COMPARISON AND ANALYSIS OF THE IMPACT OF CO-INFECTIONS IN PEDIATRIC PATIENTS WITH RESPIRATORY INFECTIONS ADMITTED TO HOSPITAL OR IN PRIMARY CARE HEALTHCARE

Purpose: This study assesses the potential acute effects of heatwaves on human morbidities in primary care settings. Methods: We performed a time-stratified case-crossover study to assess the acute effects of heatwaves on selected morbidities in primary care settings in Flanders, Belgium, between 2000 and 2015. We used conditional logistic regression models. We assessed the effect of heatwaves on the day of the event (lag 0) and X days earlier (lags 1 to X). The associations are presented as Incidence Density Ratios (IDR). Results: We included 22,344 events. Heatwaves are associated with increased heat-related morbidities such as heat stroke IDR 3.93 [2.94–5.26] at lag 0, dehydration IDR 3.93 [2.94–5.26] at lag 1, and orthostatic hypotension IDR 2.06 [1.37–3.10] at lag 1. For cardiovascular morbidities studied, there was only an increased risk of stroke at lag 3 IDR 1.45 [1.04–2.03]. There is no significant association with myocardial ischemia/infarction or arrhythmia. Heatwaves are associated with decreased respiratory infection risk. The IDR for upper respiratory infections is 0.82 [0.78–0.87] lag 1 and lower respiratory infections (LRI) is 0.82 [0.74–0.91] at lag 1. There was no significant effect modification by age or premorbid chronic disease (diabetes, hypertesnsion). Conclusion: Heatwaves are associated with increased heat-related morbidities and decreased respiratory infection risk. The study of heatwaves’ effects in primary care settings helps evaluate the impact of heatwaves on the general population. Primary care settings might be not suitable to study acute life-threatening morbidities.

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COVID-19 Pandemic Impact on Respiratory Infectious Diseases in Primary Care Practice in Children

Frontiers in Pediatrics ◽

10.3389/fped.2021.722483 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ravinder Kaur ◽

Steven Schulz ◽

Naoko Fuji ◽

Michael Pichichero

Keyword(s):

Primary Care ◽

Infectious Diseases ◽

Respiratory Infections ◽

New York State ◽

Acute Otitis Media ◽

Care Practice ◽

Respiratory Pathogens ◽

Nasopharyngeal Colonization ◽

Respiratory Infectious Diseases ◽

The Impact

Background: The coronavirus disease 2019 (COVID-19) pandemic led to day care and school closures and children staying home for several months. When they gradually returned, aggressive regulations were implemented in New York State to reduce viral transmission.Method: An ongoing prospective study occurring in the Rochester, NY region, focused on early childhood respiratory infectious diseases, afforded an opportunity to assess the impact of the pandemic on the incidence of these illnesses in a primary care outpatient setting. Physician-diagnosed, medically attended infection visits were assessed in two child cohorts, age 6–36 months old: from March 15 to December 31, 2020 (the pandemic period) compared to the same months in 2019 (prepandemic). Nasopharyngeal colonization by potential otopathogens during healthy/well-child and acute otitis media (AOM) visits was evaluated.Results: One hundred and forty-four children were included in the pandemic cohort and 215 in the prepandemic cohort. The pandemic cohort of children experienced 1.8-fold less frequent infectious disease visits during the pandemic (p < 0.0001). Specifically, visits for AOM were 3.7-fold lower (p < 0.0001), viral upper respiratory infections (URI) 3.8-fold lower (p < 0.0001), croup 27.5-fold lower (p < 0.0001), and bronchiolitis 7.4-fold lower (p = 0.04) than the prepandemic cohort. Streptococcus pneumoniae (p = 0.03), Haemophilus influenzae (p < 0.0001), and Moraxella catarrhalis (p < 0.0001) nasopharyngeal colonization occurred less frequently among children during the pandemic.Conclusion: In primary care pediatric practice, during the first 9 months of the COVID-19 pandemic, significant decreases in the frequency of multiple respiratory infections and nasopharyngeal colonization by potential bacterial respiratory pathogens occurred in children age 6–36 months old.

