Referral rates for children with acute gastroenteritis: a retrospective cohort study

BackgroundHospital admission rates are increasing for children with acute gastroenteritis. However, it is unknown whether this increase is accompanied by an increase in referral rates from GPs due to increased workloads in primary care out-of-hours (OOH) services.AimTo assess trends in referral rates from primary care OOH services to specialist emergency care for children presenting with acute gastroenteritis.Design & settingThis retrospective cohort study covered a period from September 2007–September 2014. Children aged 6 months to 6 years presenting with acute gastroenteritis to a primary care OOH service were included.MethodPseudonymised data were obtained, and children were analysed overall and by age category. Χ2 trend tests were used to assess rates of acute gastroenteritis, referrals, face-to-face contacts, and oral rehydration therapy (ORT) prescriptions.ResultsThe data included 12 455 children (6517 boys), with a median age of 20.2 months (interquartile range [IQR] 11.6 to 36.0 months). Over 7 years, incidence rates of acute gastroenteritis decreased significantly, and face-to-face contact rates increased significantly (both, P<0.01). However, there was no significant trend for referral rates (P = 0.87) or prescription rates for ORT (P = 0.82). Subgroup analyses produced comparable results, although there was an increase in face-to-face contact rates for the older children.ConclusionIncidence rates for childhood acute gastroenteritis presenting in OOH services decreased and referral rates did not increase significantly. These findings may be useful as a reference for the impact of new interventions for childhood acute gastroenteritis.

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The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care

Journal of Primary Care & Community Health ◽

10.1177/21501327211051930 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110519

Author(s):

Thuraiya Al Harthi ◽

Huda Anwar ◽

Anwaar Al Lawati ◽

Fathyia Al Shuriqi ◽

Fakhria Al Rashdi ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Glycated Hemoglobin ◽

Telephone Consultation ◽

Face To Face ◽

Before And After ◽

Patients With Diabetes ◽

The Impact

Background COVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients’ and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients’ glycemic outcome in Oman. Aim and Objectives To explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients’ glycemic outcome. Methods Before and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients’ glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients’ HbA1c and mode of consultation was measured using multivariable regression analysis. Results A total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was −0.3 (−2.3 to 1.5), P = .734 for telephone consultation alone, −0.5 (−2.4 to 1.4), P = .613 for face-to-face alone, and −0.5 (−2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation. Conclusion Despite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

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Changes in presentations with features potentially indicating cancer in primary care during the COVID-19 pandemic: a retrospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-050131 ◽

2021 ◽

Vol 11 (5) ◽

pp. e050131

Author(s):

Lauren J Scott ◽

Mairead Murphy ◽

Sarah Price ◽

Rhys Lewis ◽

Rachel Denholm ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Signs And Symptoms ◽

Patient Characteristics ◽

Face To Face ◽

Number Of Patients ◽

Potential Cancer ◽

Remote Consultations

ObjectivesTo investigate how the COVID-19 pandemic affected the number of people aged 50+ years presenting to primary care with features that could potentially indicate cancer, and to explore how reporting differed by patient characteristics and in face-to-face vs remote consultations.Design, setting and participantsA retrospective cohort study of general practitioner (GP), nurse and paramedic primary care consultations in 21 practices in South-West England covering 123 947 patients. The models compared potential cancer indicators reported in April–July 2019 with April–July 2020.Main outcome measuresPotential indicators of cancer were identified using code lists for symptoms, signs, test results and diagnoses listed in the National Institute for Health and Care Excellence suspected cancer referral guidance (NG12).ResultsDuring April–July 2019, 17% of registered patients aged 50+ years reported a potential cancer indicator in a consultation with a GP or nurse. During April–July 2020, this reduced to 11% (incidence rate ratio (IRR) 0.64, 95% CI 0.62 to 0.67, p<0.001). Reductions in potential cancer indicators were stable across age group, sex, ethnicity, index of multiple deprivation quintile and shielding status, but less marked in patients with mental health conditions than without (IRR 0.75, 95% CI 0.72 to 0.79, interaction p<0.001). Proportions of GP consultations with potential indicators of cancer reduced between 2019 and 2020 for face-to-face consultations (IRR 0.84, 95% CI 0.76 to 0.92, p<0.001) and increased for remote consultations (IRR 1.17, 95% CI 1.07 to 1.29, p=0.001), although it remained lower in remote consulting than face-to-face in April–July 2020. This difference was greater for nurse/paramedic consultations (face-to-face: IRR 0.61, 95% CI 0.44 to 0.83, p=0.002; remote: IRR 1.60, 95% CI 1.10 to 2.333, p=0.014).ConclusionThe number of patients consulting with presentations that could potentially indicate cancer reduced during the first wave of the COVID-19 pandemic. Patients should be encouraged to continue contacting primary care for persistent signs and symptoms, and GPs and nurses should be encouraged to probe patients for further information during remote consulting, in the absence of non-verbal cues.

