Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review (Preprint)

BACKGROUND There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. OBJECTIVE This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. METHODS Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). RESULTS In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. CONCLUSIONS There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

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Impact of Remote Consultations on Antibiotic Prescribing in Primary Health Care: Systematic Review

Journal of Medical Internet Research ◽

10.2196/23482 ◽

2020 ◽

Vol 22 (11) ◽

pp. e23482 ◽

Cited By ~ 1

Author(s):

Seung Min Han ◽

Geva Greenfield ◽

Azeem Majeed ◽

Benedict Hayhoe

Keyword(s):

Systematic Review ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Antibiotic Prescribing ◽

Remote Consultation ◽

Face To Face ◽

Primary Health ◽

The Impact ◽

Remote Consultations

Background There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed. Objective This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing. Methods Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations). Results In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations. Conclusions There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropriate implementation of remote consulting to ensure that there is no unintended impact on antimicrobial resistance.

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Promoting cross-jurisdictional primary health care research: developing a set of common indicators across 12 community-based primary health care teams in Canada

Primary Health Care Research & Development ◽

10.1017/s1463423618000518 ◽

2018 ◽

Vol 20 ◽

Cited By ~ 5

Author(s):

Sabrina T. Wong ◽

Julia M. Langton ◽

Alan Katz ◽

Martin Fortin ◽

Marshall Godwin ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Working Group ◽

Scale Up ◽

Data Sources ◽

Knowledge Generation ◽

Community Based ◽

Primary Health ◽

The Impact

AbstractAimTo describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.BackgroundA pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.MethodsA working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.FindingsNineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

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The impact of COVID-19 on primary health care and antibiotic prescribing in rural China: qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07082-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tingting Zhang ◽

Xingrong Shen ◽

Rong Liu ◽

Linhai Zhao ◽

Debin Wang ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Primary Health Care ◽

Rural Areas ◽

Rural China ◽

Antibiotic Prescribing ◽

Epidemic Control ◽

Primary Health ◽

Tract Infections ◽

The Impact

Abstract Background In China, the primary health care (PHC) system has been designated responsible for control and prevention of COVID-19, but not treatment. Suspected COVID-19 cases presenting to PHC facilities must be transferred to specialist fever clinics. This study aims to understand the impact of COVID-19 on PHC delivery and on antibiotic prescribing at a community level in rural areas of central China. Methods Qualitative semi-structured interviews were conducted with 18 PHC practitioners and seven patients recruited from two township health centres and nine village clinics in two rural residential areas of Anhui province. Interviews were transcribed verbatim and analysed thematically. Results PHC practitioners reported a major shift in their work away from seeing and treating patients (due to government-mandated referral to specialist Covid clinics) to focus on the key public health roles of tracing, screening and educating in rural areas. The additional work, risk, and financial pressure that PHC practitioners faced, placed considerable strain on them, particularly those working in village clinics. Face to face PHC provision was reduced and there was no substitution with consultations by phone or app, which practitioners attributed to the fact that most of their patients were elderly and not willing or able to switch. Practitioners saw COVID-19 as outside of their area of expertise and very different to the non-COVID-19 respiratory tract infections that they frequently treated pre-pandemic. They reported that antibiotic prescribing was reduced overall because far fewer patients were attending rural PHC facilities, but otherwise their antibiotic prescribing practices remained unchanged. Conclusions The COVID-19 pandemic had considerable impact on PHC in rural China. Practitioners took on substantial additional workload as part of epidemic control and fewer patients were seen in PHC. The reduction in patients seen and treated in PHC led to a reduction in antibiotic prescribing, although clinical practice remains unchanged. Since COVID-19 epidemic control work has been designated as a long-term task in China, rural PHC clinics now face the challenge of how to balance their principal clinical and increased public health roles and, in the case of the village clinics, remain financially viable.

