scholarly journals OpenSAFELY NHS Service Restoration Observatory 1: primary care clinical activity in England during the first wave of COVID-19

2021 ◽  
pp. BJGP.2021.0380
Author(s):  
Helen J Curtis ◽  
Brian MacKenna ◽  
Richard Croker ◽  
Peter Inglesby ◽  
Alex J Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Respiratory Disease ◽  
Laboratory Tests ◽  
Respiratory Infections ◽  
Seasonal Pattern ◽  
Substantial Reduction ◽  
Chronic Obstructive ◽  
Clinical Activity ◽  
Ratio Test

BackgroundThe COVID-19 pandemic has disrupted healthcare activity. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.AimTo describe the volume and variation of coded clinical activity in general practice, taking respiratory disease and laboratory procedures as examples.Design and settingWorking on behalf of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY.MethodActivity using Clinical Terms Version 3 codes and keyword searches from January 2019 to September 2020 are described.ResultsActivity recorded in general practice declined during the pandemic, but largely recovered by September. There was a large drop in coded activity for laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was the international normalised ratio test, with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 6.9). The pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as ‘no change’. Respiratory infections exhibited a sustained drop, not returning to pre-pandemic levels by September. Asthma reviews experienced a small drop but recovered, whereas chronic obstructive pulmonary disease reviews remained below baseline.ConclusionAn open-source software framework was delivered to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September, with some important tests less affected and recording of respiratory disease codes was mixed.

scholarly journals OpenSAFELY NHS Service Restoration Observatory 1: describing trends and variation in primary care clinical activity for 23.3 million patients in England during the first wave of COVID-19

2021 ◽  
Author(s):  
Helen J Curtis ◽  
Brian MacKenna ◽  
Alex J Walker ◽  
Peter Inglesby ◽  
Richard Croker ◽  
...  
Keyword(s):  
Primary Care ◽  
Open Source ◽  
Respiratory Disease ◽  
Open Source Software ◽  
Laboratory Tests ◽  
Substantial Reduction ◽  
Clinical Activity ◽  
Software Framework ◽  
Service Restoration ◽  
Tract Infections

Background The COVID-19 pandemic has disrupted healthcare activity globally. The NHS in England stopped most non-urgent work by March 2020, but later recommended that services should be restored to near-normal levels before winter where possible. The authors are developing the OpenSAFELY NHS Service Restoration Observatory, using data to describe changes in service activity during COVID-19, and reviewing signals for action with commissioners, researchers and clinicians. Here we report phase one: generating, managing, and describing the data. Objective To describe the volume and variation of coded clinical activity in English primary care across 23.8 million patients records, taking respiratory disease and laboratory procedures as key examples. Methods Working on behalf of NHS England we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care EHR data on 23.8 million patients; and conducted a population cohort-based study to describe activity using CTV3 coding hierarchy and keyword searches from January 2019-September 2020. Results Much activity recorded in general practice declined to some extent during the pandemic, but largely recovered by September 2020, with some exceptions. There was a large drop in coded activity for commonly used laboratory tests, with broad recovery to pre-pandemic levels by September. One exception was blood coagulation tests such as International Normalised Ratio (INR), with a smaller reduction (median tests per 1000 patients in 2020: February 8.0; April 6.2; September 7.0). The overall pattern of recording for respiratory symptoms was less affected, following an expected seasonal pattern and classified as no change from the previous year. Respiratory tract infections exhibited a sustained drop compared with pre-pandemic levels, not returning to pre-pandemic levels by September 2020. Various COVID-19 codes increased through the period. We observed a small decline associated with high level codes for long-term respiratory conditions such as chronic obstructive pulmonary disease (COPD) and asthma. Asthma annual reviews experienced a small drop but since recovered, while COPD annual reviews remain below baseline. Conclusions We successfully delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. The COVD-19 pandemic led to a substantial change in healthcare activity. Most laboratory tests showed substantial reduction, largely recovering to near-normal levels by September 2020, with some important tests less affected. Records of respiratory infections decreased with the exception of codes related to COVID-19, whilst activity of other respiratory disease codes was mixed. We are expanding the NHS Service Restoration Observatory in collaboration with clinicians, commissioners and researchers and welcome feedback.