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PREVALENCE AND IMPACT OF CO-INFECTIONS IN PEDIATRIC PATIENTS WITH RESPIRATORY INFECTIONS ATTENDING PRIMARY CARE HEALTHCARE (FLUGAL)

10.26226/morressier.5ad774dcd462b80296ca66f5 ◽

2018 ◽

Author(s):

Federico Martinón Torres

Keyword(s):

Primary Care ◽

Pediatric Patients ◽

Respiratory Infections

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Health care for undocumented immigrants during the early phase of the Covid-19 pandemic in Lombardy, Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa205 ◽

2020 ◽

Vol 30 (6) ◽

pp. 1186-1188

Author(s):

Carlo Devillanova ◽

Cinzia Colombo ◽

Primo Garofolo ◽

Anna Spada

Keyword(s):

Primary Care ◽

Undocumented Immigrants ◽

Respiratory Infections ◽

Housing Conditions ◽

Quantitative Evidence ◽

Health Measures ◽

Clinical Burden ◽

Access To Primary Care ◽

The Impact ◽

Visit Number

Abstract Despite concern on the impact of coronavirus disease 2019 (COVID-19) pandemic on undocumented immigrants, quantitative evidence on the issue is scant. We analyze socioeconomic and health conditions of 1590 undocumented immigrants in Milan, Lombardy, one of the regions with the highest COVID-19 clinical burden in the world that does not guarantee access to primary care for these individuals. We document a sharp reduction in visit number after lockdown, with 16% frequency of acute respiratory infections, compatible with COVID-19. Moreover, housing conditions make it difficult to implement public health measures. Results suggest the need to foster primary care by undocumented immigrants to face COVID-19 emergency.

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Empathy, burnout, and antibiotic prescribing for acute respiratory infections: a cross-sectional primary care study in the US

British Journal of General Practice ◽

10.3399/bjgp17x691901 ◽

2017 ◽

Vol 67 (661) ◽

pp. e565-e571 ◽

Cited By ~ 4

Author(s):

Bob Z Sun ◽

Alexander Chaitoff ◽

Bo Hu ◽

Kathleen Neuendorf ◽

Mahesh Manne ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Respiratory Infections ◽

Maslach Burnout Inventory ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Cross Sectional ◽

The Us ◽

Physician Empathy ◽

The Impact

BackgroundThe impact of physician–patient relationship factors, such as physician empathy and burnout, on antibiotic prescribing has not been characterised.AimTo assess associations between physician empathy and burnout and antibiotic prescribing for acute respiratory infections (ARIs) in primary care.Design and settingCross-sectional study of primary care practices in the Cleveland Clinic Health System in the US.MethodPatient and prescribing data were obtained from the medical record. All patients with primary diagnoses of ARIs from 1 January 2012 to 31 December 2013, except those with chronic obstructive pulmonary disease (COPD) or who were immunocompromised, were included. Physician empathy was measured using the Jefferson Scale of Empathy while physician burnout was measured using the Maslach Burnout Inventory. The relationship between empathy and burnout and antibiotic prescribing, adjusted for patient and provider characteristics, was analysed using multiple linear regression.ResultsIn 5937 ARI visits to 102 primary care physicians, the median proportion resulting in antibiotic prescribing was 48.6% (interquartile range [IQR] 24.1% to 70.0%). Neither physician empathy (correlation coefficient [β] 0.005, 95% confidence interval [CI] = −0.001 to 0.010, P = 0.07) nor any burnout measures were significantly associated with antibiotic prescribing: emotional exhaustion (β 0.001, 95% CI = −0.005 to 0.006, P = 0.79), tendency to depersonalise patients (β −0.009, 95% CI = −0.021 to 0.003, P = 0.13), and sense of personal accomplishment (β −0.004, 95% CI = −0.014 to 0.006, P = 0.44).ConclusionThe authors found no significant association between empathy or burnout measures and antibiotic prescribing for ARIs in primary care. Other physician characteristics should be investigated to explain individual variation in antibiotic prescribing.

