General practice attendances among patients attending a post-COVID-19 clinic: A pilot study

BackgroundAbout 10-35% of people with COVID-19 merit medical care within three weeks of infection. However, the prevalence of ongoing care needs among those experiencing severe COVID-19 illness is unclear.AimThis pilot study aimed to address this knowledge gap by examining GP attendance trends among patients attending a post-COVID-19 hospital follow-up clinic, 3-6 months after an initial clinic visit.Design, and SettingData was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland.MethodParticipants completed questionnaires outlining their demographics, medical histories, emergency hospital admissions/re-admissions where applicable, and where relevant, GP attendances following hospital discharge. Analyses were conducted using descriptive/inferential statistics.ResultsParticipants’ (n=153) median age =43.5 (IQR =30.9–52.1 years). There were 105 females (68.6%, 95% CI=61.3%–75.9%). Various medical histories were reported among participants. 67 (43.2%, 95% CI=35.9%–51.6%) received emergency COVID-19 hospital care. Older adults, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI=13.7%–34.2%) and 26 (39%, 95% CI=27.3%–50.7%) attended GPs within seven and 30 days of hospital discharge. Older adults, people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees.ConclusionPersistent health issues appear to be common among severe COVID-19 patients, particularly those who are older adults, have pre-existing health problems, and had been in ICU and/or re-admission care. Larger scale studies of ongoing COVID-19 care needs in general practice/primary care are required.

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Mapping end-of-life and anticipatory medications in palliative care patients using a longitudinal general practice database

Palliative & Supportive Care ◽

10.1017/s1478951521000092 ◽

2021 ◽

pp. 1-7

Author(s):

H. Khalil ◽

M. Garett ◽

A. Byrne ◽

P. Poon ◽

K. Gardner ◽

...

Keyword(s):

Health Care ◽

Palliative Care ◽

General Practice ◽

End Of Life ◽

Nurse Practitioners ◽

Hospital Admissions ◽

Population Level ◽

Screening Tools ◽

Care Needs ◽

Stakeholder Consultation

Abstract Objective End-of-life and anticipatory medications (AMs) have been widely used in various health care settings for people approaching end-of-life. Lack of access to medications at times of need may result in unnecessary hospital admissions and increased patient and family distress in managing palliative care at home. The study aimed to map the use of end-of-life and AM in a cohort of palliative care patients through the use of the Population Level Analysis and Reporting Data Space and to discuss the results through stakeholder consultation of the relevant organizations. Methods A retrospective observational cohort study of 799 palliative care patients in 25 Australian general practice health records with a palliative care referral was undertaken over a period of 10 years. This was followed by stakeholders’ consultation with palliative care nurse practitioners and general practitioners who have palliative care patients. Results End-of-life and AM prescribing have been increasing over the recent years. Only a small percentage (13.5%) of palliative care patients received medications through general practice. Stakeholders’ consultation on AM prescribing showed that there is confusion about identifying patients needing medications for end-of-life and mixed knowledge about palliative care referral pathways. Significance of results Improved knowledge and information around referral pathways enabling access to palliative care services for general practice patients and their caregivers are needed. Similarly, the increased utility of screening tools to identify patients with palliative care needs may be useful for health care practitioners to ensure timely care is provided.

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Abstract O.02: Validation of Kawasaki Disease Incidence Assessment as Derived from Health System Administrative Databases vs. Active Retrospective Surveillance in Ontario, Canada

Circulation ◽

10.1161/circ.131.suppl_2.o02 ◽

2015 ◽

Vol 131 (suppl_2) ◽

Author(s):

Cedric Manlhiot ◽

Sunita O’Shea ◽

Bailey Bernknopf ◽

Michael Labelle ◽

Mathew Mathew ◽

...