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Effect of COVID-19 pandemic on glycaemic monitoring and other processes of care in Type 2 Diabetes: Protocol for a retrospective cohort study (Preprint)

10.2196/preprints.35971 ◽

2021 ◽

Author(s):

Mekha Mathew ◽

Jeremy van Vlymen ◽

Bernardo Meza-Torres ◽

William Hinton ◽

Gayathri Delanerolle ◽

...

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Cohort Study ◽

Retrospective Cohort ◽

Glycated Haemoglobin ◽

First Year ◽

Process Of Care ◽

Face To Face ◽

The Impact

BACKGROUND Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM delivered in primary care services advise ‘routine annual reviews’ and were developed when face-to-face consultations were the norm. The shift in consultations from face-to-face to remoted-consultations caused a reduction in direct clinical contact and may impact on the process of care for people with T2DM. OBJECTIVE The aim of this study is to explore the impact of the first year of COVID-19 pandemic on the monitoring of T2DM with ‘routine annual reviews’ from a national primary care perspective in England. METHODS A retrospective cohort study of adults with T2DM will be performed using routinely collected primary care data from the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC). We will describe the change in the rate of monitoring of glycated haemoglobin (HbA1c) between the first year of the COVID pandemic (2020) and the preceding year (2019). We will also report any change in the eight checks that compose the components of these reviews. The change in glycated haemoglobin (HbA1c) monitoring rates will be determined using a multi-level logistic regression model adjusting for patient and practice characteristics and similarly the change in a composite measure of the completeness of all eight checks will be modelled using ordinal regression. The models will be adjusted for the following patient level variables: age, gender, socio economic status, ethnicity, COVID-19 shielding status, duration of diabetes, comorbidities; then at practice-level: urban versus rural, practice size, Quality and Outcomes Framework (QOF) achievement, NHS Region and proportion of face-to-face consultations. Ethical approval was provided by the University of Oxford Medical Sciences Interdivisional Research Ethics Committee (2nd September 2021, Reference: R77306/RE001). RESULTS To create the retrospective diabetic cohort, we will use a representative sample of the adult Orchid-RCGP RSC population of approximately 6.5 million from 721 practices, 128 (17.8%) in the rural setting and 593 (82.2%) urban. The number of adults aged between 18 and 115 years, with a T2DM diagnosis was 393,987 (6.1%). CONCLUSIONS The COVID-19 pandemic has impacted on the delivery of care but little is known on the process of care of people with T2DM. This study will report the impact of the COVID-19 pandemic on these process of care.

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The Incidence of Psychotic Disorders and Area-level Marginalization in Ontario, Canada: A Population-based Retrospective Cohort Study

The Canadian Journal of Psychiatry ◽

10.1177/07067437211011852 ◽

2021 ◽

pp. 070674372110118

Author(s):