scholarly journals Epidemiology and Clinical Symptoms Related to Seasonal Coronavirus Identified in Patients with Acute Respiratory Infections Consulting in Primary Care over Six Influenza Seasons (2014–2020) in France

Viruses ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 630
Author(s):  
Shirley Masse ◽  
Lisandru Capai ◽  
Natacha Villechenaud ◽  
Thierry Blanchon ◽  
Rémi Charrel ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Clinical Features ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Epidemiological Data ◽  
Influenza Surveillance ◽  
Respiratory Pathogens ◽  
Detection Rates ◽  
Representative Samples

There is currently debate about human coronavirus (HCoV) seasonality and pathogenicity, as epidemiological data are scarce. Here, we provide epidemiological and clinical features of HCoV patients with acute respiratory infection (ARI) examined in primary care general practice. We also describe HCoV seasonality over six influenza surveillance seasons (week 40 to 15 of each season) from the period 2014/2015 to 2019/2020 in Corsica (France). A sample of patients of all ages presenting for consultation for influenza-like illness (ILI) or ARI was included by physicians of the French Sentinelles Network during this period. Nasopharyngeal samples were tested for the presence of 21 respiratory pathogens by real-time RT-PCR. Among the 1389 ILI/ARI patients, 105 were positive for at least one HCoV (7.5%). On an annual basis, HCoVs circulated from week 48 (November) to weeks 14–15 (May) and peaked in week 6 (February). Overall, among the HCoV-positive patients detected in this study, HCoV-OC43 was the most commonly detected virus, followed by HCoV-NL63, HCoV-HKU1, and HCoV-229E. The HCoV detection rates varied significantly with age (p = 0.00005), with the age group 0–14 years accounting for 28.6% (n = 30) of HCoV-positive patients. Fever and malaise were less frequent in HCoV patients than in influenza patients, while sore throat, dyspnoea, rhinorrhoea, and conjunctivitis were more associated with HCoV positivity. In conclusion, this study demonstrates that HCoV subtypes appear in ARI/ILI patients seen in general practice, with characteristic outbreak patterns primarily in winter. This study also identified symptoms associated with HCoVs in patients with ARI/ILI. Further studies with representative samples should be conducted to provide additional insights into the epidemiology and clinical features of HCoVs.

A Study of Difficult Respiratory Infections in General Practice

1982 ◽  
Vol 27 (1_suppl) ◽  
pp. S17-S20 ◽  
Author(s):  
C.E. Langan ◽  
D.J. Platt ◽  
A.J. Guthrie
Keyword(s):  
General Practice ◽  
Haemophilus Influenzae ◽  
Clinical Response ◽  
Antimicrobial Agents ◽  
Respiratory Infections ◽  
Chronic Obstructive ◽  
Obstructive Airways Disease ◽  
Chronic Obstructive Airways Disease

Augmentin was used to treat 40 patients in general practice with exacerbations of bronchiectasis or chronic obstructive airways disease who had not responded clinically to treatment with antimicrobial agents. After ten days treatment 15 patients (38%) were clinically free from infection, 21 (52%) had improved but their sputum still contained pus. Four patients (10%) did not respond to treatment. Pathogens were isolated from 63 per cent of the patients; Haemophilus influenzae was the most common. The clinical response was significantly better in patients from whom recognised pathogens were not isolated.

scholarly journals Do we need lipid clinics? Shifting the balance between secondary and primary care

2005 ◽  
Vol 42 (6) ◽  
pp. 463-467 ◽  
Author(s):  
W Stuart ◽  
A Smellie
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Waiting Times ◽  
Shared Care ◽  
High Rate ◽  
Lipid Lowering ◽  
Clinical Activity ◽  
Lipid Lowering Therapy ◽  
Care Clinic

