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Homburg M, Berger M, Berends M, Meijer E, Kupers T, Ramerman L, Rijpkema C, de Schepper E, Olde Hartman T, Muris J, Verheij R, Peters L. Dutch GP healthcare consumption in COVID-19 heterogeneous regions: an interregional time-series approach in 2020-2021. BJGP Open 2024:BJGPO.2023.0121. [PMID: 38128964 DOI: 10.3399/bjgpo.2023.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/22/2023] [Accepted: 11/01/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence. AIM To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019. DESIGN & SETTING Population-based cohort study using electronic health records. The study was undertaken in Dutch general practices involved in regional research networks. METHOD An interrupted time-series analysis of changes in healthcare consumption from before to during the pandemic was performed. Descriptive statistics were used on the number of potential COVID-19-related contacts, reason for contact, and type of contact. RESULTS The study covered 3 595 802 contacts (425 639 patients), 3 506 637 contacts (433 340 patients), and 4 105 413 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time. CONCLUSION Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates.
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Affiliation(s)
- Maarten Homburg
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Marjolein Berger
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Matthijs Berends
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Medical Epidemiology, Certe Medical Diagnostics and Advice Foundation, Groningen, the Netherlands
| | - Eline Meijer
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Thijmen Kupers
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Lotte Ramerman
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Corinne Rijpkema
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Evelien de Schepper
- Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute of Health Sciences, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Jean Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Robert Verheij
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Tranzo, Department of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
| | - Lilian Peters
- Department of Primary and Long-term Care, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Round T, Sethuraman L, Ashworth M, Purushotham A. Transforming post pandemic cancer services. Br J Cancer 2024; 130:1233-1238. [PMID: 38491174 PMCID: PMC11014976 DOI: 10.1038/s41416-024-02596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/15/2023] [Accepted: 01/19/2024] [Indexed: 03/18/2024] Open
Abstract
This paper outlines the impact of the COVID-19 pandemic on cancer services in the UK including screening, symptomatic diagnosis, treatment pathways and projections on clinical outcomes as a result of these care disruptions. A restoration of cancer services to pre-pandemic levels is not likely to mitigate this adverse impact, particularly with an ageing population and increased cancer burden. New cancer cases are projected to rise to over 500,000 per year by 2035, with over 4 million people living with and beyond cancer. This paper calls for a strategic transformation to prioritise effort on the basis of available datasets and evidence-in particular, to prioritise cancers where an earlier diagnosis is feasible and clinically useful with a focus on mortality benefit by preventing emergency presentations by harnessing data and analytics. This could be delivered by a focus on underperforming groups/areas to try and reduce inequity, linking near real-time datasets with clinical decision support systems at the primary and secondary care levels, promoting the use of novel technologies to improve patient uptake of services, screening and diagnosis, and finally, upskilling and cross-skilling healthcare workers to expand supply of diagnostic and screening services.
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Affiliation(s)
- Thomas Round
- School of Life Course and Population Sciences, King's College London, London, UK.
| | | | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
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Hayrumyan V, Abrahamyan A, Harutyunyan A, Libaridian L, Sahakyan S. Impact of COVID-19 on essential healthcare services at the primary healthcare level in Armenia: a qualitative study. BMC PRIMARY CARE 2024; 25:131. [PMID: 38658818 PMCID: PMC11044568 DOI: 10.1186/s12875-024-02377-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The COVID-19 pandemic has presented significant global healthcare challenges, particularly impacting the continuity of essential health services in low- and middle-income countries. This study investigates the impact of the COVID-19 pandemic on the utilization and provision of essential health services in Armenia. METHODS We employed a conventional qualitative study design, conducting semi-structured in-depth interviews (n = 17) within public and private primary healthcare (PHC) facilities in Armenia in 2021. Our study participants encompassed physicians providing specialty services in PHC facilities (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular visitors to PHC facilities (e.g. adults with chronic diseases, parents of children), and policymakers. Thematic analysis was conducted, yielding five emergent categories: mobilization and organization of PHC services during COVID-19; PHC visits during COVID-19; worsening of chronic conditions due to the decline in PHC visits; problems with routine childhood vaccinations; and patient-provider communication challenges. RESULTS The number of in-person visits to PHC facilities declined due to adaptations in service delivery, imposed lockdown measures, and the public's fear of visiting healthcare facilities. Maternal and child health services continued with no major disruptions. PHC providers deliberately limited the number of maternal and child visits to essential antenatal care, newborn screenings, and routine childhood immunizations. Still, children experienced some delays in vaccination administration. The pandemic resulted in a notable reduction in follow-up visits and monitoring of patients with chronic conditions, thereby exacerbating their chronic conditions. Phone calls were the primary method of patient-provider communication during the pandemic. CONCLUSIONS The COVID-19 pandemic has had a profound impact on the delivery and utilization of essential healthcare services at PHC facilities, especially for those with chronic conditions who needed continuous care. Unified national-level guidance and technical capacity are needed to direct the provision of essential services at the PHC level, promote effective health communication, and implement digital platforms for the uninterrupted provision of essential care during public health emergencies.
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Affiliation(s)
- Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia.
| | - Arpine Abrahamyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Arusyak Harutyunyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Lorky Libaridian
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
| | - Serine Sahakyan
- Turpanjian College of Health Sciences, American University of Armenia, 40 Baghramyan Ave, Yerevan, 0019, Armenia
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Giacopelli P, Cristaudi A, Majno P, Roesel R, Iaquinandi F, Mongelli F. COVID-free surgical pathways for treating patients with acute calculous cholecystitis: a retrospective comparative study. Front Surg 2024; 11:1393948. [PMID: 38650660 PMCID: PMC11033475 DOI: 10.3389/fsurg.2024.1393948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction During the Sars-Cov-2 crisis, some of the resources committed to emergency surgery services were transiently reallocated to the care of patients with severe COVID-19, preserving immediate treatment of mostly non-deferrable conditions. Moreover, the fear of contracting infections or hindering the treatment of critical COVID-19 patients has caused many individuals to defer seeking emergency care. This situation has then possibly modified the standard of care of some common surgical conditions and the relative outcomes. Our aims was to highlight any difference in surgical outcomes in patients treated for acute cholecystitis before and during the COVID-19 outbreak. Method This is a retrospective study on a prospectively collected database that included all consecutive patients treated for acute cholecystitis from March 2019 to February 2021 at the Lugano Regional Hospital, a COVID-free hospital for general surgery patients. Patients were divided into pre-and post-COVID-19 outbreak groups. We collected thorough clinical characteristics and intra-and postoperative outcomes. Results We included 124 patients, of which 60 and 64 were operated on before and after the COVID-19 outbreak respectively. The two groups resulted similar in terms of patients' clinical characteristics (age, gender, body mass index, ASA score, and comorbidities). Patients in the post-outbreak period were admitted to the hospital 0.7 days later than patients in the pre-outbreak period (3.8 ± 6.0 days vs. 3.1 ± 4.1 days, p = 0.453). Operative time, recovery room time, complications, and reoperations resulted similar between groups. More patients in the post-outbreak period received postoperative antibiotic therapy (63.3% vs. 37.5%, p = 0.004) and for a longer time (6.9 ± 5.1 days vs. 4.5 ± 3.9 days, p = 0.020). No significant histopathological difference was found in operatory specimens. Discussion Despite more frequent antibiotic therapy that suggests eventually worse inflammatory local status, our results showed similar outcomes for patients treated for acute cholecystitis before and during the COVID-19 pandemic. The local COVID management, reallocating resources, and keeping COVID-free hospitals was key to offering patients a high standard of treatment.
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Affiliation(s)
- Pietro Giacopelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | | | - Pietro Majno
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
- Faculty of Biomedical Science, Università della Svizzera Italiana, Lugano, Switzerland
| | - Raffaello Roesel
- Department of Surgery, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland
| | - Fabiano Iaquinandi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli, EOC, Bellinzona, Switzerland
- Faculty of Biomedical Science, Università della Svizzera Italiana, Lugano, Switzerland
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Gruiskens JRJH, van Hoef LFM, Theunissen MM, Courtens AM, Gidding-Slok AHM, van Schayck OCP, van den Beuken-van Everdingen MMHJ. Recommendations for Improving Chronic Care in Times of a Pandemic Based on Patient Experiences. J Am Med Dir Assoc 2024; 25:623-632.e5. [PMID: 38000443 DOI: 10.1016/j.jamda.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 08/24/2023] [Accepted: 10/14/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVES The COVID-19 pandemic had a profound and pervasive impact on the health of chronic care patients and disrupted care systems worldwide. Our research aimed to assess the impact of the pandemic on chronic care provision and provide recommendations for improving care provision, based on patient experiences. DESIGN Qualitative semi-structured interviews were held among patients with chronic obstructive pulmonary disease (COPD) or heart failure. SETTING AND PARTICIPANTS Using stratified sampling, 23 patients with COPD, heart failure, or both were recruited to participate in semi-structured interviews. In the summer of 2021, online interviews were conducted. METHODS An iterative process was adopted to analyze the data. Going back and forth through the data and our analytical structure, we first coded the data, and subsequently developed categories, themes, and aggregate dimensions. The data were synthesized in a data structure and a data table, which were analyzed using an interpretative approach. RESULTS We found 3 dimensions through which care might be improved: (1) proactive and adaptive health care organization and use of innovative technologies, (2) assistance in maintaining patient resilience and coping strategies, and (3) health care built on outreaching and person-centered care enabling identification of individual patient needs. Experiences of impaired accessibility to care, altered and unmet care demands and patient needs, and the negative impact of national containment strategies on patient resilience support the need for improvement in these dimensions. CONCLUSIONS AND IMPLICATIONS The in-depth insight gained on the impact of the pandemic on chronic care provision was used to propose recommendations for improving care, supported by not only the what and how but also the why developments require additional efforts made by policymakers and change agents, augmented by structural use and development of innovations. Health care organizations should be enabled to rapidly respond to changing internal and external environments, develop and implement innovations, and match care to patient needs.
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Affiliation(s)
- Jeroen R J H Gruiskens
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands.
| | - Liesbeth F M van Hoef
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Maurice M Theunissen
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Annerika H M Gidding-Slok
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
| | - Onno C P van Schayck
- Department of Family Medicine, CAPHRI School of Public Health and Preventive Medicine, Maastricht University, Maastricht, The Netherlands
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Van Poel E, Vanden Bussche P, Pétré B, Ponsar C, Collins C, De Jonghe M, Donneau AF, Gillain N, Guillaume M, Willems S. Quality of care in Belgian general practices during the COVID-19 pandemic: results of the cross-sectional PRICOV-19 study. BMC PRIMARY CARE 2024; 24:282. [PMID: 38443780 PMCID: PMC10916333 DOI: 10.1186/s12875-024-02305-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/09/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND The COVID-19 pandemic immensely impacted care provision, including quality of care in general practice. This paper aimed: (1) to assess how Belgian general practices acted upon the six dimensions of quality of care during COVID-19; (2) to study differences between the three Belgian regions; and (3) to benchmark the performance of the Belgian practices against the performance in other European countries. METHODS The data collected from 479 Belgian practices during 2020-2021 using an online survey as part of the international cross-sectional PRICOV-19 study were analyzed. Hereby, descriptive statistics, chi-squared tests, and binary logistic regression analyses were performed. Thirty-four survey questions related to the six dimensions of quality of care were selected as outcome variables. The adjusted regression models included four practice characteristics as covariates: practice type, being a teaching practice for GP trainees, multidisciplinarity of the team, and payment system. RESULTS Belgian practices made important organizational changes to deliver high-quality care during COVID-19. Most practices (n = 259; 56.1%) actively reached out to vulnerable patients. Limitations to the practice building or infrastructure threatened high-quality care in 266 practices (55.5%). Infection prevention measures could not always be implemented during COVID-19, such as using a cleaning protocol (n = 265; 57.2%) and providing a separate doctor bag for infection-related home visits (n = 130; 27.9%). Three hundred and sixty practices (82.0%) reported at least one safety incident related to a delayed care process in patients with an urgent condition. The adjusted regression analysis showed limited significant differences between the Belgian regions regarding the quality of care delivered. Belgian practices demonstrated varied performance compared to other European countries. For example, they excelled in always checking the feasibility of isolation at home but reported more patient safety incidents related to timely care than at least three-quarters of the other European countries. CONCLUSIONS Future studies using different design methods are crucial to investigate which country and practice characteristics are associated with delivering high-quality care.