Martin Rotenberg ◽

Andrew Tuck ◽

Kelly K. Anderson ◽

Kwame McKenzie

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Psychotic Disorders ◽

Geographic Location ◽

Population Based ◽

Incidence Rates ◽

Future Research ◽

Incident Cases ◽

The Impact

Background: There is limited Canadian evidence on the impact of socio-environmental factors on psychosis risk. We sought to examine the relationship between area-level indicators of marginalization and the incidence of psychotic disorders in Ontario. Methods: We conducted a retrospective cohort study of all people aged 14 to 40 years living in Ontario in 1999 using health administrative data and identified incident cases of psychotic disorders over a 10-year follow-up period. Age-standardized incidence rates were estimated for census metropolitan areas (CMAs). Poisson regression models adjusting for age and sex were used to calculate incidence rate ratios (IRRs) based on CMA and area-level marginalization indices. Results: There is variation in the incidence of psychotic disorders across the CMAs. Our findings suggest a higher rate of psychotic disorders in areas with the highest levels of residential instability (IRR = 1.26, 95% confidence interval [CI], 1.18 to 1.35), material deprivation (IRR = 1.30, 95% CI, 1.16 to 1.45), ethnic concentration (IRR = 1.61, 95% CI, 1.38 to 1.89), and dependency (IRR = 1.35, 95% CI, 1.18 to 1.54) when compared to areas with the lowest levels of marginalization. Marginalization attenuates the risk in some CMAs. Conclusions: There is geographic variation in the incidence of psychotic disorders across the province of Ontario. Areas with greater levels of marginalization have a higher incidence of psychotic disorders, and marginalization attenuates the differences in risk across geographic location. With further study, replication, and the use of the most up-to-date data, a case may be made to consider social policy interventions as preventative measures and to direct services to areas with the highest risk. Future research should examine how marginalization may interact with other social factors including ethnicity and immigration.

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Overall survival based on oncologist density in the United States: A retrospective cohort study

PLoS ONE ◽

10.1371/journal.pone.0250894 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0250894

Author(s):

Sudeep K. Siddappa Malleshappa ◽

Smith Giri ◽

Smit Patel ◽

Tapan Mehta ◽

Leonard Appleman ◽

...

Keyword(s):

Primary Care ◽

Overall Survival ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Care Services ◽

The United States ◽

Rank Test ◽

Care Services ◽

The Impact

Medically underserved areas (MUA) or health professional shortage areas (HPSA) designations are based on primary care health services availability. These designations are used in recruiting international medical graduates (IMGs) trained in primary care or subspecialty (e.g., oncology) to areas of need. Whether the MUA/HPSA designation correlates with Oncologist Density (OD) and supports IMG oncologists’ recruitment to areas of need is unknown. We evaluated the concordance of OD with the designation of MUAs/HPSAs and evaluated the impact of OD and MUA/HPSA status on overall survival. We conducted a retrospective cohort study of patients diagnosed with hematological malignancies or metastatic solid tumors in 2011 from the Surveillance Epidemiology and End Results (SEER) database. SEER was linked to the American Medical Association Masterfile to calculate OD, defined as the number of oncologists per 100,000 population at the county level. We calculated the proportion of counties with MUA or HPSA designation for each OD category. Overall survival was estimated using the Kaplan-Meier method and compared between the OD category using a log-rank test. We identified 68,699 adult patients with hematologic malignancies or metastatic solid cancers in 609 counties. The proportion of MUA/HPSA designation was similar across counties categorized by OD (93.2%, 95.4%, 90.3%, and 91.7% in counties with <2.9, 2.9–6.5, 6.5–8.4 and >8.4 oncologists per 100K population, p = 0.7). Patients’ median survival in counties with the lowest OD was significantly lower compared to counties with the highest OD (8 vs. 11 months, p<0.0001). The difference remained statistically significant in multivariate and subgroup analysis. MUA/HPSA status was not associated with survival (HR 1.03, 95%CI 0.97–1.09, p = 0.3). MUA/HPSA designation based on primary care services is not concordant with OD. Patients in counties with lower OD correlated with inferior survival. Federal programs designed to recruit physicians in high-need areas should consider the availability of health care services beyond primary care.

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The impact of penicillin allergy labels on antibiotic and health care use in primary care: a retrospective cohort study

Clinical and Translational Allergy ◽

10.1186/s13601-017-0154-y ◽

2017 ◽

Vol 7 (1) ◽

Cited By ~ 15

Author(s):

Tanly Su ◽

Berna D. L. Broekhuizen ◽

Theo J. M. Verheij ◽

Heike Rockmann

Keyword(s):

Primary Care ◽

Health Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Health Care Use ◽

Penicillin Allergy ◽

The Impact

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Effect of the 2016 Kumamoto earthquakes on preventable hospital admissions: a retrospective cohort study in Japan

