scholarly journals Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK

2020 ◽  
Vol 70 (697) ◽  
pp. e540-e547 ◽  
Author(s):  
Mark Joy ◽  
Dylan McGagh ◽  
Nicholas Jones ◽  
Harshana Liyanage ◽  
Julian Sherlock ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Temporal Trends ◽  
Rapid Change ◽  
Home Visits ◽  
Relative Increase ◽  
Cross Sectional ◽  
Sentinel Network ◽  
Database Study ◽  
Face To Face

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined.AimTo assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic.Design and settingA cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK.MethodThe authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR).ResultsAcross 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70–82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41).ConclusionPrimary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.

scholarly journals Identified mental disorders in older adults in primary care: A cross-sectional database study

2018 ◽  
Vol 24 (1) ◽  
pp. 84-91 ◽  
Author(s):  
Geoff McCombe ◽  
Frank Fogarty ◽  
Davina Swan ◽  
Ailish Hannigan ◽  
Gerard M. Fealy ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Mental Disorders ◽  
Cross Sectional ◽  
Database Study

scholarly journals Prevalence and factors associated with chronic wounds in older adults in primary care

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Chrystiany Plácido de Brito Vieira ◽  
Telma Maria Evangelista de Araújo
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Primary Care ◽  
Chronic Wounds ◽  
Family Income ◽  
Family Health ◽  
Multivariate Logistic Regression Model ◽  
Cross Sectional ◽  
Diabetic Ulcer ◽  
Dietary Restrictions

ABSTRACT Objective: To analyze the prevalence of pressure injuries, diabetic and vasculogenic ulcers and associated factors in older adults attended in primary care. Method: A cross-sectional, analytical study with older adults attended in the Family Health Strategy in a Brazilian municipality. Data collection was performed from January to March 2016 using interviews and evaluations of injuries. The variables were submitted to the multivariate logistic regression model using the odds ratio, with their respective 95% confidence intervals and significance set at <0.05. Results: 339 older adults participated in the study. The mean age was 71.1 years, 67.3% were female, 44% were illiterate, 85% had low family income, 91.7% had underlying diseases, 37.2% had dietary restrictions, and 76.1% did not practice physical activity. The prevalence of pressure injury was 5.0%, diabetic ulcer 3.2%, and vasculogenic ulcer 2.9%. Not working and not regularly practicing physical activity increased the chances of presenting these injuries by 1.5 and 2.3 times, respectively. Being actively mobility and not having dietary restrictions were protective factors for not developing chronic wounds. Conclusion: The prevalence of injuries among older adults was high, and its occurrence is associated with socioeconomic and clinical characteristics.

scholarly journals Trends and Inequalities in the Incidence of Acute Myocardial Infarction among Beijing Townships, 2007–2018

2021 ◽  
Vol 18 (23) ◽  
pp. 12276
Author(s):  
Jie Chang ◽  
Qiuju Deng ◽  
Moning Guo ◽  
Majid Ezzati ◽  
Jill Baumgartner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Urban Areas ◽  
Disease Surveillance ◽  
Temporal Trends ◽  
Relative Increase ◽  
Mitigation Strategies ◽  
Middle Aged ◽  
Geographic Variations ◽  
Cross Sectional

Acute myocardial infarction (AMI) poses a serious disease burden in China, but studies on small-area characteristics of AMI incidence are lacking. We therefore examined temporal trends and geographic variations in AMI incidence at the township level in Beijing. In this cross-sectional analysis, 259,830 AMI events during 2007–2018 from the Beijing Cardiovascular Disease Surveillance System were included. We estimated AMI incidence for 307 consistent townships during consecutive 3-year periods with a Bayesian spatial model. From 2007 to 2018, the median AMI incidence in townships increased from 216.3 to 231.6 per 100,000, with a greater relative increase in young and middle-aged males (35–49 years: 54.2%; 50–64 years: 33.2%). The most pronounced increases in the relative inequalities was observed among young residents (2.1 to 2.8 for males and 2.8 to 3.4 for females). Townships with high rates and larger relative increases were primarily located in Beijing’s northeastern and southwestern peri-urban areas. However, large increases among young and middle-aged males were observed throughout peri-urban areas. AMI incidence and their changes over time varied substantially at the township level in Beijing, especially among young adults. Targeted mitigation strategies are required for high-risk populations and areas to reduce health disparities across Beijing.