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Affiliation(s)
- Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Pierre Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Benoît Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Cécile Ponsar
- Institute of Health and Society, University of Louvain, Louvain, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Research Centre, Irish College of General Practitioners, Dublin, D02 XR68, Ireland
| | - Michel De Jonghe
- Centre Académique de Médecine Générale, Université Catholique de Louvain, Brussels, Belgium
| | | | - Nicolas Gillain
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Michèle Guillaume
- Department of Public Health, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Udelsman BV, Detterbeck F, Tanoue L, Mase V, Boffa D, Blasberg J, Dhanasopon A, Ely S, Mazzarelli LJ, Bader A, Woodard G. Impact of the COVID-19 Pandemic on Lung Cancer Screening Processes in a Northeast Tertiary Health Care Network. J Comput Assist Tomogr 2024; 48:222-225. [PMID: 37832536 DOI: 10.1097/rct.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
ABSTRACT The coronavirus disease 2019 (COVID-19) pandemic disrupted health care systems, including implementation of lung cancer screening programs. The impact and recovery from this disruption on screening processes is not well appreciated. Herein, the radiology database of a Northeast tertiary health care network was reviewed before and during the pandemic (2013-2022). In the 3 months before the pandemic, an average of 77.3 lung cancer screening with computed tomography scans (LCS-CT) were performed per month. The average dropped to 23.3 between April and June of 2020, whereas COVID-19 hospitalizations peaked at 1604. By July, average hospitalizations dropped to 50, and LCS-CTs rose to >110 per month for the remaining year. LCS-CTs did not decline during COVID-19 surges in December of 2021 and 2022. The LCS-CT performance grew by 4.5% in 2020, 69.6% in 2021, and 27.0% in 2022, exceeding projected growth by 722 examinations. This resiliency indicates a potentially smaller impact of COVID-19 on lung cancer diagnoses than initially feared.
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Affiliation(s)
- Brooks V Udelsman
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Frank Detterbeck
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Lynn Tanoue
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Vincent Mase
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Daniel Boffa
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Justin Blasberg
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Andrew Dhanasopon
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Sora Ely
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | | | - Anna Bader
- Department of Radiology, Yale University School of Medicine, New Haven, CT
| | - Gavitt Woodard
- From the Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
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Zhou S, Chen CM, Shen C, Liu H, Liang J, Zhou L, Qu H, Chen X. Impact of COVID-19 pandemic on a world-wide private ophthalmic practice. Heliyon 2024; 10:e25841. [PMID: 38370169 PMCID: PMC10869871 DOI: 10.1016/j.heliyon.2024.e25841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 01/29/2024] [Accepted: 02/02/2024] [Indexed: 02/20/2024] Open
Abstract
Purpose To assess the impact of the COVID-19 pandemic on a worldwide private ophthalmic practice. Design In this retrospective study, we reviewed the 2020 monthly outpatient and surgical volume of refractive, cataract, and retinal disease in Aier Eye clinics/hospitals of different regions, including the United States, Germany, Spain, Italy, and six major cities in China (Wuhan, Beijing, Shanghai, Shenyang, Urumqi and Yili). All of these data were compared to those of the same period of 2019. Results Overall, during the early stage (2020 January to 2020 April) of COVID-19 outbreak, the outpatient and surgical volume of three main type ocular diseases (refractive, cataract and retinal surgery) showed an obvious reduction and reached the bottom in February in China. The data from the United States, Germany, Spain and Italy revealed the same trend, but the visit count nadir occurred until April, which is consistent with the spread trend of COVID-19 disease around the world. The average change rates of surgery volume (refractive, cataract and retinal surgery) in Chinese centers are 5.59%, -26.38%, 11.76%. The change rates of refractive (REF) and cataract volumes (CAT) in the United States are -8.62% and -10.58%, in Germany are -13.71% and -20.49%, in Spain are 15.35% and 27.97%, in Italy are 30.43% and -22.64%. In addition, the optometry outpatient volumes keep going up since May, with an average increasing rate of 21.18%, ranging from 7.43% to 49.51%. Conclusion In conclusion, in this global chain of eye care units, the visit volumes of cataract, retinal and refractive changed significantly with the spread of COVID-19 pandemic. Among them, cataract surgery was the most affected sub-specialty, and refractive surgery and optometry volumes showed a potential growth in the near future. Therefore, medical institutions should make corresponding adjustments to the disease diagnosis and treatment strategies.
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Affiliation(s)
- Suowang Zhou
- Aier Eye Hospital, Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Chloe Mengdi Chen
- Aier Eye Hospital Group, Aier Global Vision Care Management Co, China
| | - Chong Shen
- Aier Eye Hospital Group, Aier Global Vision Care Management Co, China
| | - Hui Liu
- Department of Opthalmology, Changsha Aier Eye Hospital, Changsha, China
| | - Jianheng Liang
- Department of Opthalmology, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lijing Zhou
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
| | - Haokun Qu
- Aier Eye Hospital, Jinan University, No.601, Huangpu Road West, Guangzhou, China
| | - Xu Chen
- Department of Ophthalmology, Shanghai Aier Eye Hospital, Shanghai, China
- Aier School of Ophthalmology, Central South University, Changsha, Hunan Province, China
- New Bund Medical and Surgical Center, Sino United Health Clinics, Shanghai, China
- Department of Ophthalmology, Shanghai Aier Qingliang Eye Hospital, Qingpu, Shanghai, China
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Lifford KJ, Grozeva D, Cannings-John R, Quinn-Scoggins H, Moriarty Y, Gjini A, Goddard M, Hepburn J, Hughes J, Moore G, Osborne K, Robling M, Townson J, Waller J, Whitelock V, Whitaker KL, Brain K. Satisfaction with remote consultations in primary care during COVID-19: a population survey of UK adults. Br J Gen Pract 2024; 74:e96-e103. [PMID: 38253548 PMCID: PMC10824329 DOI: 10.3399/bjgp.2023.0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Mode of access to primary care changed during the COVID-19 pandemic; remote consultations became more widespread. With remote consultations likely to continue in UK primary care, it is important to understand people's perceptions of remote consultations and identify potential resulting inequalities. AIM To assess satisfaction with remote GP consultations in the UK during the COVID-19 pandemic and identify demographic variation in satisfaction levels. DESIGN AND SETTING A cross-sectional survey from the second phase of a large UK-based study, which was conducted during the COVID-19 pandemic. METHOD In total, 1426 adults who self-reported having sought help from their doctor in the past 6 months completed an online questionnaire (February to March 2021). Items included satisfaction with remote consultations and demographic variables. Associations were analysed using multivariable regression. RESULTS A novel six-item scale of satisfaction with remote GP consultations had good psychometric properties. Participants with higher levels of education had significantly greater satisfaction with remote consultations than participants with mid-level qualifications (B = -0.82, 95% confidence interval [CI] = -1.41 to -0.23) or those with low or no qualifications (B = -1.65, 95% CI = -2.29 to -1.02). People living in Wales reported significantly higher satisfaction compared with those living in Scotland (B = -1.94, 95% CI = -3.11 to -0.78), although caution is warranted due to small group numbers. CONCLUSION These findings can inform the use and adaptation of remote consultations in primary care. Adults with lower educational levels may need additional support to improve their experience and ensure equitable care via remote consultations.
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Affiliation(s)
- Kate J Lifford
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | | | - Harriet Quinn-Scoggins
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
| | | | - Ardiana Gjini
- Public Health Wales; senior lecturer, Cardiff University, Cardiff
| | - Mark Goddard
- Centre for Trials Research, Cardiff University, Cardiff
| | - Julie Hepburn
- Public Involvement Community, Health and Care Research Wales Support Centre, Cardiff
| | | | - Graham Moore
- DECIPHer (Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement), School of Social Sciences, Cardiff University, Cardiff
| | | | | | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff
| | - Jo Waller
- Centre for Cancer Screening, Prevention and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine & Dentistry, Queen Mary University of London, London; reader of cancer screening & early diagnosis, School of Cancer and Pharmaceutical Sciences, King's College London, London
| | | | | | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff
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Segger L, Lerchbaumer MH, Collettini F, Hamm B, Fleckenstein FN, Fehrenbach U, Gebauer B, Auer TA. Percutaneous Computed Tomography (CT) Fluoroscopy-Guided Biopsy of the Spleen Using Fibrin Glue as a Sealant. Diagnostics (Basel) 2024; 14:162. [PMID: 38248038 PMCID: PMC10814976 DOI: 10.3390/diagnostics14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024] Open
Abstract
Some authors consider the risk of bleeding an absolute contraindication to percutaneous image-guided splenic puncture. While splenic punctures are mainly performed at specialized centers, no technique for the closure of the puncture tract has been broadly established. The aim of this study was to investigate the effectiveness and safety of a percutaneous image-guided biopsy of the spleen using fibrin glue to plug the tract. A total of 27 requests for splenic image-guided interventions were identified between 2010 and 2021 and considered for inclusion in our retrospective single-center study. Seven patients needed to be excluded, which left twenty patients who underwent a percutaneous computed tomography (CT) fluoroscopy-guided biopsy of a splenic lesion during this period. In all patients, a 17G coaxial needle with an 18G core biopsy needle was used. Diagnostic adequacy and accuracy were evaluated, and complications were classified using the CIRSE classification system for adverse events. Diagnostic adequacy was 100% (20/20), and a median of four samples were collected. Diagnostic accuracy was 80% (16/20). The four off-target samples included one inconclusive finding and three samples of regular spleen tissue. The overall complication rate was 5% (1/20). No mild (grade 1-2) or moderate (grade 3-4) complications occurred. One severe (grade 5-6) complication occurred. Although controversial and potentially high-risk, diagnostic percutaneous biopsies of the spleen appear to be relatively safe with the use of fibrin glue to seal the tract.
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Affiliation(s)
- Laura Segger
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | | | - Federico Collettini
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Florian Nima Fleckenstein
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Bernhard Gebauer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
| | - Timo A. Auer
- Department of Radiology, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.C.); (B.H.); (F.N.F.); (U.F.); (B.G.); (T.A.A.)
- Berlin Institute of Health (BIH), Anna-Louisa-Karsch-Straße 2, 10178 Berlin, Germany
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11
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de Barros MLGP, Silva VG, Moreira FR, Perez SV, Younes RN, Abrão FC. Five-year survival of resectable stage IIIA non-small cell lung cancer in Brazil. J Surg Oncol 2023; 128:1195-1204. [PMID: 37448240 DOI: 10.1002/jso.27394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND In stage IIIA non-small cell lung cancer (NSCLC), surgery plays a role in terms of multimodal treatment. Surgery rates have increased in recent years, mainly due to the combination of more accurate imaging tools, electromagnetic navigation bronchoscopy, robotic bronchoscopy, robotic surgery, and a wide range of challenging clinical scenarios to lead surgeons and oncologists to include surgery as an option in therapeutic management. OBJECTIVES To assess the prognostic factors, the 5-year overall survival (OS) and cancer-specific survival (CSS) of patients with resectable stage III-NSCLC. METHODS Patients' information was extracted from 76 Hospitals' Cancer Registry. OS and CSS were constructed using the Kaplan-Meier method, and the log-rank test was used to assess differences between curves. In addition, Cox regression was conducted to evaluate the patients' characteristics leading to better OS and CSS. RESULTS Overall, 433 stage III NSCLC surgical patients followed over 19 years were included. The median age was 61.29 ± 9.62 years, 58.4% male, 50.1% with adenocarcinoma, 29.3% with squamous cell carcinoma, 3.7% with large-cell lung carcinoma, and 16,9% with other lung cancer types. The 5-year OS was 30.6% (95% confidence interval [CI]: 27.4-36.1), and the CSS was 35.0% (95% CI: 29.4-41.0). In the Cox multivariate regression, squamous cell carcinoma was associated with reduced OS (hazard ratio [HR]: 1.40; 95% CI: 1.07-1.83; p=0.014) and CSS (HR: 1.56; 95% CI: 1.17-2.08; p = 0.002), in comparison with adenocarcinoma. The 2015-2019 quinquennial had a 50% reduction in HR (0.49; 95% CI: 0.29-0.81; p = 0.006), and the 2010-2014 group had a 40% reduction (0.59; 95% CI: 0.42-0.83; p = 0.006) in comparison with the 2000-2004 patients' group. CONCLUSION The OS and CSS of patients with resectable stage III NSCLC have improved over the past 19 years in our region. Squamous cell carcinoma was associated with increased mortality risk from any cause or specific cancer.