Background: Increasing activity in cholesterol lowering is placing increasing demands on lipid clinics to be able to cope with the increase in demand. A combination of interventions has been used to improve laboratory testing, focus interpretative results and provide educational and advisory facilities for general practitioners in order to increase shared care of many potential clinic patients. Methods: Retrospective study of clinic waiting times, results in patients managed on a shared care basis, and overall clinical activity over a three-and-a-half-year intervention period between March 2001 and August 2004 in a single-consultant, single-centre secondary care clinic serving three primary care trusts, covering a population of approximately 270,000 people. The interventions involved a change to the laboratory request form, outreach educational meetings and promotion of use of 'written advice only' for certain patients as an alternative to direct clinic referral. The main outcome measures were percentages of patients followed up in primary care, change in cholesterol and triglyceride results after advice, and clinic waiting time. Results: A total of 520 patients were referred over three and a half years, either to be seen or for written advice only. About 291 of these were handled by advisory letters. In all, 90% of these patients were already receiving or had received lipid-lowering therapy at the time of referral. 98% of patients were followed up by their general practice post-advice. Cholesterol and triglyceride concentrations fell by 23% and 39%, respectively, post-advice. Waiting times fell from a peak of 35 weeks before the interventions to an average of three weeks after. This fall has been maintained over the three-and-a-half years the intervention has run. Conclusions: The interventions have resulted in a large fall in clinic waiting times, improvement in lipid results, and high rate of general practice follow-up, all of which have been sustained in the long term.

scholarly journals PRS5 PRIMARY CARE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS FROM GENERAL PRACTICE DATABASE

2009 ◽  
Vol 12 (7) ◽  
pp. A299
Author(s):  
A Citarella ◽  
E Menditto ◽  
S Cammarota ◽  
S de Portu ◽  
S Riegler ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Primary Care ◽  
General Practice ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

scholarly journals Declining influenza activity in Europe while public concern over SARS has not increased general practice consultations for influenza-like illness or acute respiratory infections

2003 ◽  
Vol 7 (16) ◽  
Author(s):  
W J Paget ◽  
M Zambon ◽  
H Upphoff ◽  
A I M Bartelds
Keyword(s):  
General Practice ◽  
Respiratory Infections ◽  
Influenza Surveillance ◽  
Clinical Activity ◽  
Acute Respiratory Infections ◽  
Public Concern ◽  
Influenza Like Illness ◽  
Influenza Activity ◽  
Baseline Levels ◽  
Surveillance Scheme

Influenza activity in the 22 networks (19 countries) that participate in the European Influenza Surveillance Scheme (EISS, http://www.eiss.org/) in the week ending 6 April 2003 (week 14/2003) was regional in Italy, local in nine networks and sporadic in eight networks (1). One network – Portugal – reported no influenza activity, indicating that the overall level of clinical activity was at baseline levels. Compared to week 13/2003, clinical morbidity rates declined in thirteen networks and remained stable in two (France and Slovenia).

scholarly journals The quality of COPD care in German general practice—A cross-sectional study

2020 ◽  
Vol 17 ◽  
pp. 147997312096481
Author(s):  
Stefan Heinmüller ◽  
Emmily Schaubroeck ◽  
Luca Frank ◽  
Anina Höfle ◽  
Michael Langer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Of Care ◽  
Pneumococcal Vaccination ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Care Network

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a common health problem to be dealt with in primary care. Little is known about the quality of care provided for patients with COPD in Germany. Therefore, we wanted to assess the current quality of care delivered by a primary care network (PCN) for patients with COPD. Methods: A cross-sectional study was conducted in collaboration with a primary care network (PCN). All patients of the PCN aged 40 years and older with a diagnosis of COPD were identified through electronic health records (EHR). A set of quality indicators (QIs) developed in accordance with current COPD-guidelines were appraised through numerical data retrieved from the EHR. Results: In total, 2,568 patients with COPD were identified. Their mean age was 67 (SD±12) years, 49% were male. Thirty-five percent had a parallel diagnosis of asthma. There was no documentation of any spirometry for 54% of patients; 29% had a spirometry within the previous year. An influenza vaccination was documented for 37% within the preceding 12 months; 12% received a pneumococcal vaccination in the last 6 years. Smoking status was documented for 44% within the last year. Conclusion: The quality of care for patients with COPD in the PCN seemed suboptimal, despite the presence of a Disease Management Program (DMP). This finding is likely to apply widely to German general practice. Quality assessment through currently available EHR data was challenging due to non-standardized and insufficient documentation.