Keyword(s):

Kawasaki Disease ◽

Hospital Discharge ◽

Hospital Admissions ◽

Disease Incidence ◽

Administrative Databases ◽

Canadian Hospital ◽

Hospital Discharge Database ◽

Incident Cases ◽

Discharge Database

Introduction: Historically, 2 methods have been used to determine the incidence of Kawasaki disease (KD): active or passive surveillance, or the use of administrative databases. Given the increasing regulatory requirements, mainly around patient privacy, periodic retrospective surveillances have become increasingly challenging. Administrative databases are not curated datasets and doubts have been cast on their accuracy. Methods: The Hospital for Sick Children has been conducting retrospective triennial surveillances of KD since 1995 by contacting all hospitals in Ontario and manually reviewing all cases through chart review, reconciling inter-hospital transfers and multiple readmissions. We queried the Canadian hospital discharge database (Canadian Institute for Health Information) for hospitalizations associated with a diagnosis of KD between 2004-9. The administrative dataset was manually reviewed; patient national health number, institution and dates of admission/discharge were used to identify inter-hospital transfers, readmission and follow-up episodes. Results: The Canadian hospital discharge database reported 1,685 admissions during the study period (281±44 per year) for Ontario. Manual review of the dataset identified 219 (13%) as inter-hospital transfers (56, 26%), readmissions (122, 56%), admissions for follow-up of coronary artery aneurysms (14, 6%) or hospital admissions not related to KD (27, 12%). When these admissions were removed, the total number of incident cases for the study period was 1,466 (244±45 per year). The retrospective triennial surveillance identified 1,373 KD cases during the same period (229±33 per year). The Canadian hospital discharge database overestimated the number of cases in all 6 years by an average of 6.7±5.9%. The overestimation likely comes from patients who were originally diagnosed with KD but in whom the diagnosis of KD was subsequently excluded (historically ~5-6%). Conclusions: Reliance on administrative data to determine incidence of KD is possible and accurate; data should be manually reviewed to remove non-incident cases and estimates should be adjusted to reflect the expected proportion of patients in whom the diagnosis of KD will be subsequently excluded.

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UNALTERED IMAGE OF HEALTH MAINTENANCE: AN OBSERVATION OF NON-PARTICIPANTS IN A SWEDISH COHORT STUDY OF 85 TO 86 YEAR OLDS

Journal of Frailty & Aging ◽

10.14283/jfa.2015.47 ◽

2015 ◽

pp. 1-7

Author(s):

H.-J. DONG ◽

E. WRESSLE ◽

J. MARCUSSON

Keyword(s):

Home Visit ◽

Hospital Admissions ◽

Clinic Visit ◽

Old People ◽

Related Factors ◽

Health Maintenance ◽

Very Old ◽

Significant Difference ◽

Sheltered Accommodation

Background: Selection bias is often inevitable in epidemiologic studies. It is not surprising that study conclusions based on participants’ health status are frequently questioned. Objective: This study aimed to assess whether the non-participants affected the characteristics of a general population of the very old people. Design, Setting and Participants: Prospective, cross-sectional (N=650, aged 85 years old) analysis and 1-year follow-up (n=273), in Linköping, Sweden. Measurements: We analysed data on health-related factors from a postal questionnaire, a home visit and a clinic visit at baseline and at the 1-year follow-up. We calculated the effect size to evaluate the degree of differences between the groups. Results: A greater proportion of non-participants resided in sheltered accommodation or nursing homes (participants vs non-response vs refusal, 11% vs 22% vs 40, P<0.001, φ=0.24). During the home visit or clinic visit, a higher proportion of dropouts reported mid-severe problems in EQ-5D domains (mobility and self-care) and limitations in personal activities of daily living, but the differences between participants and dropouts were very small (φ<0.2). No significant difference was found between the groups with regard to emergency room visits or hospital admissions, despite the fact that more participants than dropouts (φ=0.23) had multimorbidities (≥2 chronic diseases). Living in sheltered accommodation or a nursing home (odds ratio (OR), 2.8; 95% confidence interval (CI), 1.5-5), female gender (OR, 1.8; 95% CI, 1.1-3.1) and receiving more home visits in primary care (OR, 1.03; 95% CI, 1-1.06) contributed positively to drop out in the data collection stages over the study period. Conclusion: Non-participants were not considered to be a group with worse health. Mobility problems may influence very old people when considering further participation, which threatens attrition.

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A randomised controlled trial exploring the impact of a dedicated Health and Social Care Professionals team in the Emergency Department on the quality, safety, clinical and cost-effectiveness of care for older adults: Study Protocol

10.21203/rs.2.12207/v2 ◽

2019 ◽

Author(s):

Marica Cassarino ◽

Katie Robinson ◽

Íde O’Shaughnessy ◽

Eimear Smalle ◽

Stephen White ◽

...