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Affiliation(s)
| | | | | | | | | | - Fernando Conrado Abrão
- Hospital Alemão Oswaldo Cruz, Sao Paulo, Brazil
- Hospital Santa Marcelina, Sao Paulo, Brazil
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Decker KM, Feely A, Bucher O, Czaykowski P, Hebbard P, Kim JO, Singh H, Thiessen M, Pitz M, Musto G, Galloway K, Lambert P. Cancer incidence during the COVID-19 pandemic by region of residence in Manitoba, Canada: A cancer registry-based interrupted time series study. Cancer Med 2023; 12:21465-21479. [PMID: 37974380 PMCID: PMC10726851 DOI: 10.1002/cam4.6698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/13/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Health care in Manitoba, Canada is divided into five regions, each with unique geographies, demographics, health care access, and health status. COVID-19-related restrictions and subsequent responses also differed by region. To understand the impact of the pandemic on cancer incidence in the context of these differences, we examined age-standardized cancer incidence rates by region over time before and after the COVID-19 pandemic. METHODS We used a population-based quasi-experimental study design, population-based data, and an interrupted time series analysis to examine the rate of new cancer diagnoses before (January 2015 until December 2019) and after the start of COVID-19 and the interventions implemented to mitigate its impact (April 2020 until December 2021) by region. RESULTS Overall cancer incidence differed by region and remained lower than expected in Winnipeg (4.6% deficit, 447 cases), Prairie Mountain (6.9% deficit, 125 cases), and Southern (13.0% deficit, 238 cases). Southern was the only region that had a significantly higher deficit in cases compared to Manitoba (ratio 0.92, 95% CI 0.86, 0.99). Breast and colorectal cancer incidence decreased at the start of the pandemic in all regions except Northern. Lung cancer incidence decreased in the Interlake-Eastern region and increased in the Northern region. Prostate cancer incidence increased in Interlake-Eastern. CONCLUSIONS The impact of the COVID-19 pandemic on cancer incidence differed by region. The deficit in the number of cases was largest in the southern region and was highest for breast and prostate cancers. Cancer incidence did not significantly decrease in the most northern, remote region.
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Affiliation(s)
- Kathleen M. Decker
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Allison Feely
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Oliver Bucher
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Piotr Czaykowski
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Pamela Hebbard
- Department of Surgery, Section of General Surgery, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Julian O. Kim
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Radiology, Section of Radiation Oncology, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Radiation OncologyUniversity of ManitobaWinnipegManitobaCanada
| | - Harminder Singh
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
| | - Maclean Thiessen
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Marshall Pitz
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health SciencesUniversity of ManitobaWinnipegManitobaCanada
- Department of Medical Oncology and HematologyCancerCare ManitobaWinnipegManitobaCanada
| | - Grace Musto
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Katie Galloway
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
| | - Pascal Lambert
- Paul Albrechtsen Research Institute CancerCare ManitobaWinnipegManitobaCanada
- Department of Epidemiology and Cancer RegistryCancerCare ManitobaWinnipegManitobaCanada
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13
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De Santis KK, Helmer S, Barnes B, Kraywinkel K, Imhoff M, Müller-Eberstein R, Kirstein M, Quatmann A, Simke J, Stiens L, Christianson L, Zeeb H. Impact of the COVID-19 pandemic on oncological care in Germany: rapid review. J Cancer Res Clin Oncol 2023; 149:14329-14340. [PMID: 37507594 PMCID: PMC10590309 DOI: 10.1007/s00432-023-05063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES The COVID-19 pandemic affected medical care for chronic diseases. This study aimed to systematically assess the pandemic impact on oncological care in Germany using a rapid review. METHODS MEDLINE, Embase, study and preprint registries and study bibliographies were searched for studies published between 2020 and 2 November 2022. Inclusion was based on the PCC framework: population (cancer), concept (oncological care) and context (COVID-19 pandemic in Germany). Studies were selected after title/abstract and full-text screening by two authors. Extracted data were synthesized using descriptive statistics or narratively. Risk of bias was assessed and summarized using descriptive statistics. RESULTS Overall, 77 records (59 peer-reviewed studies and 18 reports) with administrative, cancer registry and survey data were included. Disruptions in oncological care were reported and varied according to pandemic-related factors (e.g., pandemic stage) and other (non-pandemic) factors (e.g., care details). During higher restriction periods fewer consultations and non-urgent surgeries, and delayed diagnosis and screening were consistently reported. Heterogeneous results were reported for treatment types other than surgery (e.g., psychosocial care) and aftercare, while ongoing care remained mostly unchanged. The risk of bias was on average moderate. CONCLUSIONS Disruptions in oncological care were reported during the COVID-19 pandemic in Germany. Such disruptions probably depended on factors that were insufficiently controlled for in statistical analyses and evidence quality was on average only moderate. Research focus on patient outcomes (e.g., longer term consequences of disruptions) and pandemic management by healthcare systems is potentially relevant for future pandemics or health emergencies.
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Affiliation(s)
- Karina Karolina De Santis
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany.
| | - Stefanie Helmer
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Benjamin Barnes
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Klaus Kraywinkel
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | - Maren Imhoff
- German Center for Cancer Registry Data, Robert Koch Institute (RKI), Berlin, Germany
| | | | - Mathia Kirstein
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Anna Quatmann
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Julia Simke
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lisa Stiens
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Lara Christianson
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology- BIPS, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Bremen, Germany
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Pogorzelska K, Marcinowicz L, Chlabicz S. Understanding satisfaction and dissatisfaction of patients with telemedicine during the COVID-19 pandemic: An exploratory qualitative study in primary care. PLoS One 2023; 18:e0293089. [PMID: 37847684 PMCID: PMC10581451 DOI: 10.1371/journal.pone.0293089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Due to the COVID-19 pandemic, healthcare organizations had to face challenging circumstances and modify the usual modality of service provision, introducing telehealth services in their routine patient care to lessen the risk of direct human-to-human exposure. Patients expressed concerns about personal visits to healthcare units and the possibility of accessing telemedicine turned out to be an effective tool for the continuity of care. Due to the limited experience with telemedicine before the COVID-19 pandemic in Poland, we sought to fill this gap by studying the experiences of Polish patients. Our study aimed to understand how patients define satisfaction and dissatisfaction with telemedicine during the COVID-19 pandemic in primary care. MATERIAL AND METHODS Twenty semi-structured interviews with primary care patients in the Podlaskie Voivodeship, Poland were conducted to understand satisfaction with telemedicine. Interview transcripts were analyzed using qualitative content analysis. The qualitative content analysis process involved familiarizing ourselves with the data, extracting text regarding satisfaction and dissatisfaction with the teleconsultation, condensing it into meaningful units assigning codes to them, and organizing codes into subcategories and categories. The entire analysis process was done through reflection and discussion until a consensus was reached between the researchers. RESULTS From the participants' perspective, satisfaction with telemedicine was associated with receiving enough space to express their concerns. It was reported that they trusted their primary care physicians and felt comfortable during telemedicine consultations. Participants noted that connecting with a known, trusted doctor was more important than having a face-to-face visit with an unfamiliar physician. In our study, the participants equated satisfaction with treatment effectiveness. It was emphasized that in the event of unknown or unstable conditions, patients would prefer to be seen in person and receive a physical examination. CONCLUSION In our research telemedicine met with a positive reception and was recognized by the majority of patients who made use of it as a valuable channel of contact with a primary care physician. In order to increase the level of patient satisfaction, the focus should be on improving aspects such as physician engagement and showing empathy during telemedicine, as well as providing complete, exhaustive information on the treatment process. Respecting patient needs and preferences during performing telemedicine visits is the goal of patient-centered care.
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Affiliation(s)
- Karolina Pogorzelska
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, The Medical University of Bialystok, Bialystok, Poland
| | - Slawomir Chlabicz
- Department of Family Medicine, The Medical University of Bialystok, Bialystok, Poland
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15
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Yan C, Zhang X, Yang Y, Kang K, Were MC, Embí P, Patel MB, Malin BA, Kho AN, Chen Y. Differences in Health Professionals' Engagement With Electronic Health Records Based on Inpatient Race and Ethnicity. JAMA Netw Open 2023; 6:e2336383. [PMID: 37812421 PMCID: PMC10562942 DOI: 10.1001/jamanetworkopen.2023.36383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/17/2023] [Indexed: 10/10/2023] Open
Abstract
Importance US health professionals devote a large amount of effort to engaging with patients' electronic health records (EHRs) to deliver care. It is unknown whether patients with different racial and ethnic backgrounds receive equal EHR engagement. Objective To investigate whether there are differences in the level of health professionals' EHR engagement for hospitalized patients according to race or ethnicity during inpatient care. Design, Setting, and Participants This cross-sectional study analyzed EHR access log data from 2 major medical institutions, Vanderbilt University Medical Center (VUMC) and Northwestern Medicine (NW Medicine), over a 3-year period from January 1, 2018, to December 31, 2020. The study included all adult patients (aged ≥18 years) who were discharged alive after hospitalization for at least 24 hours. The data were analyzed between August 15, 2022, and March 15, 2023. Exposures The actions of health professionals in each patient's EHR were based on EHR access log data. Covariates included patients' demographic information, socioeconomic characteristics, and comorbidities. Main Outcomes and Measures The primary outcome was the quantity of EHR engagement, as defined by the average number of EHR actions performed by health professionals within a patient's EHR per hour during the patient's hospital stay. Proportional odds logistic regression was applied based on outcome quartiles. Results A total of 243 416 adult patients were included from VUMC (mean [SD] age, 51.7 [19.2] years; 54.9% female and 45.1% male; 14.8% Black, 4.9% Hispanic, 77.7% White, and 2.6% other races and ethnicities) and NW Medicine (mean [SD] age, 52.8 [20.6] years; 65.2% female and 34.8% male; 11.7% Black, 12.1% Hispanic, 69.2% White, and 7.0% other races and ethnicities). When combining Black, Hispanic, or other race and ethnicity patients into 1 group, these patients were significantly less likely to receive a higher amount of EHR engagement compared with White patients (adjusted odds ratios, 0.86 [95% CI, 0.83-0.88; P < .001] for VUMC and 0.90 [95% CI, 0.88-0.92; P < .001] for NW Medicine). However, a reduction in this difference was observed from 2018 to 2020. Conclusions and Relevance In this cross-sectional study of inpatient EHR engagement, the findings highlight differences in how health professionals distribute their efforts to patients' EHRs, as well as a method to measure these differences. Further investigations are needed to determine whether and how EHR engagement differences are correlated with health care outcomes.