scholarly journals Heart failure in primary care: prevalence related to age and comorbidity

2019 ◽  
Vol 20 ◽  
Author(s):  
Lieke Bosch ◽  
Patricia Assmann ◽  
Wim J. C. de Grauw ◽  
Bianca W. M. Schalk ◽  
Marion C. J. Biermans
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Elderly Patients ◽  
Chronic Obstructive ◽  
Routine Practice ◽  
Chronic Obstructive Pulmonary Disorder ◽  
Pulmonary Disorder ◽  
General Practices ◽  
Using Data

Abstract Background Diagnosing heart failure (HF) in primary care can be challenging, especially in elderly patients with comorbidities. Insight in the prevalence, age, comorbidity and routine practice of diagnosing HF in general practice may improve the process of diagnosing HF. Aim To examine the prevalence of HF in relation to ageing and comorbidities, and routine practice of diagnosing HF in general practice. Methods A retrospective cohort study was performed using data from electronic health records of 56 320 adult patients of 11 general practices. HF patients were compared with patients without HF using descriptive analyses and χ2 tests. The following comorbidities were considered: chronic obstructive pulmonary disorder (COPD), diabetes mellitus (DM), hypertension, anaemia and renal function disorder (RFD). Separate analyses were performed for men and women. Findings The point prevalence of HF was 1.2% (95% confidence interval 1.13–1.33) and increased with each age category from 0.04% (18–44 years) to 20.9% (⩾85 years). All studied comorbidities were significantly (P<0.001) more common in HF patients than in patients without HF: COPD (24.1% versus 3.1%), DM (34.7% versus 6.5%), hypertension (52.7% versus 16.0%), anaemia (10.9% versus 2.3%) and RFD (61.8% versus 7.5%). N-terminal pro-BNP (NT-proBNP) was recorded in 38.1% of HF patients. Conclusions HF is highly associated with ageing and comorbidities. Diagnostic use of NT-proBNP in routine primary care seems underutilized. Instruction of GPs to determine NT-proBNP in patients suspected of HF is recommended, especially In elderly patients with comorbidities.

scholarly journals Pulmonary Talaromycosis: A Window into the Immunopathogenesis of an Endemic Mycosis

2021 ◽  
Author(s):  
Shanti Narayanasamy ◽  
John Dougherty ◽  
H. Rogier van Doorn ◽  
Thuy Le
Keyword(s):  
Respiratory Disease ◽  
Respiratory Infections ◽  
Antibody Test ◽  
Cd40 Ligand ◽  
Reticuloendothelial System ◽  
Interferon Γ ◽  
Mediastinal Lymphadenopathy ◽  
Chronic Obstructive ◽  
Effector Cells ◽  
Pulmonary Manifestations

AbstractTalaromycosis is an invasive mycosis caused by the thermally dimorphic saprophytic fungus Talaromyces marneffei (Tm) endemic in Asia. Like other endemic mycoses, talaromycosis occurs predominantly in immunocompromised and, to a lesser extent, immunocompetent hosts. The lungs are the primary portal of entry, and pulmonary manifestations provide a window into the immunopathogenesis of talaromycosis. Failure of alveolar macrophages to destroy Tm results in reticuloendothelial system dissemination and multi-organ disease. Primary or secondary immune defects that reduce CD4+ T cells, INF-γ, IL-12, and IL-17 functions, such as HIV infection, anti-interferon-γ autoantibodies, STAT-1 and STAT-3 mutations, and CD40 ligand deficiency, highlight the central roles of Th1 and Th17 effector cells in the control of Tm infection. Both upper and lower respiratory infections can manifest as localised or disseminated disease. Upper respiratory disease appears unique to talaromycosis, presenting with oropharyngeal lesions and obstructive tracheobronchial masses. Lower respiratory disease is protean, including alveolar consolidation, solitary or multiple nodules, mediastinal lymphadenopathy, cavitary disease, and pleural effusion. Structural lung disease such as chronic obstructive pulmonary disease is an emerging risk factor in immunocompetent hosts. Mortality, up to 55%, is driven by delayed or missed diagnosis. Rapid, non-culture-based diagnostics including antigen and PCR assays are shown to be superior to blood culture for diagnosis, but still require rigorous clinical validation and commercialisation. Our current understanding of acute pulmonary infections is limited by the lack of an antibody test. Such a tool is expected to unveil a larger disease burden and wider clinical spectrum of talaromycosis.