Keyword(s):

Older Adults ◽

Cost Effectiveness ◽

Randomised Controlled Trial ◽

Hospital Admissions ◽

Controlled Trial ◽

Health And Social Care ◽

Effectiveness Of Care ◽

Randomised Controlled ◽

The Impact

Abstract Background : Older people are frequent Emergency Department (ED) users who present with complex issues that are linked to poorer health outcomes post-index visit, often have increased ED length of stay and tend to have raised healthcare costs. Encouraging evidence suggests that ED teams involving health and social care professionals (HSCPs) can contribute to enhanced patient flow and improved patient experience by improving care decision-making and thus promoting timely and effective care. However, the evidence supporting the impact of HSCPs teams assessing and intervening with older adults in the ED is limited and identifies important methodological limitations, highlighting the need for more robust and comprehensive investigations of this model of care. This study aims to evaluate the impact of a dedicated ED-based HSCP team on the quality, safety, clinical and cost-effectiveness of care of older adults when compared to usual care. Methods : The study is a single-site randomised controlled trial whereby patients aged ≥65 years who present to the ED of a large Irish hospital will be randomised to the experimental group (ED-based HSCP assessment and intervention) or the control group (usual ED care). The recruitment target is 320 participants. The HSCP team will provide a comprehensive functional assessment as well as interventions to promote a safe discharge for the patient. The primary outcome is ED length of stay (from arrival to discharge). Secondary outcomes include: rates of hospital admissions from the ED, ED re-visits, unplanned hospital admissions and healthcare utilisation at 30-days, four and six-month follow-up; patient functional status and quality of life (at baseline and follow-up); patient satisfaction; costs-effectiveness in terms of costs associated with ED-based HSCP compared to usual care; and perceptions on implementation by ED staff members. Discussion : This is the first randomised controlled trial testing the impact of HSCPs working in teams in the ED on the quality, safety, clinical and cost-effectiveness of care for older patients. The findings of the study will provide important information on the effectiveness of this model of care for future implementation. Trial registration : ClinicalTrials.gov, NCT03739515; registered on 12 th November 2018. Protocol version 1. URL: https://clinicaltrials.gov/ct2/show/NCT03739515

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The Prevalence and Impact on Patient Outcomes of Malnutrition Among Older Adults Presenting at an Irish Emergency Department: A Secondary Analysis of the OPTIMEND Trial

10.21203/rs.3.rs-36075/v1 ◽

2020 ◽

Author(s):

Anne Griffin ◽

Aoife O´Neill ◽

Margaret O´Connor ◽

Damien Ryan ◽

Audrey Tierney ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Functional Ability ◽

Hospital Admissions ◽

Functional Decline ◽

Secondary Analysis ◽

Adverse Outcomes ◽

Nutrition Status

Abstract BackgroundMalnutrition is common among older adults and is associated with adverse outcomes but remains undiagnosed on healthcare admissions. Older adults use emergency departments (EDs) more than any other age group. This study aimed to determine the prevalence and factors associated with malnutrition on admission and with adverse outcomes post-admission among older adults attending an Irish ED. MethodsSecondary analysis of data collected from a randomised trial exploring the impact of a dedicated team of health and social care professionals on the care of older adults in the ED. Nutritional status was determined using the Mini Nutritional Assessment- short form. Patient parameters and outcomes included health related quality of life, functional ability, frailty, hospital admissions, falls history and clinical outcomes at index visit, 30-day and 6-month follow up. Aggregate anonymised participant data linked from baseline to 30-days and 6-month follow-up were used for statistical analysis.ResultsAmong 353 older adults (mean age 79.6 years (SD=7.0); 59.2% (n=209) female) the prevalence of malnutrition was 7.6% (n=27) and ‘risk of malnutrition’ was 28% (n=99). At baseline, those who were malnourished had poorer quality of life scores, functional ability, were more frail, more likely to have been hospitalised or had a fall recently, had longer waiting times and were more likely to be discharged home from the ED than those who had normal nutrition status. At 30-days, those who were malnourished were more likely to have reported another hospital admission, a nursing home admission, reduced quality of life and functional decline than older adults who had normal nutrition status at the baseline ED visit. At 6-months, a reported further decline in functional ability was more likely among those who were malnourished compared to those who had normal nutritional status. ConclusionOver one-third of older adults admitted to an Irish ED are either malnourished or at risk of malnourishment. Malnutrition was associated with a longer stay in the ED, functional decline, poorer quality of life, increased risk of hospital admissions and a greater likelihood of admission to long-term care at 30 days. Trial registration: Protocol registered in ClinicalTrials.gov, ID: NCT03739515, first posted November 13, 2018. https://clinicaltrials.gov/ct2/show/NCT03739515

