽  
Sophia Giebultowicz ◽  
Katie Fankhauser ◽  
Shakira F Suglia ◽  
...  
Keyword(s):  
Primary Care ◽  
Influenza Vaccination ◽  
Negative Binomial ◽  
Social Deprivation ◽  
Pneumococcal Vaccination ◽  
Negative Binomial Regression ◽  
High Deprivation ◽  
Care Utilisation ◽  
Binomial Regression ◽  
Children With Asthma

ObjectiveAsthma care is negatively impacted by neighbourhood social and environmental factors, and moving is associated with undesirable asthma outcomes. However, little is known about how movement into and living in areas of high deprivation relate to primary care use. We examined associations between neighbourhood characteristics, mobility and primary care utilisation of children with asthma to explore the relevance of these social factors in a primary care setting.DesignIn this cohort study, we conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.SettingWe used data from community health centres in 15 OCHIN states.ParticipantsThe sample included 23 773 children with asthma aged 3–17 across neighbourhoods with different levels of social deprivation from 2012 to 2017. We conducted negative binomial regression to examine the rates of primary care visits and annual influenza vaccination and logistic regression to study receipt of pneumococcal vaccination. All models were adjusted for patient-level covariates.ResultsClinic visit rates were higher among children living in or moving to areas with higher deprivation than those living in areas with low deprivation (rate ratio (RR) 1.09, 95% CI 1.02 to 1.17; RR 1.05, 95% CI 1.00 to 1.11). Children moving across neighbourhoods with similarly high levels of deprivation had increased RRs of influenza vaccination (RR 1.13, 95% CI 1.03 to 1.23) than those who moved but stayed in neighbourhoods of low deprivation.ConclusionsMovement into and living within areas of high deprivation is associated with more primary care use, and presumably greater opportunity to reduce undesirable asthma outcomes. These results highlight the need to attend to patient movement in primary care visits, and increase neighbourhood-targeted population management to improve equity and care for children with asthma.

scholarly journals Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jen Murphy ◽  
William Whittaker ◽  
Mark Elliot ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Unmet Need ◽  
Negative Binomial Regression ◽  
City Region ◽  
Hub Location ◽  
Barriers To Access ◽  
Access To Primary Care ◽  
The Right ◽  
The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

086 The rapid efficacy of natalizumab vs fingolimod in patients with active relapsing-remitting multiple sclerosis (RRMS): results from reveal, a randomised, head-to-head study

2018 ◽  
Vol 89 (6) ◽  
pp. A35.1-A35
Author(s):  
Helmut Butzkueven ◽  
Douglas Jeffery ◽  
Douglas L Arnold ◽  
Massimo Filippi ◽  
Jeroen JG Geurts ◽  
...  
Keyword(s):  
Negative Binomial ◽  
Cox Regression ◽  
Negative Binomial Regression ◽  
Patient Characteristics ◽  
Estimating Equation ◽  
Study Patient ◽  
Cumulative Probability ◽  
Open Label ◽  
Randomised Study ◽  
Kaplan Meier

IntroductionREVEAL was designed as a 1 year, multicentre, randomised, rater- and sponsor-blinded, prospective study comparing natalizumab and fingolimod in patients with active RRMS. Although the study closed early (for non-safety/non-efficacy reasons), data permitted comparison of effects occurring shortly after treatment initiation. This analysis compares onset of efficacy with natalizumab and fingolimod in REVEAL.MethodsPatients were randomised to open-label intravenous natalizumab 300 mg every 4 weeks (n=54) or oral fingolimod 0.5 mg once daily (n=54). Magnetic resonance imaging was scheduled every 4 weeks for the first 24 weeks and at weeks 36 and 52. Analyses included Kaplan-Meier and Cox regression, negative binomial regression (annualised relapse rate [ARR] and number of T1 gadolinium-enhancing [Gd+] lesions) and a negative binomial generalised estimating equation (cumulative Gd +lesions over time).ResultsAs expected for a randomised study, patient characteristics and follow-up time (median 39 weeks) were generally similar between groups. Natalizumab patients were less likely than fingolimod patients to develop new Gd +lesions (for ≥1 lesion, cumulative probability 40.68% vs 57.99%; hazard ratio [HR]=1.678 [95% CI: 0.865 to 3.255]; p=0.1258; for ≥2 lesions, cumulative probability 11.54% vs 48.48%; HR=4.053 [95% CI: 1.474 to 11.144]; p=0.007). Natalizumab patients consistently had 63%–72% fewer Gd +lesions than fingolimod patients, with between-group differences apparent within 4 weeks and reaching significance by 12 weeks (p=0.030). ARR was 83% lower with natalizumab than with fingolimod (0.05 vs 0.29; p=0.023), and cumulative probability of relapse was 1.85% with natalizumab vs 22.28% with fingolimod (HR=12.184 [95% CI: 1.552 to 95.634]; p=0.017). Adverse events were consistent with known safety profiles.ConclusionThese results suggest that natalizumab reduces disease activity more rapidly and to a greater extent than fingolimod in patients with active RRMS. Given the early study closure, available data did not permit primary endpoint evaluation, and interpretation of these results requires caution.Study SupportBiogen.