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Affiliation(s)
- Chao Yan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xinmeng Zhang
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
| | - Yuyang Yang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Martin C. Were
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter Embí
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mayur B. Patel
- Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research and Education Clinical Center, Veterans Affairs, Tennessee Valley Healthcare System, Nashville
- Division of Acute Care Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Bradley A. Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Abel N. Kho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine-General Internal Medicine, Northwestern University, Chicago, Illinois
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Computer Science, Vanderbilt University, Nashville, Tennessee
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Ramos-Rincon JM, Pinargote-Celorio H, de Mendoza C, Ramos-Belinchón C, Moreno-Torres V, Treviño A, Barreiro P, Corral O, Soriano V. Impact of the COVID-19 pandemic on hospital admissions due to viral hepatitis in Spain. J Clin Virol 2023; 167:105553. [PMID: 37549555 DOI: 10.1016/j.jcv.2023.105553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Before the advent of COVID-19 vaccines, hospitalizations due to SARS-CoV-2 infection during 2020 collapsed most medical centers worldwide. Disruptions in health care for clinical conditions other than COVID-19 were not uniform. Herein, we report the impact of COVID-19 on hospitalizations due to viral hepatitis in Spain. METHODS Retrospective study of all hospitalizations in Spain during 10 months before (pre-pandemic period) and after (pandemic period) March 1st 2020. Admissions with a diagnosis of hepatitis B, C and/or delta were retrieved and compared using the Spanish National Registry of Hospital Discharges. RESULTS Nationwide hospitalizations declined 14.6% during the pandemic period, from 3,144,164 to 2,684,845. This reduction was significantly more pronounced for admissions due to viral hepatitis (18.1% drop), falling from 46,521 to 38,115. During the pandemic period, patients admitted with viral hepatitis died significantly more frequently than during the pre-pandemic period (7.2% vs 6.1%; p < 0.001). Liver transplants significantly declined during the pandemic period. COVID-19 was diagnosed in 10.3% of patients hospitalized with viral hepatitis during the pandemic period. This subset of patients was older and died 2.4-fold more frequently than the rest, despite having advanced liver disease less frequently. CONCLUSION Hospitalizations due to viral hepatitis significantly declined in Spain during the COVID-19 pandemic. Patients admitted with viral hepatitis experienced a greater mortality during the pandemic period. Deaths were more pronounced when coinfected with SARS-CoV-2 despite having advanced liver disease less frequently.
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Affiliation(s)
- José Manuel Ramos-Rincon
- Internal Medicine Department, General University Hospital of Alicante-ISABIAL & Miguel Hernández University of Elche, Alicante, Spain
| | - Héctor Pinargote-Celorio
- Internal Medicine Department, General University Hospital of Alicante-ISABIAL & Miguel Hernández University of Elche, Alicante, Spain
| | - Carmen de Mendoza
- Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Madrid, Spain
| | | | - Víctor Moreno-Torres
- Department of Internal Medicine, Puerta de Hierro Research Institute & University Hospital, Majadahonda, Madrid, Spain; UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - Ana Treviño
- UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Hospital Isabel Zendal, Madrid, Spain
| | - Octavio Corral
- UNIR Health Sciences School & Medical Center, Madrid, Spain
| | - Vicente Soriano
- UNIR Health Sciences School & Medical Center, Madrid, Spain.
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17
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Nduka I, Kabasinguzi I, Ali N, Ochepo P, Abdy D, Cook EJ, Egbutah C, Cartwright S, Randhawa G. The impact of COVID-19 on the changes in health behaviours among Black, Asian and Minority Ethnic (BAME) communities in the United Kingdom (UK): a scoping review. BMC Public Health 2023; 23:1466. [PMID: 37525154 PMCID: PMC10391900 DOI: 10.1186/s12889-023-15978-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 05/24/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has led to changes in health behaviours, which include eating patterns and nutrition, smoking, alcohol consumption, sleeping patterns, physical activity and sedentary behaviour. There is a dearth of evidence reporting the impact of COVID-19 on the health behaviour of Black, Asian and minority ethnic (BAME) communities. This scoping review synthesises the available evidence on the impact of COVID-19 on the changes in health behaviours among BAME communities in the UK. METHODS Following a keyword strategy, 16 electronic databases were searched for articles that met the screening criteria. These articles were then reviewed in full text. Empirical studies that assessed COVID-19 related health behaviour changes among BAME communities in the UK, conducted during the COVID-19 pandemic between July 2020 and August 2021 and published in English language, were set as inclusion criteria. An initial 2160 studies were identified in the selected databases. After removing duplications and screening the title and abstracts of the 2154 studies, only 4 studies were selected to be reviewed as they met the inclusion criteria. The included studies employed different sample sizes which ranged from N = 47 to N = 30,375 and reported several health behaviour changes. Out of the 4 included studies, 3 studies included BAME groups within their sample as a subgroup while one study focused specifically on BAME groups. RESULTS The scoping review found that there were lower levels of physical activity among BAME groups compared to the White ethnic groups. About 41.7% of BAME groups reported drinking less alcohol than usual compared to their white counterparts who were 34%. Study participants from BAME backgrounds had the greatest effect of COVID-19 on decisions to purchase healthier food compared to those from white backgrounds whose decisions on purchasing healthier food were least affected. Some participants reported an increase in positive hygiene practices due to the COVID-19 pandemic. CONCLUSION COVID-19 had a significant impact on the health behaviours of BAME groups especially during the lockdowns as they reported changes to behaviour such as low levels of physical activities. Hence, it is important to promote health awareness among BAME groups to encourage healthy living. In addition, programmes such as physical fitness activities that favour BAME groups should be put in place, for example BAME women's walking groups to encourage people from BAME backgrounds to engage in physical activities. Furthermore, healthy food programmes such as food parcels can be given to people from BAME backgrounds who are not able to afford healthy food due to the impact of COVID-19. Nonetheless, the COVID-19 pandemic has increased positive hygiene among BAME groups which is important in preventing other diseases and infections.
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Affiliation(s)
- Ifunanya Nduka
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | | | - Nasreen Ali
- Institute for Health Research, University of Bedfordshire, Luton, UK.
| | - Peter Ochepo
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - David Abdy
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | | | | | | | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Brower JV, Rhodes SS, Remick JS, Russo AL, Dunn EF, Ayala-Peacock DN, Petereit DG, Bradley KA, Taunk NK. Effect of COVID-19 on Gynecologic Oncology Care: A Survey of Practicing Gynecologic Radiation Oncologists in the United States. Adv Radiat Oncol 2023; 8:101188. [PMID: 36974086 PMCID: PMC9968481 DOI: 10.1016/j.adro.2023.101188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/27/2023] [Indexed: 02/27/2023] Open
Abstract
Purpose The COVID-19 pandemic has placed demands and limitations on the delivery of health care. We sought to assess the effect of COVID-19 on the delivery of gynecologic oncologic care from the perspective of practicing radiation oncologists in the United States. Methods and Materials An anonymous online survey was created and distributed to preidentified radiation oncologists in the United States with clinical expertise in the management of gynecologic patients. The survey consisted of demographic questions followed by directed questions to assess specific patterns of care related to the COVID-19 pandemic. Results A total of 47 of 96 invited radiation oncologists responded to the survey for a response rate of 49%. Fifty-six percent of respondents reported an increase in locally advanced cervical cancer with no similar increase for endometrial, vulvar, or vaginal patients. Most respondents (66%) reported a pause in surgical management, with a duration of 1 to 3 months being most common (61%). There was a reported increased use of shorter brachytherapy regimens during the pandemic. Most providers (61%) reported caring for at least 1 patient with a positive COVID-19 test. A pause or delay in treatment due to COVID-19 positivity was reported by 45% of respondents, with 55% reporting that patients chose to delay their own care because of COVID-19-related concerns. Total treatment times >8 weeks for patients with cervical cancer were observed by 33% of respondents, but occurred in >25% of patients. Conclusions Data from this prospectively collected anonymous survey of practice patterns among radiation oncologists reveal that the COVID-19 pandemic resulted in delays initiating care, truncated brachytherapy treatment courses, and a reported increase in locally advanced cervical cancer cases at presentation. These data can be used as a means of self-assessment to ensure appropriate decision making for gynecologic patients during the endemic phase of COVID-19.
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Affiliation(s)
- Jeffrey V. Brower
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Radiation Oncology Associates–New England, Manchester, New Hampshire
| | - Sylvia S. Rhodes
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Jill S. Remick
- Department of Radiation Oncology, Winship Cancer Institute, Emory School of Medicine, Atlanta, Georgia
| | - Andrea L. Russo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily F. Dunn
- Department of Radiation Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, Oregon
| | | | - Daniel G. Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, South Dakota
| | - Kristin A. Bradley
- Department of Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Neil K. Taunk
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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19
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Lucas E, Murillo R, Arrossi S, Bárcena M, Chami Y, Nessa A, Perera S, Silva P, Sangrajrang S, Muwonge R, Basu P. Quantification of impact of COVID-19 pandemic on cancer screening programmes - a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand. eLife 2023; 12:e86527. [PMID: 37191660 PMCID: PMC10188105 DOI: 10.7554/elife.86527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/17/2023] Open
Abstract
It is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income countries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) categories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the backlogs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.
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Affiliation(s)
- Eric Lucas
- International Agency for Research on CancerLyonFrance
| | - Raul Murillo
- Hospital Universitario San IgnacioBogotaColombia
| | | | | | - Youssef Chami
- Foundation Lalla Salma Cancer prevention and treatmentRabatMorocco
| | - Ashrafun Nessa
- Bangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
| | | | | | | | | | - Partha Basu
- International Agency for Research on CancerLyonFrance
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20
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Wheat CL, Gunnink EJ, Rojas J, Shah A, Nelson KM, Wong ES, Gray KE, Stockdale SE, Rosland AM, Chang ET, Reddy A. Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory. JAMA Netw Open 2023; 6:e238525. [PMID: 37067799 PMCID: PMC10111181 DOI: 10.1001/jamanetworkopen.2023.8525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/25/2023] [Indexed: 04/18/2023] Open
Abstract
Importance The COVID-19 pandemic caused significant disruptions in primary care delivery. The Veterans Health Administration (VHA) launched the Preventive Health Inventory (PHI) program-a multicomponent care management intervention, including a clinical dashboard and templated electronic health record note-to support primary care in delivering chronic disease care and preventive care that had been delayed by the pandemic. Objectives To describe patient, clinician, and clinic correlates of PHI use in primary care clinics and to examine associations between PHI adoption and clinical quality measures. Design, Setting, and Participants This quality improvement study used VHA administrative data from February 1, 2021, through February 28, 2022, from a national cohort of 216 VHA primary care clinics that have implemented the PHI. Participants comprised 829 527 veterans enrolled in primary care in clinics with the highest and lowest decile of PHI use as of February 2021. Exposure Templated electronic health record note documenting use of the PHI. Main Outcomes and Measures Diabetes and blood pressure clinical quality measures were the primary outcomes. Interrupted time series models were applied to estimate changes in diabetes and hypertension quality measures associated with PHI implementation. Low vs high PHI use was stratified at the facility level to measure whether systematic differences in uptake were associated with quality. Results A total of 216 primary clinics caring for 829 527 unique veterans (mean [SD] age, 64.1 [16.9] years; 755 158 of 829 527 [91%] were men) formed the study cohort. Use of the PHI varied considerably across clinics. The clinics in the highest decile of PHI use completed a mean (SD) of 32 997.4 (14 019.3) notes in the electronic health record per 100 000 veterans compared with 56.5 (35.3) notes per 100 000 veterans at the clinics in the lowest decile of use (P < .001). Compared with the clinics with the lowest use of the PHI, clinics with the highest use had a larger mean (SD) clinic size (12 072 [7895] patients vs 5713 [5825] patients; P < .001), were more likely to be urban (91% vs 57%; P < .001), and served more non-Hispanic Black veterans (16% vs 5%; P < .001) and Hispanic veterans (14% vs 4%; P < .001). Staffing did not differ meaningfully between high- and low-use clinics (mean [SD] ratio of full-time equivalent staff to clinician, 3.4 [1.2] vs 3.4 [0.8], respectively; P < .001). After PHI implementation, compared with the clinics with the lowest use, those with the highest use had fewer veterans with a hemoglobin A1c greater than 9% or missing (mean [SD], 6577 [3216] per 100 000 veterans at low-use clinics; 9928 [4236] per 100 000 veterans at high-use clinics), more veterans with an annual hemoglobin A1c measurement (mean [SD], 13 181 [5625] per 100 000 veterans at high-use clinics; 8307 [3539] per 100 000 veterans at low-use clinics), and more veterans with adequate blood pressure control (mean [SD], 20 582 [12 201] per 100 000 veterans at high-use clinics; 12 276 [6850] per 100 000 veterans at low-use clinics). Conclusions and Relevance This quality improvement study of the implementation of the VHA PHI suggests that higher use of a multicomponent care management intervention was associated with improved quality-of-care metrics. The study also found significant variation in PHI uptake, with higher uptake associated with clinics with more racial and ethnic diversity and larger, urban clinic sites.