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Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria

Mental Illness ◽

10.4081/mi.2010.e10 ◽

2010 ◽

Vol 2 (1) ◽

pp. 46-50 ◽

Cited By ~ 9

Author(s):

Olawale O. Ogunsemi ◽

Francis A. Oluwole ◽

Festus Abasiubong ◽

Adebayo R. Erinfolami ◽

Olufemi E. Amoran ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Mental Disorders ◽

Patient Health Questionnaire ◽

Health Questionnaire ◽

Primary Care Settings ◽

Primary Health ◽

Patient Health ◽

The Impact

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

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Gender Makes a Difference in the Description of Dyspnoea in Patients with Chronic Heart Failure

European Journal of Cardiovascular Nursing ◽

10.1016/j.ejcnurse.2004.10.004 ◽

2005 ◽

Vol 4 (2) ◽

pp. 117-121 ◽

Cited By ~ 17

Author(s):

Inger Ekman ◽

Kurt Boman ◽

Mona Olofsson ◽

Nibia Aires ◽

Karl Swedberg

Keyword(s):

Heart Failure ◽

Primary Care ◽

Health Care ◽

Heart Disease ◽

Primary Health Care ◽

Chronic Heart Failure ◽

Community Setting ◽

Common Symptom ◽

Primary Health ◽

The Impact

Background: Dyspnoea is a common symptom of chronic heart failure (CHF). In the community setting, patients with CHF are most often women. Aim: To examine the impact of gender on the description of dyspnoea and to explore which clinical variables support a diagnosis of CHF. Methods: From four primary health care centres, 158 patients with CHF were included. Patients were examined with echocardiography and a cardiologist assessed the diagnosis of CHF. The patients filled in a questionnaire containing 11 descriptors of dyspnoea. Results: A diagnosis of CHF was confirmed in 87 (55%) patients (47 males and 40 females). One descriptor, I feel that I am suffocating, was significantly scored higher in CHF patients ( p=0.014) as compared to non-CHF patients. Three descriptors, My breath does not go in all the way ( p=0.006), I feel that I am suffocating ( p=0.040), and I cannot get enough air ( p=0.0327) were significantly scored higher among men with CHF, compared to no descriptor among women with CHF. Being male (OR=2.7; CI: 1.3–5.6, p=0.008), having diabetes (OR=5.6; CI: 1.7–18.2, p=0.004), IHD (OR=3.3; CI: 1.3–8.5, p=0.014), and a borderline significance for age (OR=1.04; CI: 0.99–1.08, p=0.058) predicted a confirmed diagnosis of CHF. Conclusion: Three descriptors of dyspnoea were associated with CHF among men, whereas no such association was found among women. Our results suggest that gender is an important factor and should—together with age, underlying heart disease, and diabetes—be taken into account when symptoms are evaluated in the diagnosis of CHF in primary care.

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Incidence and Prevalence of Morbidity and Mortality From Sensitive Conditions to Primary Health Care in Adult Men: A Systematic Review and Meta-analysis Protocol

10.21203/rs.3.rs-27659/v1 ◽

2020 ◽

Author(s):

Cácia Régia de Paula ◽

Cristiane José Borges ◽

Flavio Henrique Alves de Lima ◽

Celmo Celeno Porto ◽

Marcos André Matos ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Systematic Reviews ◽

Meta Analysis ◽

Morbidity And Mortality ◽

Adult Men ◽

Primary Health ◽

Sensitive Conditions

Abstract Background: Scientific studies on human health are not remote and show that mortality in this population is increasing. Although male morbidity and mortality rates have a considerable weight in national and international epidemiological profiles, the presence of men in primary health care services is lower than that of women. Many injuries could be avoided if men regularly carried out the first preventive measures. Sensitive Conditions to Primary Care are consolidated as an important marker of access to health services and the resolution capacity of Primary Care. In this systematic review, the objective is to identify what is known about the prevalence and / or incidence of Sensitive Conditions to Primary Care in adult men.Methods: We will identify the studies through systematic research in PUBMED-MEDLINE, SCOPUS, Web of Science, Embase, Cochrane, BDTD and OpenGrey. The quality assessment of retrieved articles will be carried out using the critical assessment tools of the Joanna Briggs Institute (JBI). The quantitative synthesis of the data will be carried out if the studies are homogeneous and provide adequate result data for meta-analysis. Otherwise, the data will be synthesized, using the narrative synthesis approach.Discussion: This review will explore theprevalenceand / orincidenceofSensitiveConditionstoprimarycare (prevalenceofhospitalizations; incidenceofhospitalizationsand deaths from ACSC) in adultmenandwillact as a usefulsource for researchers, policymakersand stakeholders whendevelopingandimplementinginterventions for thatgroup. Systematic review registration: This systematic review protocol was submitted to International Prospective Register of Systematic Reviews (PROSPERO). Submission number: ID 169447. This protocol was prepared using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols checklist (PRISMA-P).