scholarly journals Unmet Social Needs and No-Show Visits in Primary Care in a US Northeastern Urban Health System, 2018–2019

2020 ◽  
Vol 110 (S2) ◽  
pp. S242-S250 ◽  
Author(s):  
Kevin P. Fiori ◽  
Caroline G. Heller ◽  
Colin D. Rehm ◽  
Amanda Parsons ◽  
Anna Flattau ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Health System ◽  
Urban Health ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Social Needs ◽  
Positive Trend ◽  
Missed Appointments ◽  
Primary Care Practices

Objectives. To characterize the association between social needs prevalence and no-show proportion and variation in these associations among specific social needs. Methods. In this study, we used results from a 10-item social needs screener conducted across 19 primary care practices in a large urban health system in Bronx County, New York, between April 2018 and July 2019. We estimated the association between unmet needs and 2-year history of missed appointments from 41 637 patients by using negative binomial regression models. Results. The overall no-show appointment proportion was 26.6%. Adjusted models suggest that patients with 1 or more social needs had a significantly higher no-show proportion (31.5%) than those without any social needs (26.3%), representing an 19.8% increase (P < .001). We observed a positive trend (P < .001) between the number of reported social needs and the no-show proportion—26.3% for those with no needs, 30.0% for 1 need, 32.1% for 2 needs, and 33.8% for 3 or more needs. The strongest association was for those with health care transportation need as compared with those without (36.0% vs 26.9%). Conclusions. We found unmet social needs to have a significant association with missed primary care appointments with potential implications on cost, quality, and access for health systems.

scholarly journals Determinants and extent of weight recording in UK primary care: an analysis of 5 million adults’ electronic health records from 2000 to 2017

BMC Medicine ◽  
2019 ◽  
Vol 17 (1) ◽  
Author(s):  
B. D. Nicholson ◽  
P. Aveyard ◽  
C. R. Bankhead ◽  
W. Hamilton ◽  
F. D. R. Hobbs ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Negative Binomial ◽  
Cox Regression ◽  
Clinical Care ◽  
Negative Binomial Regression ◽  
Routine Activity ◽  
Health Records ◽  
Clinical Events ◽  
Electronic Health

Abstract Background Excess weight and unexpected weight loss are associated with multiple disease states and increased morbidity and mortality, but weight measurement is not routine in many primary care settings. The aim of this study was to characterise who has had their weight recorded in UK primary care, how frequently, by whom and in relation to which clinical events, symptoms and diagnoses. Methods A longitudinal analysis of UK primary care electronic health records (EHR) data from 2000 to 2017. Descriptive statistics were used to summarise weight recording in terms of patient sociodemographic characteristics, health professional encounters, clinical events, symptoms and diagnoses. Negative binomial regression was used to model the likelihood of having a weight record each year, and Cox regression to the likelihood of repeated weight recording. Results A total of 14,049,871 weight records were identified in the EHR of 4,918,746 patients during the study period, representing 26,998,591 person-years of observation. Around a third of patients had a weight record each year. Forty-nine percent of weight records were repeated within a year with an average time to a repeat weight record of 1.92 years. Weight records were most often taken by nursing staff (38–42%) and GPs (37–39%) as part of a routine clinical care, such as chronic disease reviews (16%), medication reviews (6–8%) and health checks (6–7%), or were associated with consultations for contraception (5–8%), respiratory disease (5%) and obesity (1%). Patient characteristics independently associated with an increased likelihood of weight recording were as follows: female sex, younger and older adults, non-drinkers, ex-smokers, low or high BMI, being more deprived, diagnosed with a greater number of comorbidities and consulting more frequently. The effect of policy-level incentives to record weight did not appear to be sustained after they were removed. Conclusion Weight recording is not a routine activity in UK primary care. It is recorded for around a third of patients each year and is repeated on average every 2 years for these patients. It is more common in females with higher BMI and in those with comorbidity. Incentive payments and their removal appear to be associated with increases and decreases in weight recording.