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Affiliation(s)
- Chelle L. Wheat
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Eric J. Gunnink
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Jorge Rojas
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | - Ami Shah
- Office of Primary Care, Veterans Health Affairs, Washington, DC
| | - Karin M. Nelson
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
| | - Edwin S. Wong
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Kristen E. Gray
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Susan E. Stockdale
- Department of Psychiatry and Biobehavioral Medicine, David Geffen School of Medicine, University of California at Los Angeles
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ann-Marie Rosland
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
- Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Health Care System, Pittsburgh, Pennsylvania
| | - Evelyn T. Chang
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles
- Division of General Internal Medicine, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ashok Reddy
- Center for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle, Washington
- Department of Health Systems and Population Health, University of Washington, Seattle
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle
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21
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Shi T, Zhao X, Zhang X, Meng L, Li D, Liu X, Zheng H, Yu D, Wang T, Li R, Li J, Shen X, Ren X. Immediate and long-term changes in the epidemiology, infection spectrum, and clinical characteristics of viral and bacterial respiratory infections in Western China after the COVID-19 outbreak: a modeling study. Arch Virol 2023; 168:120. [PMID: 36976267 PMCID: PMC10044131 DOI: 10.1007/s00705-023-05752-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The impact of COVID-19 on the epidemiology, clinical characteristics, and infection spectrum of viral and bacterial respiratory infections in Western China is unknown. METHODS We conducted an interrupted time series analysis based on surveillance of acute respiratory infections (ARI) in Western China to supplement the available data. RESULTS The positive rates of influenza virus, Streptococcus pneumoniae, and viral and bacterial coinfections decreased, but parainfluenza virus, respiratory syncytial virus, human adenovirus, human rhinovirus, human bocavirus, non-typeable Haemophilus influenzae, Mycoplasma pneumoniae, and Chlamydia pneumoniae infections increased after the onset of the COVID-19 epidemic. The positive rate for viral infection in outpatients and children aged <5 years increased, but the positive rates of bacterial infection and viral and bacterial coinfections decreased, and the proportion patients with clinical symptoms of ARI decreased after the onset of the COVID-19 epidemic. Non-pharmacological interventions reduced the positive rates of viral and bacterial infections in the short term but did not have a long-term limiting effect. Moreover, the proportion of ARI patients with severe clinical symptoms (dyspnea and pleural effusion) increased in the short term after COVID-19, but in the long-term, it decreased. CONCLUSIONS The epidemiology, clinical characteristics, and infection spectrum of viral and bacterial infections in Western China have changed, and children will be a high-risk group for ARI after the COVID-19 epidemic. In addition, the reluctance of ARI patients with mild clinical symptoms to seek medical care after COVID-19 should be considered. In the post-COVID-19 era, we need to strengthen the surveillance of respiratory pathogens.
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Affiliation(s)
- Tianshan Shi
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xin Zhao
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xiaoshu Zhang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, Gansu, China
| | - Lei Meng
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, Gansu, China
| | - Donghua Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xinfeng Liu
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, Gansu, China
| | - Hongmiao Zheng
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Deshan Yu
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, 730000, Gansu, China
| | - Tingrong Wang
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Rui Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Juansheng Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xiping Shen
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China
| | - Xiaowei Ren
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, 730000, Gansu, China.
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22
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Fujita M, Hashimoto H, Nagashima K, Suzuki K, Kasai T, Yamaguchi K, Onouchi Y, Sato D, Fujisawa T, Hata A. Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan. Sci Rep 2023; 13:4977. [PMID: 36973536 PMCID: PMC10041497 DOI: 10.1038/s41598-023-32317-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Various countries have reported a decrease in breast cancer surgeries during the coronavirus disease 2019 (COVID-19) pandemic; however, inconsistent results have been reported in Japan. This study revealed changes in the number of surgeries during the pandemic using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) from January 2015 to January 2021, where insurance claims data from Japan as a whole are comprehensively accumulated. The number of breast-conserving surgeries (BCS) without axillary lymph node dissection (ALND) significantly decreased in July (- 846; 95% confidence interval (CI) - 1190 to - 502) and October 2020 (- 540; 95% CI - 861 to - 218). No decrease was observed for other types of surgery, BCS with ALND, and mastectomy with or without ALND. In the age-specific subgroup analysis, significant and transient reduction in BCS without ALND was observed in all age groups (0-49, 50-69, and ≥ 70 years). The number of BCS without ALND significantly decreased for a relatively short period in the early pandemic stages, suggesting reduced surgery for patients with a relatively low stage of cancer. Some patients with breast cancer might have been left untreated during the pandemic, and an unfavorable prognosis would be a concern.
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Affiliation(s)
- Misuzu Fujita
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan.
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, 260-8670, Japan.
| | - Hideyuki Hashimoto
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
| | - Kengo Nagashima
- Biostatistics Unit, Clinical and Translational Research Center, Keio University Hospital, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kiminori Suzuki
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
| | - Tokuzo Kasai
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
| | - Kazuya Yamaguchi
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
| | - Yoshihiro Onouchi
- Department of Public Health, Chiba University Graduate School of Medicine, Chiba, 260-8670, Japan
| | - Daisuke Sato
- Center for Next Generation of Community Health, Chiba University Hospital, Chiba, 260-0856, Japan
| | - Takehiko Fujisawa
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
| | - Akira Hata
- Department of Health Research, Chiba Foundation for Health Promotion and Disease Prevention, 32-14 Shin-Minato, Mihama-Ku, Chiba, 261-0002, Japan
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23
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Aparicio T, Layese R, Hemery F, Tournigand C, Paillaud E, De Angelis N, Quero L, Ganne N, Prat F, Pachev A, Galula G, Benderra MA, Canouï-Poitrine F. The 10-month mortality rate among older patients treated for digestive system cancer during the first wave of the COVID-19 pandemic: The CADIGCOVAGE multicentre cohort study. J Geriatr Oncol 2023; 14:101443. [PMID: 36709553 PMCID: PMC9883010 DOI: 10.1016/j.jgo.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic has had a dramatic impact on cancer diagnosis and care pathways. Here, we assessed the mid-term impact of the COVID-19 pandemic on older adults with cancer before, during and after the lockdown period in 2020. MATERIALS AND METHODS We performed a retrospective, observational, multicentre cohort study of prospectively collected electronic health records. All adults aged 65 or over and having been newly treated for a digestive system cancer in our institution between January 2018 until August 2020 were enrolled. RESULTS Data on 7,881 patients were analyzed. Although the overall 10-month mortality rate was similar in 2020 vs. 2018-2019, the mortality rate among for patients newly treated in the 2020 post-lockdown period was (after four months of follow-up) significantly higher. A subgroup analysis revealed higher mortality rates for (i) patients diagnosed in the emergency department during the pre-lockdown period, (ii) patients with small intestine cancer newly treated during the post-lockdown period, and (iii) patients having undergone surgery with curative intent during the post-lockdown period. However, when considering individuals newly treated during the lockdown period, we observed lower mortality rates for (i) patients aged 80 and over, (ii) patients with a biliary or pancreatic cancer, and (iii) patients diagnosed in the emergency department. DISCUSSION There was no overall increase in mortality among patients newly treated in 2020 vs. 2018-2019. Longer follow-up is needed to assess the consequences of the pandemic. A subgroup analysis revealed significant intergroup differences in mortality.
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Affiliation(s)
- Thomas Aparicio
- AP-HP, Saint Louis Hospital, Gastroenterology and Digestive Oncology Department, F-75010 Paris, France; Université de Paris, F-75000 Paris, France.
| | - Richard Layese
- AP-HP, Henri-Mondor Hospital, Public Health and Clinical Research department (URC Mondor), F-94010 Créteil, France; Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France
| | - François Hemery
- AP-HP, Henri-Mondor Hospital, Medical Information Departement, F-94010 Créteil, France
| | | | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France; AP-HP, Paris Cancer Institute CARPEM, Georges Pompidou Hospital, Geriatric Department, F-75015 Paris, France
| | - Nicola De Angelis
- AP-HP, Henri-Mondor Hospital, Digestive Surgery, F-94010 Créteil, France
| | - Laurent Quero
- Université de Paris, F-75000 Paris, France; AP-HP, Saint Louis Hospital, Radiotherapy Department, F-75010 Paris, France
| | - Nathalie Ganne
- AP-HP, Avicenne Hospital, Hepatology Department, F-93000 Bobigny, France
| | - Fredéric Prat
- Université de Paris, F-75000 Paris, France; AP-HP, Beaujon Hospital, Endoscopy Department, F-92110 Clichy, France
| | - Atanas Pachev
- AP-HP, Saint Louis Hospital, Radiology Department, F-75010 Paris, France
| | - Gilles Galula
- AP-HP, Tenon Hospital, Medical Oncology, F-75020 Paris, France
| | | | - Florence Canouï-Poitrine
- AP-HP, Henri-Mondor Hospital, Public Health and Clinical Research department (URC Mondor), F-94010 Créteil, France; Univ Paris Est Creteil, INSERM, IMRB U955, F-94000 Creteil, France
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24
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Impact of the COVID-19 Outbreak-Delayed Referral of Colorectal and Lung Cancer in Primary Care: A National Retrospective Cohort Study. Cancers (Basel) 2023; 15:cancers15051462. [PMID: 36900257 PMCID: PMC10000463 DOI: 10.3390/cancers15051462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/14/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) outbreak impacted health care. We investigated its impact on the time to referral and diagnosis for symptomatic cancer patients in The Netherlands. We performed a national retrospective cohort study utilizing primary care records linked to The Netherlands Cancer Registry. For patients with symptomatic colorectal, lung, breast, or melanoma cancer, we manually explored free and coded texts to determine the durations of the primary care (IPC) and secondary care (ISC) diagnostic intervals during the first COVID-19 wave and pre-COVID-19. We found that the median IPC duration increased for colorectal cancer from 5 days (Interquartile Range (IQR) 1-29 days) pre-COVID-19 to 44 days (IQR 6-230, p < 0.01) during the first COVID-19 wave, and for lung cancer, the duration increased from 15 days (IQR) 3-47) to 41 days (IQR 7-102, p < 0.01). For breast cancer and melanoma, the change in IPC duration was negligible. The median ISC duration only increased for breast cancer, from 3 (IQR 2-7) to 6 days (IQR 3-9, p < 0.01). For colorectal cancer, lung cancer, and melanoma, the median ISC durations were 17.5 (IQR (9-52), 18 (IQR 7-40), and 9 (IQR 3-44) days, respectively, similar to pre-COVID-19 results. In conclusion, for colorectal and lung cancer, the time to primary care referral was substantially prolonged during the first COVID-19 wave. In such crises, targeted primary care support is needed to maintain effective cancer diagnosis.
