scholarly journals COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology

10.2196/21434 ◽  
2020 ◽  
Vol 6 (4) ◽  
pp. e21434 ◽  
Author(s):  
Simon de Lusignan ◽  
Harshana Liyanage ◽  
Dylan McGagh ◽  
Bhautesh Dinesh Jani ◽  
Jorgen Bauwens ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
National Level ◽  
Mitigation Measures ◽  
Identification Algorithm ◽  
Use Case ◽  
Sentinel Network ◽  
Case Identification ◽  
Ontological Approach ◽  
Application Ontology

Background Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. Objective This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. Methods We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. Results Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). Conclusions The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.

scholarly journals COVID-19 Surveillance in a Primary Care Sentinel Network: In-Pandemic Development of an Application Ontology (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
Harshana Liyanage ◽  
Dylan McGagh ◽  
Bhautesh Dinesh Jani ◽  
Jorgen Bauwens ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
National Level ◽  
Mitigation Measures ◽  
Identification Algorithm ◽  
Use Case ◽  
Sentinel Network ◽  
Case Identification ◽  
Ontological Approach ◽  
Application Ontology

BACKGROUND Creating an ontology for COVID-19 surveillance should help ensure transparency and consistency. Ontologies formalize conceptualizations at either the domain or application level. Application ontologies cross domains and are specified through testable use cases. Our use case was an extension of the role of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) to monitor the current pandemic and become an in-pandemic research platform. OBJECTIVE This study aimed to develop an application ontology for COVID-19 that can be deployed across the various use-case domains of the RCGP RSC research and surveillance activities. METHODS We described our domain-specific use case. The actor was the RCGP RSC sentinel network, the system was the course of the COVID-19 pandemic, and the outcomes were the spread and effect of mitigation measures. We used our established 3-step method to develop the ontology, separating ontological concept development from code mapping and data extract validation. We developed a coding system–independent COVID-19 case identification algorithm. As there were no gold-standard pandemic surveillance ontologies, we conducted a rapid Delphi consensus exercise through the International Medical Informatics Association Primary Health Care Informatics working group and extended networks. RESULTS Our use-case domains included primary care, public health, virology, clinical research, and clinical informatics. Our ontology supported (1) case identification, microbiological sampling, and health outcomes at an individual practice and at the national level; (2) feedback through a dashboard; (3) a national observatory; (4) regular updates for Public Health England; and (5) transformation of a sentinel network into a trial platform. We have identified a total of 19,115 people with a definite COVID-19 status, 5226 probable cases, and 74,293 people with possible COVID-19, within the RCGP RSC network (N=5,370,225). CONCLUSIONS The underpinning structure of our ontological approach has coped with multiple clinical coding challenges. At a time when there is uncertainty about international comparisons, clarity about the basis on which case definitions and outcomes are made from routine data is essential.

scholarly journals Ontology to identify pregnant women in electronic health records: primary care sentinel network database study

2019 ◽  
Vol 26 (1) ◽  
pp. e100013 ◽  
Author(s):  
Harshana Liyanage ◽  
John Williams ◽  
Rachel Byford ◽  
Simon de Lusignan
Keyword(s):  
Primary Care ◽  
Pregnant Women ◽  
Primary Care Providers ◽  
Identification Algorithm ◽  
Care Providers ◽  
Sentinel Network ◽  
Network Database ◽  
Coding Systems ◽  
Ontological Approach ◽  
Significant Difference

ObjectiveTo develop an ontology to identify pregnant women from computerised medical record systems with dissimilar coding systems in a primary care sentinel network.Materials and methodsWe used a three-step approach to develop our pregnancy ontology in two different coding schemata, one hierarchical and the other polyhierarchical. We developed a coding system–independent pregnancy case identification algorithm using the Royal College of General Practitioners Research and Surveillance Centre sentinel network database which held 1.8 million patients’ data drawn from 150 primary care providers. We tested the algorithm by examining individual patient records in a 10% random sample of all women aged 29 in each year from 2004 to 2016. We did an external comparison with national pregnancy data. We used χ2 test to compare results obtained for the two different coding schemata.Results243 005 women (median age 29 years at start of pregnancy) had 405 591 pregnancies from 2004 to 2016 of which 333 689 went to term. We found no significant difference between results obtained for two populations using different coding schemata. Pregnancy mean ages did not differ significantly from national data.DiscussionThis ontologically driven algorithm enables consistent analysis across data drawn from populations using different coding schemata. It could be applied to other hierarchical coding systems (eg, International Classification of Disease) or polyhierarchical systems (eg, SNOMED CT to which our health system is currently migrating).ConclusionThis ontological approach will improve our surveillance in particular of influenza vaccine exposure in pregnancy.

Primary Care and Public Health: A Vision for the Future

PsycCRITIQUES ◽  
2013 ◽  
Vol 58 (11) ◽  
Author(s):  
Patrick H. DeLeon ◽  
Michaela Shafer
Keyword(s):  
Public Health ◽  
Primary Care ◽  
The Future

Promoting respiratory infection control practices in primary care: Primary care/public health collaboration

2005 ◽  
Author(s):  
William Hogg ◽  
Patricia Houston ◽  
Carmel Martin ◽  
Raphael Saginur ◽  
Adriana Newbury ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Infection Control ◽  
Respiratory Infection

Public Health and Primary Care Collaboration: Interactional Factors Influencing Capacity Building

2011 ◽  
Author(s):  
Linda O'Mara ◽  
Ruta Valaitis ◽  
Nancy Murray ◽  
Donna Meagher-Stewart ◽  
Sabrina Wong ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Capacity Building ◽  
Factors Influencing

Public Health and Primary Care Collaboration: An Evolving Conceptual Framework

2011 ◽  
Author(s):  
Ruta Valaitis ◽  
Marjorie MacDonald ◽  
Sabrina Wong ◽  
Linda O'Mara ◽  
Donna Meagher-Stewart ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Conceptual Framework

17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners

2007 ◽  
Vol 30 (4) ◽  
pp. 36
Author(s):  
M. L. Russell ◽  
L. McIntyre
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Community Health ◽  
Royal College ◽  
Community Medicine ◽  
Work Setting ◽  
Public Health Medicine ◽  
Work Settings ◽  
Main Work

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP). We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded. CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes). There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada. Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6. Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8. Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.

scholarly journals The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity

Obesity Facts ◽  
2021 ◽  
pp. 1-6
Author(s):  
Michele O. Carruba ◽  
Luca Busetto ◽  
Sheree Bryant ◽  
Antonio Caretto ◽  
Nathalie J. Farpour-Lambert ◽  
...  
Keyword(s):  
Public Health ◽  
Social Stigma ◽  
National Level ◽  
Well Being ◽  
Communicable Diseases ◽  
Urban Environments ◽  
Shared Responsibility ◽  
Access To Treatment ◽  
Non Communicable Diseases ◽  
Health Goals

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors – within health systems and at a national level – along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity – not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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