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Telehealth Facilitates Value-Based Care in Emergency Department Settings

10.1093/med/9780190066475.003.0022 ◽

2021 ◽

pp. 256-261

Author(s):

Deborah Ann Mulligan ◽

Krista Drobac ◽

Robert Shesser

Keyword(s):

Value Chain ◽

Hospital Admissions ◽

Leadership Role ◽

Emergency Physicians ◽

Coordinated Care ◽

Care Needs ◽

Unscheduled Care ◽

Value Based Care

Spurred by the COVID-19 pandemic, the health care industry is increasingly aware of benefits emergency physicians could contribute to value-based care. The use of emergency telehealth—to reduce the number of hospital admissions, readmissions, and missed outpatient follow-up appointments—will play an increasing role in the shift to value-based care paradigms. Although certain legal, regulatory, and reimbursement challenges remain, the COVID-19 outbreak should stimulate lawmakers and regulatory agencies to promulgate further measures that facilitate widespread adoption of telemedicine, which will inevitably extend into emergency care. Emergency physicians should play a leadership role in the development and implementation of coordinated care before, during, and after acute unscheduled care needs of patients. Coordinated care is a recognized role of emergency telehealth in the value chain. For emergency telehealth to be effective, it must be appropriately integrated into standard practice of emergency medicine.

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Delirium and post-discharge dementia: results from a cohort of older adults without baseline cognitive impairment

Age and Ageing ◽

10.1093/ageing/afz107 ◽

2019 ◽

Vol 48 (6) ◽

pp. 845-851 ◽

Cited By ~ 5

Author(s):

Flavia Barreto Garcez ◽

Daniel Apolinario ◽

Flavia Campora ◽

Jose Antonio Esper Curiati ◽

Wilson Jacob-Filho ◽

...

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Clinical History ◽

University Hospital ◽

Proportional Hazard ◽

Post Discharge ◽

Preventable Risk Factor ◽

Admission Data ◽

Incident Dementia

Abstract Objectives to investigate the association between delirium occurrence in acutely ill older adults and incident dementia after hospital discharge. Methods retrospective cohort study examining acutely ill older adults aged +60 years and consecutively admitted to the geriatric ward of a tertiary university hospital from 2010 to 2016. Inclusion criteria were absence of baseline cognitive decline on admission and documented clinical follow-up of +12 months after discharge. Admission data were collected from our local database, including results from a standardized comprehensive geriatric assessment completed for every patient. Pre-existing cognitive decline was identified based on clinical history, CDR and IQCODE-16. Delirium was diagnosed using short-CAM criteria, while post-discharge dementia after 12 months was identified based on medical records’ review. We used competing-risk proportional-hazard models to explore the association between delirium and post-discharge dementia. Results we included 309 patients. Mean age was 78 years, and 186 (60%) were women. Delirium was detected in 66 (21%) cases. After a median follow-up of 24 months, 21 (32%) patients who had experienced delirium progressed with dementia, while only 38 (16%) of those without delirium had the same outcome (P = 0.003). After adjusting for possible confounders, delirium was independently associated with post-discharge dementia with a sub-hazard ratio of 1.94 (95%CI = 1.10–3.44; P = 0.022). Conclusion one in three acutely ill older adults who experienced delirium in the hospital developed post-discharge dementia during follow-up. Further understanding of delirium as an independent and potentially preventable risk factor for cognitive decline emphasizes the importance of systematic initiatives to fight it.