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25
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O'Reilly S, Kathryn Carroll H, Murray D, Burke L, McCarthy T, O'Connor R, Kilty C, Lynch S, Feighan J, Cloherty M, Fitzpatrick P, Falvey K, Murphy V, Jane O'Leary M, Gregg S, Young L, McAuliffe E, Hegarty J, Gavin A, Lawler M, Kavanagh P, Spillane S, McWade T, Heffron M, Ryan K, Kelly PJ, Murphy A, Corrigan M, Redmond HP, Redmond P, Walsh PM, Tierney P, Zhang M, Bennett K, Mullooly M. Impact of the COVID-19 pandemic on cancer care in Ireland - Perspectives from a COVID-19 and Cancer Working Group. J Cancer Policy 2023; 36:100414. [PMID: 36841473 PMCID: PMC9951610 DOI: 10.1016/j.jcpo.2023.100414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/17/2023] [Indexed: 02/27/2023]
Abstract
Upon the COVID-19 pandemic onset in Ireland, cancer service disruptions occurred due to prioritisation of COVID-19 related care, redeployment of staff, initial pausing of screening, diagnostic, medical and surgical oncology procedures, staff shortages due to COVID-19 infection and impacts on the physical and mental health of cancer healthcare workers. This was coupled with reluctance among people with symptoms suspicious for cancer to attend for clinical evaluation, due to concerns of contracting the virus. This was further compounded by a cyber-attack on national health service IT systems on May 14th 2021. The Irish Cancer Society, a national cancer charity with a role in advocacy, research and patient supports, convened a multi-disciplinary stakeholder group (COVID-19 and Cancer Working Group) to reflect on and understand the impact of the pandemic on cancer patients and services in Ireland, and discuss potential mitigation strategies. Perspectives on experiences were gathered across domains including timeliness of data acquisition and its conversion into intelligence, and the resourcing of cancer care to address cancer service impacts. The group highlighted aspects for future research to understand the long-term pandemic impact on cancer outcomes, while also highlighting potential strategies to support cancer services, build resilience and address delayed diagnosis. Additional measures include the need for cancer workforce recruitment and retention, increased mental health supports for both patients and oncology professionals, improvements to public health messaging, a near real-time multimodal national cancer database, and robust digital and physical infrastructure to mitigate impacts of the current pandemic and future challenges to cancer care systems.
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Affiliation(s)
- Seamus O'Reilly
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland; Cancer Trials Ireland, Dublin, Ireland.
| | - Hailey Kathryn Carroll
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Deirdre Murray
- School of Public Health, University College Cork, Cork, Ireland; National Cancer Registry Ireland, Cork, Ireland
| | - Louise Burke
- Department of Pathology, Cork University Hospital and University College Cork, Cork, Ireland
| | | | | | | | - Sonya Lynch
- PPI Contributor c/o Cancer Research, UCC University College Cork, T12 DCA4 Cork, Ireland
| | - Jennifer Feighan
- Irish Nutrition & Dietetic Institute, Airfield Estate, Overend Ave, Dundrum, Dublin, Ireland
| | - Maeve Cloherty
- Department of Medical Oncology, Cork University Hospital and Cancer Research@UCC, University College Cork, Cork, Ireland
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland; National Screening Service, Dublin, Ireland
| | | | | | - Mary Jane O'Leary
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Sophie Gregg
- Palliative Medicine, Marymount University Hospital and Hospice, Cork, Ireland
| | - Leonie Young
- Endocrine Oncology Research Group, Department of Surgery, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eilish McAuliffe
- UCD IRIS Centre, School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Belfast, UK
| | - Mark Lawler
- Faculty of Medicine, Health and Life Sciences, Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Northern Ireland, UK; DATA-CAN, the UK's Health Data Research Hub for Cancer, UK
| | - Paul Kavanagh
- National Health Intelligence Unit, Strategy and Research, Jervis House, Jervis St, Health Service Executive, Dublin 1, Ireland
| | - Susan Spillane
- Health Information and Quality Authority, Dublin, Ireland
| | - Terry McWade
- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | - Karen Ryan
- Department of Palliative Medicine, Mater Misericordiae University Hospital and St Francis Hospice Dublin, Ireland
| | - Paul J Kelly
- Bon Secours Radiotherapy Centre, Bon Secours, Cork, Ireland; UPMC Hillman Cancer Centre, Cork, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - Mark Corrigan
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - H Paul Redmond
- Department of Breast Surgery, Cork University Hospital, Cork, Ireland
| | - Patrick Redmond
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | | | - Mengyang Zhang
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Bojaj G, Tahirbegolli B, Beqiri P, Alloqi Tahirbegolli I, Van Poel E, Willems S, Rizanaj N, Hoxha I. Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3768. [PMID: 36834461 PMCID: PMC9965489 DOI: 10.3390/ijerph20043768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic. OBJECTIVE This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic. METHODS In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices. RESULTS Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo. CONCLUSIONS Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.
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Affiliation(s)
- Gazmend Bojaj
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- Principal Family Medicine Center, 32000 Kline, Kosovo
| | - Bernard Tahirbegolli
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- National Sports Medicine Centre, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
| | - Iliriana Alloqi Tahirbegolli
- Laboratory Technician Department, Heimerer College, 10000 Prishtina, Kosovo
- Hematology Clinic, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Nderim Rizanaj
- Nursing Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir Hoxha
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
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Effect of the COVID-19 Pandemic on Surgical Outcomes for Rhegmatogenous Retinal Detachments. J Clin Med 2023; 12:jcm12041522. [PMID: 36836058 PMCID: PMC9959082 DOI: 10.3390/jcm12041522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/10/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
We reviewed the medical records of 438 eyes in 431 patients who had undergone surgeries for rhegmatogenous retinal detachments (RRD) or proliferative vitreoretinopathy (PVR ≥ Grade C) to determine whether the COVID-19 pandemic had affected outcomes. The patients were divided into 203 eyes in Group A that had undergone surgery from April to September 2020, during the pandemic, and 235 eyes in Group B that had undergone surgery from April to September 2019, before the pandemic. The pre- and postoperative visual acuity, macular detachment, type of retinal breaks, size of the RRD, and surgical outcomes were compared. The number of eyes in Group A was fewer by 14%. The incidence of men (p = 0.005) and PVR (p = 0.004) was significantly higher in Group A. Additionally, the patients in Group A were significantly younger than in Group B (p = 0.04). The differences in the preoperative and final visual acuity, incidence of macular detachment, posterior vitreous detachment, types of retinal breaks, and size of the RRD between the two groups were not significant. The initial reattachment rate was significantly lower at 92.6% in Group A than 98.3% in Group B (p = 0.004). The COVID-19 pandemic affected the surgical outcomes for RRD with higher incidences of men and PVR, younger aged patients and lower initial reattachment rates even though the final surgical outcomes were comparable.
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Elfiyunai NN, Nursalam N, Sukartini T, Efendi F. A systematic review on telenursing as a solution in improving the treatment compliance of tuberculosis patients in the COVID-19 pandemic. HEALTHCARE IN LOW-RESOURCE SETTINGS 2023. [DOI: 10.4081/hls.2023.11194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
Introduction: The COVID-19 pandemic had made patients scared of coming to clinics or hospitals, and this could affect the treatment of TB. Therefore, one type of service that can be used by nurses to improve compliance to TB treatment is Telenursing. This article aims to ascertain whether telenursing could be a solution in improving the compliance of TB patients to treatments in the COVID-19 pandemic.
Design and Method: This research was conducted using the Randomised Controlled Trial design as well as PRISMA. Furthermore, useful research articles were sourced from the database using the keywords, “Message Reminder and Tuberculosis OR Medication Adherence”. The databases used are Scopus, Science Direct, PubMed, and SAGE, all in English text and from 2015 to 2021, with inclusion criteria. 277 articles were obtained, and then filtered to select 3 articles by reading the main focus of the write-up, with regard to the topic of study.
Result: Telenursing can be a solution to reduce the spread of COVID-19, and a substitute for remotely motivating individuals, as social support. Furthermore, it could be used as a reminder to patients to be obedient in carrying out treatments, and as a means of educating and improving good relationships with providers.
Conclusions: Telenursing is a fairly effective solution in helping TB patients improve treatment compliance, reduce drug dropout rates and missed doses, as well as, raise awareness about the importance of health in the COVID-19 pandemic.
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Casà C, Dinapoli L, Marconi E, Chiesa S, Cornacchione P, Beghella Bartoli F, Bracci S, Salvati A, Scalise S, Colloca GF, Chieffo DPR, Gambacorta MA, Valentini V, Tagliaferri L. Integration of art and technology in personalized radiation oncology care: Experiences, evidence, and perspectives. Front Public Health 2023; 11:1056307. [PMID: 36755901 PMCID: PMC9901799 DOI: 10.3389/fpubh.2023.1056307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Cancer diagnoses expose patients to traumatic stress, sudden changes in daily life, changes in the body and autonomy, with even long-term consequences, and in some cases, to come to terms with the end-of-life. Furthermore, rising survival rates underline that the need for interventions for emotional wellbeing is in growing demand by patients and survivors. Cancer patients frequently have compliance problems, difficulties during treatment, stress, or challenges in implementing healthy behaviors. This scenario was highlighted during the COVID-19 emergency. These issues often do not reach the clinical attention of dedicated professionals and could also become a source of stress or burnout for professionals. So, these consequences are evident on individual, interpersonal, and health system levels. Oncology services have increasingly sought to provide value-based health care, considering resources invested, with implications for service delivery and related financing mechanisms. Value-based health care can improve patient outcomes, often revealed by patient outcome measures while seeking balance with economical budgets. The paper aims to show the Gemelli Advanced Radiation Therapy (ART) experience of personalizing the patients' care pathway through interventions based on technologies and art, the personalized approach to cancer patients and their role as "co-stars" in treatment care. The paper describes the vision, experiences, and evidence that have guided clinical choices involving patients and professionals in a co-constructed therapeutic pathway. We will explore this approach by describing: the various initiatives already implemented and prospects, with particular attention to the economic sustainability of the paths proposed to patients; the several pathways of personalized care, both from the patient's and healthcare professional perspective, that put the person's experience at the Gemelli ART Center. The patient's satisfaction with the treatment and economic outcomes have been considered. The experiences and future perspectives described in the manuscript will focus on the value of people's experiences and patient satisfaction indicators, patients, staff, and the healthcare organization.
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Affiliation(s)
- Calogero Casà
- UOC di Radioterapia Oncologica, Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Loredana Dinapoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elisa Marconi
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,*Correspondence: Elisa Marconi ✉
| | - Silvia Chiesa
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Patrizia Cornacchione
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Beghella Bartoli
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Serena Bracci
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessandra Salvati
- Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Scalise
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuseppe Ferdinando Colloca
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS di Psicologia Clinica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Scienze della Salute della Donna, del Bambino e di Sanità Pubblica Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Antonietta Gambacorta
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Valentini
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tagliaferri
- UOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Dipartimento di Scienze Radiologiche ed Ematologiche Università Cattolica del Sacro Cuore, Rome, Italy
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Pogorzelska K, Marcinowicz L, Chlabicz S. A Qualitative Study of Primary Care Physicians' Experiences with Telemedicine during the COVID-19 Pandemic in North-Eastern Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1963. [PMID: 36767329 PMCID: PMC9915015 DOI: 10.3390/ijerph20031963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 06/17/2023]
Abstract
(1) Background: Due to the COVID-19 pandemic, primary care clinics quickly moved to provide medical consultations via telemedicine, however, information about primary care professionals' perspectives is limited. (2) Methods: Thirty semi-structured interviews with primary care professionals working in north-eastern Poland were conducted to assess their perspectives regarding the benefits and challenges of telemedicine. (3) Results: Primary care professionals highlighted that telemedicine increases access to medical services and reduces travel inconvenience. Remote consultation is not as time-consuming as in-person visits, which enables the provision of medical services to a greater number of patients which is particularly important in primary care. The inability to see patients and loss of non-verbal communication represent a significant difficulty in providing remote care. Primary care professionals indicated patients are not always able to express themselves sufficiently in a telephone call, which leads to performing medical consultations inefficiently. Physicians also pointed out that in particular medical cases, physical contact is still necessary to reach an accurate diagnosis and give the necessary treatment. Statements of the study participants also show that primary care professionals are satisfied with providing medical advice with telemedicine and show their interest in continuing remote consultation in the post-COVID era. (4) Conclusions: Primary care professionals have moved towards incorporating telemedicine into their daily routines due to the COVID-19 pandemic. Despite the many difficulties encountered, healthcare professionals have also noticed the benefits of telemedicine, especially during challenging circumstances. The study shows telemedicine to be a valuable tool in caring for patients, although it should be emphasized that face-to-face consultations cannot be fully replaced by remote consultations.