scholarly journals Student-inflicted injuries to staff in schools: comparing risk between educators and non-educators

2017 ◽  
Vol 25 (2) ◽  
pp. 116-122 ◽  
Author(s):  
Katherine E Schofield ◽  
Andrew D Ryan ◽  
Craig Stroinski
Keyword(s):  
Risk Factors ◽  
General Education ◽  
Injury Risk ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Acting Out ◽  
Increased Risk ◽  
Educational Assistants ◽  
Reduction Methods ◽  
Rate Ratios

ObjectiveStudent-inflicted injury to staff in the educational services sector is a growing concern. Studies on violence have focused on teachers as victims, but less is known about injuries to other employee groups, particularly educational assistants. Inequities may be present, as educational assistants and non-educators may not have the same wage, benefits, training and employment protections available to them as professional educators. We identified risk factors for student-related injury and their characteristics among employees in school districts.MethodsWorkers’ compensation data were used to identify incidence and severity of student-related injury. Rates were calculated using negative binomial regression; risk factors were identified using multivariate models to calculate rate ratios (RR) and 95% CIs.ResultsOver 26% of all injuries were student-related; 8% resulted in lost work time. Special and general education assistants experienced significantly increased risk of injury (RR=6.0, CI 5.05 to 7.15; RR=2.07, CI 1.40 to 3.07) as compared with educators. Risk differed by age, gender and school district type. Text analyses categorised student-related injury. It revealed injury from students acting out occurred most frequently (45.4%), whereas injuries involving play with students resulted in the highest percentage of lost-time injuries (17.7%) compared with all interaction categories.ConclusionStudent-inflicted injury to staff occurs frequently and can be severe. Special education and general assistants bear the largest burden of injury compared with educators. A variety of prevention techniques to reduce injury risk and severity, including policy or environmental modifications, may be appropriate. Equal access to risk reduction methods for all staff should be prioritised.

scholarly journals Suicide by pesticide poisoning in India: a review of pesticide regulations and their impact on suicide trends

2019 ◽  
Author(s):  
Toby Bonvoisin ◽  
Leah Utyasheva ◽  
Duleeka Knipe ◽  
David Gunnell ◽  
Michael Eddleston
Keyword(s):  
Negative Binomial ◽  
Public Health Problem ◽  
State Level ◽  
Negative Binomial Regression ◽  
World Health ◽  
State Governments ◽  
Suicide Rates ◽  
Level Data ◽  
Agricultural Yield ◽  
Health Organization

Abstract Background Pesticide self-poisoning is a common means of suicide in India. Banning highly hazardous pesticides (HHPs) from agricultural use has been successful in reducing suicides in several Asian countries without affecting agricultural output. Here, we describe national and state-level regulation of HHPs and explore how they might relate to suicide rates across India.Methods Information on pesticide regulation was collated from agriculture departments of the central and state governments. National and state-level data on suicides from 1995 to 2015 were obtained from the National Crime Records Bureau (NCRB). We used joinpoint analysis and negative binomial regression to investigate any effects on trends in suicide rates nationally and in Kerala.Results As of October 2019, 318 pesticides were registered for use in India, of which 18 were extremely (Class Ia) or highly (Class Ib) hazardous according to World Health Organization criteria. Despite many HHPs still being available, several bans have been implemented during the period studied. In our quantitative analyses we focused on the permanent bans in Kerala in 2005 (of endosulfan) and 2011 (of 14 other pesticides); and nationally in 2011 (of endosulfan). NCRB data indicate that pesticides were used in 441,918 reported suicides in India from 1995-2015, 90.3% of which occurred in 11 of the 29 states. There was statistical evidence of lower than expected rates of pesticide suicides (rate ratio [RR] 0.52, 95% CI 0.49-0.54) and total suicides nationally by 2014 (0.90, 0.87-0.93) after the 2011 endosulfan ban. In Kerala, there was a lower than expected pesticide suicide rate (0.45, 0.42-0.49), but no change to the already decreasing trend in total suicides after the 2011 ban of 14 pesticides. The 2005 ban on endosulfan showed a similar effect. Agricultural outputs continued growing following the bans.Discussion Highly hazardous pesticides continue to be used in India and pesticide suicide remains a serious public health problem. However, some pesticide bans do appear to have impacted previous trends in the rates of both pesticide suicides and all suicides. Comprehensive national bans of HHPs could lead to a reduction in suicides across India, in addition to reduced occupational poisoning, with minimal effects on agricultural yield.