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Efficacy of Using Physical Activity Mentors to Increase the Daily Steps of Older Adults in the Primary Care Setting: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2012-0120 ◽

2014 ◽

Vol 22 (1) ◽

pp. 16-24 ◽

Cited By ~ 5

Author(s):

Karen A. Croteau ◽

Vijiayurani Suresh ◽

Elanna Farnham

Keyword(s):

Physical Activity ◽

Older Adults ◽

Primary Care ◽

Pilot Study ◽

Repeated Measures ◽

Care Setting ◽

Primary Care Setting ◽

Chronic Illnesses ◽

Main Effects

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n= 14) or a MIM+ mentor group (n= 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps,F(2.324, 59.104) = 4.168,p= .015, but no main effects for group,F(1, 25) = 2.988,p= .096, or time-by-group interaction,F(2.324, 59.104) = 0.905,p= .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

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Drug prescriptions and dementia incidence: a medication-wide association study of 17000 dementia cases among half a million participants

Journal of Epidemiology & Community Health ◽

10.1136/jech-2021-217090 ◽

2021 ◽

pp. jech-2021-217090

Author(s):

Tim Wilkinson ◽

Christian Schnier ◽

Kathryn Bush ◽

Kristiina Rannikmäe ◽

Ronan A Lyons ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Association Study ◽

Hospital Admissions ◽

Cox Regression ◽

Mortality Data ◽

Care Hospital ◽

Dementia Incidence ◽

Primary Care Hospital

BackgroundPrevious studies have suggested that some medications may influence dementia risk. We conducted a hypothesis-generating medication-wide association study to investigate systematically the association between all prescription medications and incident dementia.MethodsWe used a population-based cohort within the Secure Anonymised Information Linkage (SAIL) databank, comprising routinely-collected primary care, hospital admissions and mortality data from Wales, UK. We included all participants born after 1910 and registered with a SAIL general practice at ≤60 years old. Follow-up was from each participant’s 60th birthday to the earliest of dementia diagnosis, deregistration from a SAIL general practice, death or the end of 2018. We considered participants exposed to a medication if they received ≥1 prescription for any of 744 medications before or during follow-up. We adjusted for sex, smoking and socioeconomic status. The outcome was any all-cause dementia code in primary care, hospital or mortality data during follow-up. We used Cox regression to calculate hazard ratios and Bonferroni-corrected p values.ResultsOf 551 344 participants, 16 998 (3%) developed dementia (median follow-up was 17 years for people who developed dementia, 10 years for those without dementia). Of 744 medications, 221 (30%) were associated with dementia. Of these, 217 (98%) were associated with increased dementia incidence, many clustering around certain indications. Four medications (all vaccines) were associated with a lower dementia incidence.ConclusionsAlmost a third of medications were associated with dementia. The clustering of many drugs around certain indications may provide insights into early manifestations of dementia. We encourage further investigation of hypotheses generated by these results.

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Revision of the Beginning Breastfeeding Survey: A Cumulative Assessment of Breastfeeding

Journal of Nursing Measurement ◽

10.1891/1061-3749.21.1.80 ◽

2013 ◽

Vol 21 (1) ◽

pp. 80-95

Author(s):

Pamela Mulder

Keyword(s):

Pilot Study ◽

Breast Milk ◽

Hospital Discharge ◽

Infant Feeding ◽

Infant Formula ◽

Predictive Validity ◽

Coefficient Alpha ◽

University Hospital ◽

Infant Feeding Decisions

Background and Purpose: Women use their cumulative breastfeeding experiences, in combination with other factors, to make their infant feeding decisions. This pilot study assessed the reliability and predictive validity of the revised Beginning Breastfeeding Survey-Cumulative (BBS-C). Methods: 25 women were recruited prenatally from a university hospital. The BBS-C was completed before hospital discharge. Infant feeding outcomes were measured at 1 and 3 months postpartum. Results: Participants were 17–40 years old, mostly married, Whites, and well-educated. Coefficient alpha was .92–.94. The BBS-C predicted an infant not receiving breast milk, not feeding from the breast, and receiving infant formula feedings. Conclusions: In this sample, the BBS-C had strong reliability and predictive validity. Further testing should assess reliability and predictive validity in a wider range of populations and settings.

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