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Affiliation(s)
- Karolina Pogorzelska
- Department of Family Medicine, Medical University of Bialystok, 15054 Bialystok, Poland
| | - Ludmila Marcinowicz
- Department of Obstetrics, Gynecology and Maternity Care, Medical University of Bialystok, 15295 Bialystok, Poland
| | - Slawomir Chlabicz
- Department of Family Medicine, Medical University of Bialystok, 15054 Bialystok, Poland
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Vázquez ML, Vargas I, Rubio-Valera M, Aznar-Lou I, Eguiguren P, Mogollón-Pérez AS, Torres AL, Peralta A, Dias S, Jervelund SS. Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study. BMJ Open 2022; 12:e067439. [PMID: 36523219 PMCID: PMC9748968 DOI: 10.1136/bmjopen-2022-067439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador. METHODS AND ANALYSIS This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers). ETHICS AND DISSEMINATION This study complies with international and national legal stipulations on ethics. It was approved by each country's ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.
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Affiliation(s)
- Maria-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Maria Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ignacio Aznar-Lou
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Research and Development Unit, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | - Ana-Lucía Torres
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrés Peralta
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, NOVA University of Lisbon & Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Signe Smith Jervelund
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Aden D, Zaheer S, Raj S. Challenges faced in the cancer diagnosis and management-COVID-19 pandemic and beyond-Lessons for future. Heliyon 2022; 8:e12091. [PMID: 36483302 PMCID: PMC9721200 DOI: 10.1016/j.heliyon.2022.e12091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/28/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic with multiple waves of infection has caused panic and distress globally. Cancer patients being immuno-compromised are more susceptible to infection leading to increased morbidity and unpredictability of their survival. There has been a halt in the diagnosis and treatment of patients suffering from cancer because of the COVID-19 pandemic. Oncologists have the tedious task of assessing the urgency of managing cancer patients against the risk of Coronavirus infection. Timely diagnostic services along with the treatment strategy are needed for the proper management of cancer patients. Since the laboratories are already overwhelmed with the investigations related to the COVID-19 management, there has been a compromise and delay in the diagnosis, thus leading to an overall lag in the management of cancer patients.
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Affiliation(s)
- Durre Aden
- Department of Pathology, HIMSR and HAHC, New Delhi-62, India
| | - Sufian Zaheer
- Department of Pathology, VMMC, Safdarjang Hospital, New Delhi-29, India,Corresponding author.
| | - Swati Raj
- Department of Pathology, Government Doon Medical College, Dehradun, Uttarakhand, India
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Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care. BJGP Open 2022; 6:BJGPO.2022.0038. [PMID: 36270671 PMCID: PMC9904784 DOI: 10.3399/bjgpo.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/12/2022] [Accepted: 09/09/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively. AIM To assess the experiences of patients in primary care during the COVID-19 pandemic. DESIGN & SETTING A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands. METHOD A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach. RESULTS Twenty-eight patients were interviewed (13 men and 15 women, aged 27-91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated. CONCLUSION Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care.
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Oldani S, Petrelli F, Dognini G, Borgonovo K, Parati MC, Ghilardi M, Dottorini L, Cabiddu M, Luciani A. COVID-19 and Lung Cancer Survival: An Updated Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14225706. [PMID: 36428798 PMCID: PMC9688481 DOI: 10.3390/cancers14225706] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: The outbreak of COVID-19 poses an unprecedented challenge to global public health. Patients with cancer are at a higher risk during the SARS-CoV-2 pandemic. Patients with lung cancer and COVID-19 were compared to those without cancer and those with other malignancies for the main outcome of this study. The aim of this study was to evaluate the differences in susceptibility, disease severity, and mortality between lung cancer patients and the general population. Methods: Using PRISMA reporting guidelines, we conducted a systematic review and meta-analysis of the published literature. The Cochrane Library database, PubMed, EMBASE, and PubMed Central were comprehensively searched for published papers until 31 May 2022. A pooled risk ratio (OR) with 95% CI was presented as the result of this meta-analysis. Results: We included 29 studies involved 21,257 patients with lung cancer and SARS-CoV-2 infection. Analysis data showed that mortality in patients with lung cancer was significantly higher than that in patients without cancer (HR = 2.00 [95%CI 1.52, 2.63], p < 0.01) or with other malignancies (HR = 1.91 [95%CI 1.53, 2.39], p < 0.01). In addition, we also observed a higher risk of severe infection in terms of life-threatening or required ICU admission/mechanical ventilation for lung cancer patients (HR = 1.47 [95%CI 1.06, 2.03], p = 0.02) than for patients with no cancer or other malignancies. Regarding lung cancer as a risk factor for acquiring SARS-CoV-2 infection, we could not reach statistical significance (hazard ratio [HR] =2.73 [95%CI 0.84, 8.94], p = 0.1). Conclusion: Lung cancer represents an important comorbidity and modifies COVID-19 prognosis in terms of disease severity and mortality. More patients experience severe or even fatal events. Considering their inherent fragility, patients with lung cancer, and generally all oncological populations, should be treated more carefully during the COVID-19 pandemic.
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Affiliation(s)
| | - Fausto Petrelli
- Correspondence: ; Tel.: +39-036-342-4420; Fax: +39-036-342-4380
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Vaughan C, Lukewich J, Mathews M, Marshall EG, Hedden L, Spencer S, Ryan D, McCracken RK, Gill P, Wetmore S, Buote R, Meredith L, Moritz L, Brown JB. Family physicians' perspectives on the impact of COVID-19 on preventative care in primary care: findings from a qualitative study. Fam Pract 2022:cmac113. [PMID: 36269200 PMCID: PMC9620325 DOI: 10.1093/fampra/cmac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health system disruptions, caused by unexpected emergencies such as disease outbreaks, natural disasters, and cybercrimes, impact the delivery of routine preventative care. As comprehensive care providers, family physicians (FPs) devote significant time to prevention. However, without emergency and pandemic plans in place in primary care, FPs face added barriers to prioritizing and sustaining preventative care when health systems are strained, which was evident during the COVID-19 pandemic. This study aims to describe FPs' experiences providing preventative care during the COVID-19 pandemic and their perceptions of the impacts of disrupted preventative care in primary care settings. METHODS Using a qualitative descriptive approach, we conducted semistructured interviews with FPs across 4 provinces in Canada (i.e. Newfoundland and Labrador, Nova Scotia, Ontario, British Columbia) between October 2020 and June 2021 as part of a larger multiple case study. These interviews broadly explored the roles and responsibilities of FPs during the COVID-19 pandemic. Interviews were coded thematically and codes from the larger study were analysed further using an iterative, phased process of thematic analysis. RESULTS Interviews averaged 58 min in length (range 17-97 min) and FPs had a mean of 16.9 years of experience. We identified 4 major themes from interviews with FPs (n = 68): (i) lack of capacity and coordination across health systems, (ii) patient fear, (iii) impacts on patient care, and (iv) negative impacts on FPs. Physicians voiced concerns with managing patients' prevention needs when testing availability and coordination of services was limited. Early in the pandemic, patients were also missing or postponing their own primary care appointments. Change in the provision and coordination of routine preventative care had negative impacts on both patients and physicians, affecting disease incidence/progression, physician workload, and psychological wellbeing. CONCLUSION During the COVID-19 pandemic, upstream care efforts were impacted, and FPs were forced to reduce their provision of preventative care. FPs contribute direct insight to primary care delivery that can support pandemic planning to ensure preventative care is sustained during future emergencies.
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Affiliation(s)
- Crystal Vaughan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Rita K McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Paul Gill
- Temerty Faculty of Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Gateway Centre of Excellence in Rural Health, Gateway Rural Health Institute, Goderich, Canada
| | - Stephen Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Mavragani A, Patel H, Bakoyannis G, Haggstrom DA, Mohanty S, Dixon BE. COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study. JMIR Cancer 2022; 8:e35310. [PMID: 36201388 PMCID: PMC9555821 DOI: 10.2196/35310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 08/29/2022] [Accepted: 09/16/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. OBJECTIVE The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. METHODS We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. RESULTS During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre-COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. CONCLUSIONS The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population.
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Affiliation(s)
| | - Hetvee Patel
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Giorgos Bakoyannis
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - David A Haggstrom
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA Medical Center, Veterans Health Administration, Indianapolis, IN, United States.,Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Sanjay Mohanty
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States.,Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States.,Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA Medical Center, Veterans Health Administration, Indianapolis, IN, United States
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Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY study. Breast 2022; 65:164-171. [PMID: 35998429 PMCID: PMC9388078 DOI: 10.1016/j.breast.2022.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/13/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022] Open
Abstract
Purpose Methods Results Conclusions COVID-19 impacted on breast cancer (BC) diagnoses with a reduction of 25% in 2020. Fewer early-stage BC and more symptomatic patients were diagnosed during 2020. Timing of access to BC diagnosis, staging and treatment has not been affected by COVID-19. Less BC cases were reviewed in multidisciplinary tumor meetings during 2020.
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Nazario LC, Magajewski FRL, Pizzol ND, Saloti MHDAS, Medeiros LK. Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020. Rev Col Bras Cir 2022; 49:e20223373. [PMID: 36074394 PMCID: PMC10578828 DOI: 10.1590/0100-6991e-20223373-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. METHODS ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. RESULTS 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. CONCLUSION the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.
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Affiliation(s)
| | | | - Natalia Dal Pizzol
- - Universidade do Sul de Santa Catarina, Medicina - Tubarão - SC - Brasil
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Hassan AM, Chu CK, Liu J, Angove R, Rocque G, Gallagher KD, Momoh AO, Caston NE, Williams CP, Wheeler S, Butler CE, Offodile AC. Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: insights from a nationwide study. Support Care Cancer 2022; 30:7665-7678. [PMID: 35689108 PMCID: PMC9187333 DOI: 10.1007/s00520-022-07204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/03/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Telemedicine use during the COVID-19 pandemic among financially distressed patients with cancer, with respect to the determinants of adoption and patterns of utilization, has yet to be delineated. We sought to systematically characterize telemedicine utilization in financially distressed patients with cancer during the COVID-19 pandemic. METHODS We conducted a cross-sectional analysis of nationwide survey data assessing telemedicine use in patients with cancer during the COVID-19 pandemic collected by Patient Advocate Foundation (PAF) in December 2020. Patients were characterized as financially distressed by self-reporting limited financial resources to manage out-of-pocket costs, psychological distress, and/or adaptive coping behaviors. Primary study outcome was telemedicine utilization during the pandemic. Secondary outcomes were telemedicine utilization volume and modality preferences. Multivariable and Poisson regression analyses were used to identify factors associated with telemedicine use. RESULTS A convenience sample of 627 patients with cancer responded to the PAF survey. Telemedicine adoption during the pandemic was reported by 67% of patients, with most (63%) preferring video visits. Younger age (19-35 age compared to ≥ 75 age) (OR, 6.07; 95% CI, 1.47-25.1) and more comorbidities (≥ 3 comorbidities compared to cancer only) (OR, 1.79; 95% CI, 1.13-2.65) were factors associated with telemedicine adoption. Younger age (19-35 years) (incidence rate ratios [IRR], 1.78; 95% CI, 24-115%) and higher comorbidities (≥ 3) (IRR; 1.36; 95% CI, 20-55%) were factors associated with higher utilization volume. As area deprivation index increased by 10 units, the number of visits decreased by 3% (IRR 1.03, 95% CI, 1.03-1.05). CONCLUSIONS The rapid adoption of telemedicine may exacerbate existing inequities, particularly among vulnerable financially distressed patients with cancer. Policy-level interventions are needed for the equitable and efficient provision of this service.
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Affiliation(s)
- Abbas M Hassan
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Carrie K Chu
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Jun Liu
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | | | - Gabrielle Rocque
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Adeyiza O Momoh
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Nicole E Caston
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Courtney P Williams
- Division of Hematology and Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stephanie Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Charles E Butler
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA
| | - Anaeze C Offodile
- Department of Plastic & Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Unit 1488, Houston, TX, 77030, USA.
- Institute for Cancer Care Innovation, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Baker Institute for Public Policy, Rice University, Houston, TX, USA.