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

scholarly journals Acceptability and Results of Dementia Screening Among Older Adults in the United States

2017 ◽  
Vol 15 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Amanda Harrawood ◽  
Nicole R. Fowler ◽  
Anthony J. Perkins ◽  
Michael A. LaMantia ◽  
Malaz A. Boustani
Keyword(s):  
United States ◽  
Older Adults ◽  
Primary Care ◽  
The United States ◽  
Cognitive Screening ◽  
Cross Sectional ◽  
Community Screening ◽  
Positive Screen ◽  
Dementia Screening ◽  
Primary Care Patients

Objectives: To measure older adults acceptability of dementia screening and assess screening test results of a racially diverse sample of older primary care patients in the United States. Design: Cross-sectional study of primary care patients aged 65 and older. Setting: Urban and suburban primary care clinics in Indianapolis, Indiana, in 2008 to 2009. Participants: Nine hundred fifty-four primary care patients without a documented diagnosis of dementia. Measurements: Community Screening Instrument for Dementia, the Mini-Mental State Examination, and the Telephone Instrument for Cognitive Screening. Results: Of the 954 study participants who consented to participate, 748 agreed to be screened for dementia and 206 refused screening. The overall response rate was 78.4%. The positive screen rate of the sample who agreed to screening was 10.2%. After adjusting for demographic differences the following characteristics were still associated with increased likelihood of screening positive for dementia: age, male sex, and lower education. Patients who believed that they had more memory problems than other people of their age were also more likely to screen positive for dementia. Conclusion: Age and perceived problems with memory are associated with screening positive for dementia in primary care.

scholarly journals Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Johnny T. K. Cheung ◽  
Samuel Y.S. Wong ◽  
Dicken C. C. Chan ◽  
Dexing Zhang ◽  
Lawrence H. F. Luk ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Hong Kong ◽  
Chronic Disease ◽  
Disease Management ◽  
Continuity Of Care ◽  
Chronic Disease Management ◽  
Outpatient Clinics ◽  
Cross Sectional ◽  
The Public

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73). Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

scholarly journals Patient Portal Use, Perceptions of Electronic Health Record Value, and Self-Rated Primary Care Quality Among Older Adults: Cross-sectional Survey (Preprint)

2020 ◽  
Author(s):  
Dori A Cross ◽  
Zachary Levin ◽  
Minakshi Raj
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Electronic Health Record ◽  
Care Quality ◽  
Health Record ◽  
Patient Portal ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Value Perception ◽  
Primary Care Quality

BACKGROUND Older adults are increasingly accessing information and communicating using patient-facing portals available through their providers’ electronic health record (EHR). Most theories of technology acceptance and use suggest that patients’ overall satisfaction with care should be independent of their chosen level of portal engagement. However, achieving expected benefits of portal use depends on demonstrated support from providers to meet these expectations. This is especially true among older adults, who may require more guidance. However, little is known about whether misalignment of expectations around technology-facilitated care is associated with lower perceptions of care quality. OBJECTIVE The aims of this study were to analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement and whether perceptions of how well their provider uses the EHR to support care moderates this relationship. METHODS We conducted a cross-sectional survey analysis of 158 older adults over the age of 65 (average age 71.4 years) across Michigan using a 13-measure composite of self-assessed health care quality. Portal use was categorized as none, moderate (use of 1-3 functionalities), or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient–provider relationship. RESULTS Moderate portal users, compared to those who were extensive users, had lower estimated care quality (–0.214 on 4-point scale; <i>P</i>=.03). Differences between extensive portal users and nonportal users were not significant. Quality perception was only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups. CONCLUSIONS Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.

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