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Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

BJGP Open ◽

10.3399/bjgpo.2021.0172 ◽

2022 ◽

pp. BJGPO.2021.0172

Author(s):

Marta Wanat ◽

Melanie Eugenie Hoste ◽

Nina Helene Gobat ◽

Marilena Anastasaki ◽

Femke Böhmer ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Respiratory Infections ◽

Care Delivery ◽

European Countries ◽

Structured Interviews ◽

Delivery Of Care ◽

Primary Care Delivery ◽

The Impact ◽

Remote Consultations

BackgroundThe impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care and understanding its benefits and drawbacks may inform its implementation during this and future healthcare emergencies.AimTo explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic.Design & settingQualitative study using semi-structured interviews in primary care in eight European countriesResultsWe conducted 146 interviews with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden and Germany). Data was collected between April and July 2020 and analysed using thematic analysis. We found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns.ConclusionRemote consultations for RTI symptoms may be acceptable long-term if both groups are happy to use this format but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.

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Implementation of Veterans Affairs Primary Care Antimicrobial Stewardship Interventions For Asymptomatic Bacteriuria And Acute Respiratory Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab449 ◽

2021 ◽

Vol 8 (12) ◽

Author(s):

Grace C Mortrude ◽

Mary T Rehs ◽

Katherine A Sherman ◽

Nathan D Gundacker ◽

Claire E Dysart

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Primary Outcome ◽

Respiratory Infections ◽

Asymptomatic Bacteriuria ◽

Acute Bronchitis ◽

Educational Interventions ◽

Acute Respiratory Infections ◽

The Impact ◽

Satisfaction Surveys

Abstract Background Outpatient antimicrobial prescribing is an important target for antimicrobial stewardship (AMS) interventions to decrease antimicrobial resistance. The objective of this study was to design, implement, and evaluate the impact of AMS interventions focused on asymptomatic bacteriuria (ASB) and acute respiratory infections (ARIs) in the primary care setting. Methods This stepped-wedge trial evaluated the impact of multifaceted educational interventions to providers on adult patients presenting to primary care clinics for ARIs and ASB. The primary outcome was percentage of overall antibiotic prescriptions as a composite of prescriptions for ASB, acute bronchitis, upper respiratory infection not otherwise specified, uncomplicated sinusitis, and uncomplicated pharyngitis. Secondary outcomes were the individual components of the primary outcome; a composite safety endpoint of related hospital, emergency department, or primary care visits within 4 weeks; antibiotic selection appropriateness; and patient satisfaction surveys. Results A total of 887 patients were included (405 preintervention and 482 postintervention). After controlling for type I error using Bonferroni correction, the primary outcome was not significantly different between groups (56% vs 49%). There was a statistically significant decrease in prescriptions for acute bronchitis (20.99% vs 12.66%; P = .0003). Appropriateness of antibiotic prescriptions for uncomplicated sinusitis (odds ratio [OR], 4.96 [95% confidence interval {CI}, 1.79–13.75]; P = .0021) and pharyngitis (OR, 5.36 [95% CI, 1.93–14.90]; P = .0013) was improved in the postintervention vs the preintervention group. The composite safety outcome and patient satisfaction surveys did not differ between groups. Conclusions Multifaceted educational interventions targeting providers can improve antibiotic prescribing for indications rarely requiring antimicrobials without increasing re-visits or patient satisfaction surveys.

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The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽

10.1027/0227-5910/a000511 ◽

2018 ◽

Vol 39 (5) ◽

pp. 397-405 ◽

Cited By ~ 3

Author(s):

Steven Vannoy ◽

Mijung Park ◽

Meredith R. Maroney ◽

Jürgen Unützer ◽

Ester Carolina Apesoa-Varano ◽

...

Keyword(s):

Primary Care ◽

Low Socioeconomic Status ◽

Thematic Analysis ◽

Older Men ◽

Primary Care Providers ◽

Depression Treatment ◽

Care Providers ◽

Low Socioeconomic ◽

Self Image ◽

The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

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