scholarly journals Electronically delivered interventions to reduce antibiotic prescribing for respiratory infections in primary care: cluster RCT using electronic health records and cohort study

2019 ◽  
Vol 23 (11) ◽  
pp. 1-70 ◽  
Author(s):  
Martin C Gulliford ◽  
Dorota Juszczyk ◽  
A Toby Prevost ◽  
Jamie Soames ◽  
Lisa McDermott ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Intervention Trial ◽  
Health Records ◽  
Multicomponent Intervention ◽  
General Practices ◽  
Electronically Delivered

BackgroundUnnecessary prescribing of antibiotics in primary care is contributing to the emergence of antimicrobial drug resistance.ObjectivesTo develop and evaluate a multicomponent intervention for antimicrobial stewardship in primary care, and to evaluate the safety of reducing antibiotic prescribing for self-limiting respiratory infections (RTIs).InterventionsA multicomponent intervention, developed as part of this study, including a webinar, monthly reports of general practice-specific data for antibiotic prescribing and decision support tools to inform appropriate antibiotic prescribing.DesignA parallel-group, cluster randomised controlled trial.SettingThe trial was conducted in 79 general practices in the UK Clinical Practice Research Datalink (CPRD).ParticipantsAll registered patients were included.Main outcome measuresThe primary outcome was the rate of antibiotic prescriptions for self-limiting RTIs over the 12-month intervention period.Cohort studyA separate population-based cohort study was conducted in 610 CPRD general practices that were not exposed to the trial interventions. Data were analysed to evaluate safety outcomes for registered patients with 45.5 million person-years of follow-up from 2005 to 2014.ResultsThere were 41 intervention trial arm practices (323,155 patient-years) and 38 control trial arm practices (259,520 patient-years). There were 98.7 antibiotic prescriptions for RTIs per 1000 patient-years in the intervention trial arm (31,907 antibiotic prescriptions) and 107.6 per 1000 patient-years in the control arm (27,923 antibiotic prescriptions) [adjusted antibiotic-prescribing rate ratio (RR) 0.88, 95% confidence interval (CI) 0.78 to 0.99;p = 0.040]. There was no evidence of effect in children aged < 15 years (RR 0.96, 95% CI 0.82 to 1.12) or adults aged ≥ 85 years (RR 0.97, 95% CI 0.79 to 1.18). Antibiotic prescribing was reduced in adults aged between 15 and 84 years (RR 0.84, 95% CI 0.75 to 0.95), that is, one antibiotic prescription was avoided for every 62 patients (95% CI 40 to 200 patients) aged 15–84 years per year. Analysis of trial data for 12 safety outcomes, including pneumonia and peritonsillar abscess, showed no evidence that these outcomes might be increased as a result of the intervention. The analysis of data from non-trial practices showed that if a general practice with an average list size of 7000 patients reduces the proportion of RTI consultations with antibiotics prescribed by 10%, then 1.1 (95% CI 0.6 to 1.5) more cases of pneumonia per year and 0.9 (95% CI 0.5 to 1.3) more cases of peritonsillar abscesses per decade may be observed. There was no evidence that mastoiditis, empyema, meningitis, intracranial abscess or Lemierre syndrome were more frequent at low-prescribing practices.LimitationsThe research was based on electronic health records that may not always provide complete data. The number of practices included in the trial was smaller than initially intended.ConclusionsThis study found evidence that, overall, general practice antibiotic prescribing for RTIs was reduced by this electronically delivered intervention. Antibiotic prescribing rates were reduced for adults aged 15–84 years, but not for children or the senior elderly.Future workStrategies for antimicrobial stewardship should employ stratified interventions that are tailored to specific age groups. Further research into the safety of reduced antibiotic prescribing is also needed.Trial registrationCurrent Controlled Trials ISRCTN95232781.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 23, No. 11. See the NIHR Journals Library website for further project information.

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