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The Pacific primary health care workforce in New Zealand: What are the needs?

Journal of Primary Health Care ◽

10.1071/hc09126 ◽

2009 ◽

Vol 1 (2) ◽

pp. 126 ◽

Cited By ~ 3

Author(s):

Luisa Ape-Esera ◽

Vili Nosa ◽

Felicity Goodyear-Smith

Keyword(s):

Primary Care ◽

Health Care ◽

Primary Health Care ◽

New Zealand ◽

Health Care Workforce ◽

Pacific People ◽

Advantages And Disadvantages ◽

Pacific Population ◽

Primary Health ◽

The Impact

AIM: To scope future needs of the NZ Pacific primary care workforce. METHOD: Semi-structured interviews with key informants including Pacific primary care workers in both Pacific and mainstream primary health care organisations and managers at funding, policy and strategy levels. Qualitative thematic analysis using general inductive approach. RESULTS: Thirteen stakeholders interviewed (four males, nine females) in 2006. Included both NZ- and Island-born people of Samoan, Tongan, Niuean, Fijian and NZ European ethnicities; age 20–65 years. Occupations included general practitioner, practice nurse, community worker, Ministry of Health official and manager representing mainstream and Pacific-specific organisations. Key themes were significant differences in attributes, needs and values between ‘traditional’ and contemporary Pacific people; issues regarding recruitment and retention of Pacific people into the primary health care workforce; importance of cultural appropriateness for Pacific populations utilising mainstream and Pacific-specific primary care services and both advantages and disadvantages of ‘Pacific for Pacific’ services. CONCLUSION: Interviews demonstrated heterogeneity of Pacific population regarding ethnicity, age, duration of NZ residence and degree of immersion in their culture and language. Higher rates of mental disorder amongst NZ-born Pacific signpost urgent need to address the impact of Western values on NZ-born Pacific youth. Pacific population growth means increasing demands on health services with Pacific worker shortages across all primary health care occupations. However it is not possible for all Pacific people to be treated by Pacific organisations and/or by Pacific health workers and services should be culturally competent regardless of ethnicity of providers. KEYWORDS: Pacific Islands, New Zealand, manpower, ethnic groups, Oceanic Ancestry Group, primary health care

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Artificial Intelligence in Primary Health Care: Perceptions, Issues, and Challenges

Yearbook of Medical Informatics ◽

10.1055/s-0039-1677901 ◽

2019 ◽

Vol 28 (01) ◽

pp. 041-046 ◽

Cited By ~ 11

Author(s):

Harshana Liyanage ◽

Siaw-Teng Liaw ◽

Jitendra Jonnagaddala ◽

Richard Schreiber ◽

Craig Kuziemsky ◽

...

Keyword(s):

Artificial Intelligence ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Medical Informatics ◽

Panel Discussion ◽

Healthcare Delivery ◽

Primary Health ◽

The Impact ◽

Care Informatics

Background: Artificial intelligence (AI) is heralded as an approach that might augment or substitute for the limited processing power of the human brain of primary health care (PHC) professionals. However, there are concerns that AI-mediated decisions may be hard to validate and challenge, or may result in rogue decisions. Objective: To form consensus about perceptions, issues, and challenges of AI in primary care. Method: A three-round Delphi study was conducted. Round 1 explored experts’ viewpoints on AI in PHC (n=20). Round 2 rated the appropriateness of statements arising from round one (n=12). The third round was an online panel discussion of findings (n=8) with the members of both the International Medical Informatics Association and the European Federation of Medical Informatics Primary Health Care Informatics Working Groups. Results: PHC and informatics experts reported AI has potential to improve managerial and clinical decisions and processes, and this would be facilitated by common data standards. The respondents did not agree that AI applications should learn and adapt to clinician preferences or behaviour and they did not agree on the extent of AI potential for harm to patients. It was more difficult to assess the impact of AI-based applications on continuity and coordination of care. Conclusion: While the use of AI in medicine should enhance healthcare delivery, we need to ensure meticulous design and evaluation of AI applications. The primary care informatics community needs to be proactive and to guide the ethical and rigorous development of AI applications so that they will be safe and effective.

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