Translation of clinical prediction rules for febrile children to primary care practice: an observational cohort study

ObjectiveClinical prediction rules (CPRs) followed by D-dimer testing were shown to safely rule out venous thromboembolism (VTE) in about half of all suspected patients in controlled and experienced study settings. Yet, its real-life impact in primary care is unknown. The aim of this study was to determine the real-life impact of CPRs for suspected VTE in primary care.DesignCross-sectional cohort study.SettingPrimary care in the Netherlands.ParticipantsPatients with suspected deep venous thrombosis (n=993) and suspected pulmonary embolism (n=484).InterventionsGeneral practitioners received an educational instruction on how to use CPRs in suspected VTE. We did not rectify incorrect application of the CPR in order to mimic daily clinical care.Main outcome measuresPrimary outcomes were the diagnostic failure rate, defined as the 3-month incidence of VTE in the non-referred group, and the efficiency, defined as the proportion of non-referred patients in the total study population. Secondary outcomes were determinants for and consequences of incorrect application of the CPRs.ResultsIn 267 of the included 1477 patients, VTE was confirmed. When CPRs were correctly applied, the failure rate was 1.51% (95% CI 0.77 to 2.86), and the efficiency was 58.1% (95% CI 55.2 to 61.0). However, the CPRs were incorrectly applied in 339 patients, which resulted in an increased failure rate of 3.31% (95% CI 1.07 to 8.76) and a decreased efficiency of 35.7% (95% CI 30.6 to 41.1). The presence of concurrent heart failure increased the likelihood of incorrect application (adjusted OR 3.26; 95% CI 1.47 to 7.21).ConclusionsCorrect application of CPRs for VTE in primary care is associated with an acceptable low failure rate at a high efficiency. Importantly, in nearly a quarter of patients, the CPRs were incorrectly applied that resulted in a higher failure rate and a considerably lower efficiency.

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Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽

10.3399/bjgpopen20x101013 ◽

2020 ◽

Vol 4 (1) ◽

pp. bjgpopen20X101013

Author(s):

Jonathan Donald Kennedy ◽

Serena Moran ◽

Sue Garrett ◽

James Stanley ◽

Jenny Visser ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

New Zealand ◽

Primary Care Practice ◽

Social Care ◽

Hospital Admissions ◽

Outpatient Service ◽

Care Practice ◽

Care Needs ◽

Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

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Health Outcomes from Assisted Living Facilities: a Cohort Study of a Primary Care Practice

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2017.12.079 ◽

2018 ◽

Vol 19 (3) ◽

pp. B26

Author(s):

Mairead Bartley ◽

M. Bartley ◽

S. Quigg ◽

A. Chandra ◽

P.Y. Takahashi

Keyword(s):

Primary Care ◽

Cohort Study ◽

Health Outcomes ◽

Assisted Living ◽

Primary Care Practice ◽

Care Practice ◽

Assisted Living Facilities

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Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis

The Annals of Family Medicine ◽

10.1370/afm.1640 ◽

2014 ◽

Vol 12 (4) ◽

pp. 359-366 ◽

Cited By ~ 19

Author(s):

C. Keogh ◽

E. Wallace ◽

K. K. O'Brien ◽

R. Galvin ◽

S. M. Smith ◽

...

Keyword(s):

Primary Care ◽

Descriptive Analysis ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Prediction Rules

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Optimized retrieval of primary care clinical prediction rules from MEDLINE to establish a web-based register

Journal of Clinical Epidemiology ◽

10.1016/j.jclinepi.2010.11.011 ◽

2011 ◽

Vol 64 (8) ◽

pp. 848-860 ◽

Cited By ~ 11

Author(s):

Claire Keogh ◽

Emma Wallace ◽

Kirsty K. O’Brien ◽

Paul J. Murphy ◽

Conor Teljeur ◽

...

Keyword(s):

Primary Care ◽

Clinical Prediction ◽

Clinical Prediction Rules ◽

Web Based ◽

Prediction Rules

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An observational cohort study to produce and evaluate an improved tool to screen older women with back pain for osteoporotic vertebral fractures (Vfrac): study protocol

Archives of Osteoporosis ◽

10.1007/s11657-019-0558-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 1

Author(s):

T. K. Khera ◽

A. Burston ◽

S. Davis ◽

S. Drew ◽

R. Gooberman-Hill ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Older Women ◽

Vertebral Fractures ◽

Screening Tool ◽

Observational Cohort Study ◽

Binary Output ◽

Osteoporotic Vertebral Fractures ◽

Observational Cohort

Abstract Summary The aim of this study is to produce an easy to use checklist for general practitioners to complete whenever a woman aged over 65 years with back pain seeks healthcare. This checklist will produce a binary output to determine if the patient should have a radiograph to diagnose vertebral fracture. Purpose People with osteoporotic vertebral fractures are important to be identified as they are at relatively high risk of further fractures. Despite this, less than a third of people with osteoporotic vertebral fractures come to clinical attention due to various reasons including lack of clear triggers to identify who should have diagnostic spinal radiographs. This study aims to produce and evaluate a novel screening tool (Vfrac) for use in older women presenting with back pain in primary care based on clinical triggers and predictors identified previously. This tool will generate a binary output to determine if a radiograph is required. Methods The Vfrac study is a two-site, pragmatic, observational cohort study recruiting 1633 women aged over 65 years with self-reported back pain. Participants will be recruited from primary care in two sites. The Vfrac study will use data from two self-completed questionnaires, a simple physical examination, a lateral thoracic and lateral lumbar radiograph and information contained in medical records. Results The primary objective is to develop an easy-to-use clinical screening tool for identifying older women who are likely to have vertebral fractures. Conclusions This article describes the protocol of the Vfrac study; ISRCTN16550671.

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Alarm signs and antibiotic prescription in febrile children in primary care: an observational cohort study

British Journal of General Practice ◽

10.3399/bjgp13x669158 ◽

2013 ◽

Vol 63 (612) ◽

pp. e437-e444 ◽

Cited By ~ 18

Author(s):

Gijs Elshout ◽

Yvette van Ierland ◽

Arthur M Bohnen ◽

Marcel de Wilde ◽

Rianne Oostenbrink ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Antibiotic Prescription ◽

Observational Cohort Study ◽

Observational Cohort

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Inequalities in primary care management of knee pain and disability in older adults: an observational cohort study

Rheumatology ◽

10.1093/rheumatology/ker179 ◽

2011 ◽

Vol 50 (10) ◽

pp. 1869-1878 ◽

Cited By ~ 9

Author(s):

C. Jinks ◽

K. Vohora ◽

J. Young ◽

J. Handy ◽

M. Porcheret ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Cohort Study ◽

Knee Pain ◽

Care Management ◽

Observational Cohort Study ◽

Observational Cohort ◽

Primary Care Management

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Common Infections and Antibiotic Prescribing during the First Year of the COVID-19 Pandemic: A Primary Care-Based Observational Cohort Study

Antibiotics ◽

10.3390/antibiotics10121521 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1521

Author(s):

Josi A. Boeijen ◽

Alike W. van der Velden ◽

Saskia Hullegie ◽

Tamara N. Platteel ◽

Dorien L. M. Zwart ◽

...

Keyword(s):

Infectious Disease ◽

Primary Care ◽

Cohort Study ◽

Respiratory Tract ◽

Observational Cohort Study ◽

Antibiotic Prescribing ◽

Prescription Rates ◽

Observational Cohort ◽

Ear Infections ◽

Common Infections

Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care.

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