scholarly journals Assessing Differential Impacts of COVID-19 on Black Communities

2020 ◽  
Author(s):  
Gregorio A. Millett ◽  
Austin T. Jones ◽  
David Benkeser ◽  
Stefan Baral ◽  
Laina Mercer ◽  
...  
Keyword(s):  
Black People ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Black Communities ◽  
Negative Binomial Regression Model ◽  
County Level ◽  
Structural Racism ◽  
Black Residents ◽  
Us Counties ◽  
Rate Ratios

AbstractPurposeGiven incomplete data reporting by race, we used data on COVID-19 cases and deaths in US counties to describe racial disparities in COVID-19 disease and death and associated determinants.MethodsUsing publicly available data (accessed April 13, 2020), predictors of COVID-19 cases and deaths were compared between disproportionately (≥13%) black and all other (<13% black) counties. Rate ratios were calculated and population attributable fractions (PAF) were estimated using COVID-19 cases and deaths via zero-inflated negative binomial regression model. National maps with county-level data and an interactive scatterplot of COVID-19 cases were generated.ResultsNearly ninety-seven percent of disproportionately black counties (656/677) reported a case and 49% (330/677) reported a death versus 81% (1987/2,465) and 28% (684/ 2465), respectively, for all other counties. Counties with higher proportions of black people have higher prevalence of comorbidities and greater air pollution. Counties with higher proportions of black residents had more COVID-19 diagnoses (RR 1.24, 95% CI 1.17-1.33) and deaths (RR 1.18, 95% CI 1.00-1.40), after adjusting for county-level characteristics such as age, poverty, comorbidities, and epidemic duration. COVID-19 deaths were higher in disproportionally black rural and small metro counties. The PAF of COVID-19 diagnosis due to lack of health insurance was 3.3% for counties with <13% black residents and 4.2% for counties with ≥13% black residents.ConclusionsNearly twenty-two percent of US counties are disproportionately black and they accounted for 52% of COVID-19 diagnoses and 58% of COVID-19 deaths nationally. County-level comparisons can both inform COVID-19 responses and identify epidemic hot spots. Social conditions, structural racism, and other factors elevate risk for COVID-19 diagnoses and deaths in black communities.

scholarly journals Individual- and City-Level Socioeconomic Factors and Tooth Loss among Elderly People: A Cross-Level Multilevel Analysis

2020 ◽  
Vol 17 (7) ◽  
pp. 2345 ◽  
Author(s):  
Mario Vianna Vettore ◽  
Janete M. Rebelo Vieira ◽  
José F. F. Gomes ◽  
Nara M. O. Martins ◽  
Yan N. L. Freitas ◽  
...  
Keyword(s):  
Elderly People ◽  
Tooth Loss ◽  
Family Income ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Federal District ◽  
Level Data ◽  
Education Gaps ◽  
Individual Variables ◽  
Rate Ratios

This study aimed to test the association of contextual and individual socioeconomic status with tooth loss among Brazilian elderly people aged 65–74 years. Data from 5435 elderly participants from the Brazilian National Oral Health Survey (2010) were linked to city-level data for 27 state capitals and the Federal District. Tooth loss was clinically assessed according to the number of missing natural teeth. Contextual social variables included Human Development Index income (HDI-income) and HDI-education. Individual socioeconomic measures were monthly family income and years of schooling. Covariates included sex, skin colour, number of residents per room and number of goods. Multilevel Negative Binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals between contextual and individual variables and tooth loss. Contextual and individual income and education measures were consistently associated with tooth loss. Elderly people living in cities with low HDI-income and low HDI-education were respectively 21% and 33% more likely to present tooth loss. Cross-level interaction suggested that the relationship of lower income and lower schooling with tooth loss is different across levels of city-level income and city-level education inequality, respectively. Public policies aiming to reduce the income and education gaps and preventive dental interventions are imperative to tackle tooth loss among elderly people.

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