BMJ Open ◽

10.1136/bmjopen-2017-021294 ◽

2018 ◽

Vol 8 (7) ◽

pp. e021294 ◽

Cited By ~ 1

Author(s):

Yusuke Sasabuchi ◽

Hiroki Matsui ◽

Kazuhiko Kotani ◽

Alan Kawarai Lefor ◽

Hideo Yasunaga

Keyword(s):

Primary Care ◽

Cohort Study ◽

Health Insurance ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Admissions ◽

The 2016 Kumamoto Earthquakes ◽

Access To Primary Care ◽

The Impact ◽

2016 Kumamoto Earthquakes

Background and objectivesThe Kumamoto earthquakes struck Kumamoto prefecture, in the southwest part of Japan in April 2016. Physical and mental disorders presenting to hospital increased after the 2016 Kumamoto earthquakes. Impaired access to primary care due to the earthquakes may have contributed to this increase. However, it is not known whether the 2016 Kumamoto earthquakes affected access to primary care. The objective of the present study was to investigate the impact of the 2016 Kumamoto earthquakes on short-term health conditions by analysing ambulatory care sensitive conditions (ACSCs), using administrative data from Kumamoto prefecture.DesignA retrospective cohort study.SettingResidents enrolled in National Health Insurance or Late Elders’ Health Insurance from Kumamoto prefecture, Japan.ParticipantsAll hospital admissions due to ACSCs between 15 March and 16 May in each year from 2013 to 2016.Outcome measuresACSCs are defined as conditions for which appropriate primary care interventions could prevent admission to the hospital.ResultsWe identified a total of 7921, 18 763 and 85 436 admissions for vaccine, acute and chronic preventable ACSCs, respectively, during the study period. Admissions within 7 days after the 2016 Kumamoto earthquakes increased to 32.6% (10.2, 59.5), 44.1% (27.0, 63.5) and 27.7% (20.2, 35.6) for vaccine-preventable, acute and chronic ACSCs, respectively. However, admissions for ACSCs did not change significantly 30 days after the earthquakes.ConclusionThe 2016 Kumamoto earthquakes were associated with increased hospital admissions for ACSCs. The impact of the earthquakes on admissions for ACSCs did not persist for more than 7 days.

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Incidence of household transmission of acute gastroenteritis (AGE) in a primary care sentinel network (1992–2017): cross-sectional and retrospective cohort study protocol

BMJ Open ◽

10.1136/bmjopen-2018-022524 ◽

2018 ◽

Vol 8 (8) ◽

pp. e022524 ◽

Cited By ~ 4

Author(s):

Simon de Lusignan ◽

Emmanouela Konstantara ◽

Mark Joy ◽

Julian Sherlock ◽

Uy Hoang ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Retrospective Cohort Study ◽

Acute Gastroenteritis ◽

Retrospective Cohort ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Sentinel Network ◽

Household Transmission

IntroductionAcute gastroenteritis (AGE) is a highly transmissible condition. Determining characteristics of household transmission will facilitate development of prevention strategies and reduce the burden of this disease.We are carrying out this study to describe household transmission of medically attended AGE, and explore whether there is an increased incidence in households with young children.Methods and analysisThis study used the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network, comprising data from 1 750 167 registered patients (August 2017 database). We conducted a novel analysis using a ’household key', to identify patients within the same household (n=811 027, mean 2.16 people). A 25-year repeated cross-sectional study will explore the incidence of medically attended AGE overall and then a 5-year retrospective cohort study will describe household transmission of AGE. The cross-sectional study will include clinical data for a 25-year period—1 January 1992 until the 31 December 2017. We will describe the incidence of AGE by age-band and gender, and trends in incidence. The 5-year study will use Poisson and quasi-Poisson regression to identify characteristics of individuals and households to predict medically attended AGE transmitted in the household. This will include whether the household contained a child under 5 years and the age category of the first index case (whether adult or child under 5 years). If there is overdispersion and zero-inflation we will compare results with negative binomial to handle these issues.Ethics and disseminationAll RCGP RSC data are pseudonymised at the point of data extraction. No personally identifiable data are required for this investigation. The protocol follows STrengthening the Reporting of OBservational studies in Epidemiology guidelines (STROBE). The study results will be published in a peer-review journal, the dataset will be available to other researchers.

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