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40
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Stachteas P, Symvoulakis M, Tsapas A, Smyrnakis E. The impact of the COVID-19 pandemic on the management of patients with chronic diseases in Primary Health Care. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/152606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Silva B, Ožvačić Adžić Z, Vanden Bussche P, Van Poel E, Seifert B, Heaster C, Collins C, Tuz Yilmaz C, Knights F, de la Cruz Gomez Pellin M, Astier Peña MP, Stylianou N, Gomez Bravo R, Cerovečki V, Klemenc Ketis Z, Willems S. Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10515. [PMID: 36078230 PMCID: PMC9518383 DOI: 10.3390/ijerph191710515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.
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Affiliation(s)
- Bianca Silva
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Zlata Ožvačić Adžić
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | | | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Bohumil Seifert
- Institute of General Practice, First Medical Faculty, Charles University, CZ-121 08 Prague, Czech Republic
| | - Cindy Heaster
- Department of Family Medicine, Faculty of Medicine, Riga Stradiņš University, LV-1007 Riga, Latvia
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Canan Tuz Yilmaz
- Family Medicine Department, Bursa Uludag University, 16130 Bursa, Turkey
| | - Felicity Knights
- Population Health Research Institute, St George’s University of London, London SW17 0RE, UK
| | | | - Maria Pilar Astier Peña
- Primary Health Centre Universitas, Aragon Health Services, 50009 Zaragoza, Spain
- Medical School, Universidad de Zaragoza, GIBA-ISS-Aragón, 50009 Zaragoza, Spain
| | - Neophytos Stylianou
- RTD Talos, 2404 Nicosia, Cyprus
- International Institute for Compassionate Care, 2415 Nicosia, Cyprus
| | - Raquel Gomez Bravo
- CHNP, Rehaklinik, L-9002 Ettelbruck, Luxembourg
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, Faculty of Humanities, Education and Social Sciences, University of Luxembourg, L-4366 Esch-sur-Alzette, Luxembourg
| | - Venija Cerovečki
- Department of Family Medicine, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Health Centre Zagreb-Centar, 10000 Zagreb, Croatia
| | - Zalika Klemenc Ketis
- Ljubljana Community Health Centre, 1000 Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Considering context: Adaptive elements of a simulation program to improve primary care safety during the COVID-19 pandemic in Alberta, Canada. Am J Infect Control 2022; 50:885-889. [PMID: 35908827 PMCID: PMC9329075 DOI: 10.1016/j.ajic.2021.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022]
Abstract
Background Methods Results Conclusions
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Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system. Br J Cancer 2022; 127:558-568. [PMID: 35501391 PMCID: PMC9060409 DOI: 10.1038/s41416-022-01830-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/07/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND COVID-19 pandemic responses impacted behaviour and health services. We estimated the impact on incidence, stage and healthcare pathway to diagnosis for female breast, colorectal and non-small cell lung cancers at population level in Wales. METHODS Cancer e-record and hospital admission data linkage identified adult cases, stage and healthcare pathway to diagnosis (population ~2.5 million). Using multivariate Poisson regressions, we compared 2019 and 2020 counts and estimated incidence rate ratios (IRR). RESULTS Cases decreased 15.2% (n = -1011) overall. Female breast annual IRR was 0.81 (95% CI: 0.76-0.86, p < 0.001), colorectal 0.80 (95% CI: 0.79-0.81, p < 0.001) and non-small cell lung 0.91 (95% CI: 0.90-0.92, p < 0.001). Decreases were largest in 50-69 year olds for female breast and 80+ year olds for all cancers. Stage I female breast cancer declined 41.6%, but unknown stage increased 55.8%. Colorectal stages I-IV declined (range 26.6-29.9%), while unknown stage increased 803.6%. Colorectal Q2-2020 GP-urgent suspected cancer diagnoses decreased 50.0%, and 53.9% for non-small cell lung cancer. Annual screen-detected female breast and colorectal cancers fell 47.8% and 13.3%, respectively. Non-smal -cell lung cancer emergency presentation diagnoses increased 9.5% (Q2-2020) and 16.3% (Q3-2020). CONCLUSION Significantly fewer cases of three common cancers were diagnosed in 2020. Detrimental impacts on outcomes varied between cancers. Ongoing surveillance with health service optimisation will be needed to mitigate impacts.
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Pinato DJ, Ferrante D, Aguilar-Company J, Bower M, Salazar R, Mirallas O, Sureda A, Bertuzzi A, Brunet J, Lambertini M, Maluquer C, Pedrazzoli P, Biello F, Lee AJX, Sng CCT, Liñan R, Rossi S, Carmona-García MC, Sharkey R, Eremiev S, Rizzo G, Bain HD, Yu T, Cruz CA, Perachino M, Saoudi-Gonzalez N, Fort-Culillas R, Doonga K, Fox L, Roldán E, Zoratto F, Gaidano G, Ruiz-Camps I, Bruna R, Patriarca A, Shawe-Taylor M, Fusco V, Martinez-Vila C, Berardi R, Filetti M, Mazzoni F, Santoro A, Delfanti S, Parisi A, Queirolo P, Aujayeb A, Rimassa L, Prat A, Tabernero J, Gennari A, Cortellini A. Vaccination against SARS-CoV-2 protects from morbidity, mortality and sequelae from COVID19 in patients with cancer. Eur J Cancer 2022; 171:64-74. [PMID: 35704976 PMCID: PMC9124924 DOI: 10.1016/j.ejca.2022.04.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/18/2022] [Accepted: 04/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although SARS-CoV-2 vaccines immunogenicity in patients with cancer has been investigated, whether they can significantly improve the severity of COVID-19 in this specific population is undefined. METHODS Capitalizing on OnCovid (NCT04393974) registry data we reported COVID-19 mortality and proxies of COVID-19 morbidity, including post-COVID-19 outcomes, according to the vaccination status of the included patients. RESULTS 2090 eligible patients diagnosed with COVID-19 between 02/2020 and 11/2021 were included, of whom 1930 (92.3%) unvaccinated, 91 (4.4%) fully vaccinated and 69 (3.3%) partially vaccinated. With the exception of a higher prevalence of patients from the UK (p = 0.0003) and receiving systemic anticancer therapy at COVID-19 diagnosis (p = 0.0082) among fully vaccinated patients, no demographics/oncological features were associated with vaccination status. The 14-days case fatality rate (CFR) (5.5% vs 20.7%, p = 0.0004) and the 28-days CFR (13.2% vs 27.4%, p = 0.0028) demonstrated a significant improvement for fully vaccinated patients in comparison with unvaccinated patients. The receipt of prior full vaccination was also associated with reduced symptomatic COVID-19 (79.1% vs 88.5%, p = 0.0070), need of COVID-19 oriented therapy (34.9% vs 63.2%, p < 0.0001), complications from COVID-19 (28.6% vs 39.4%, p = 0.0379), hospitalizations due to COVID-19 (42.2% vs 52.5%, p = 0.0007) and oxygen therapy requirement (35.7% vs 52%, p = 0.0036). Following Inverse Probability Treatment Weighting (IPTW) procedure no statistically significant difference according to the vaccination status was confirmed; however, all COVID-19 related outcomes were concordantly in favour of full vaccination. Among the 1228 (58.8%) patients who underwent a formal reassessment at participating centres after COVID-19 resolution, fully vaccinated patients experienced less sequelae than unvaccinated patients (6.7% vs 17.2%, p = 0.0320). CONCLUSIONS This analysis provides initial evidence in support of the beneficial effect of SARS-CoV-2 vaccines against morbidity and mortality from COVID-19 in patients with cancer.
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Affiliation(s)
- David J Pinato
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Daniela Ferrante
- Department of Translational Medicine, Unit of Medical Statistics, University of Piemonte Orientale, Novara, Italy
| | - Juan Aguilar-Company
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain; Infectious Diseases, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Mark Bower
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Ramon Salazar
- Department of Medical Oncology, ICO L'Hospitalet, Oncobell Program (IDIBELL), CIBERONC, Hospitalet de Llobregat, Spain
| | - Oriol Mirallas
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Anna Sureda
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Alexia Bertuzzi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Joan Brunet
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Matteo Lambertini
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Clara Maluquer
- Haematology Department, ICO Hospitalet, Hospitalet de Llobregat, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Paolo Pedrazzoli
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia Italy
| | - Federica Biello
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alvin J X Lee
- Cancer Division, University College London Hospitals, London, UK
| | | | - Raquel Liñan
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Sabrina Rossi
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - M Carmen Carmona-García
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Rachel Sharkey
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Simeon Eremiev
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Gianpiero Rizzo
- Medical Oncology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Hamish Dc Bain
- Cancer Division, University College London Hospitals, London, UK
| | - Tamara Yu
- Cancer Division, University College London Hospitals, London, UK
| | - Claudia A Cruz
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain
| | - Marta Perachino
- Medical Oncology Department, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Nadia Saoudi-Gonzalez
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Roser Fort-Culillas
- Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Josep Trueta, Girona, Spain
| | - Kris Doonga
- Department of Oncology and National Centre for HIV Malignancy, Chelsea and Westminster Hospital, London, UK
| | - Laura Fox
- Department of Hematology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Elisa Roldán
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Gianluca Gaidano
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore Della Carità Hospital, Novara, Italy
| | - Isabel Ruiz-Camps
- Infectious Diseases, Vall D'Hebron University Hospital, Barcelona, Spain
| | - Riccardo Bruna
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore Della Carità Hospital, Novara, Italy
| | - Andrea Patriarca
- Division of Haematology, Department of Translational Medicine, University of Piemonte Orientale and Maggiore Della Carità Hospital, Novara, Italy
| | | | - Vittorio Fusco
- Oncology Unit and Centro Documentazione Osteonecrosi, Azienda Ospedaliera "SS Antonio e Biagio e Cesare Arrigo", Alessandria, Italy
| | | | - Rossana Berardi
- Medical Oncology, AOU Ospedali Riuniti, Polytechnic University of the Marche Region, Ancona, Italy
| | | | | | - Armando Santoro
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | - Sara Delfanti
- Mesothelioma Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro Parisi
- Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Queirolo
- Melanoma and Sarcoma Medical Treatment Unit, IEO - Istituto Europeo di Oncologia, Milan, Italy
| | - Avinash Aujayeb
- Respiratory Department, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 20090 Pieve Emanuele, Milan, Italy
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - Josep Tabernero
- Medical Oncology, Vall D'Hebron University Hospital and Institute of Oncology (VHIO), IOB-Quiron, UVic-UCC, Barcelona, Spain
| | - Alessandra Gennari
- Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessio Cortellini
- Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK.
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Saatci D, Oke J, Harnden A, Hippisley-Cox J. Childhood, teenage and young adult cancer diagnosis during the first wave of the COVID-19 pandemic: a population-based observational cohort study in England. Arch Dis Child 2022; 107:740-746. [PMID: 35318196 PMCID: PMC8960459 DOI: 10.1136/archdischild-2021-322644] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/11/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate childhood, teenage and young adult cancer diagnostic pathways during the first wave of the COVID-19 pandemic in England. DESIGN Population-based cohort study. SETTING AND PARTICIPANTS QResearch, a nationally representative primary care database, linked to hospital admission, mortality and cancer registry data, was used to identify childhood, teenage and young adult cancers (0-24 years) diagnosed between 1 January 2017 and 15 August 2020. MAIN OUTCOMES Main outcomes of interest were: (1) number of incident cancer diagnoses per month, (2) diagnostic, treatment time intervals and (3) cancer-related intensive care admissions. RESULTS 2607 childhood, teenage and young adult cancers were diagnosed from 1 January 2017 to 15 August 2020; 380 were diagnosed during the pandemic period. Overall, 17% (95% CI -28.0% to -4.0%) reduction in the incidence rate ratio of cancers was observed during the pandemic. Specific decreases were seen for central nervous system tumour (-38% (95% CI -52% to -21%)) and lymphoma (-28% (95% CI -45% to -5%)) diagnoses. Additionally, childhood cancers diagnosed during the pandemic were significantly more likely to have intensive care admissions (adjusted OR 2.2 (95% CI 1.33 to 3.47)). Median time-to-diagnosis did not significantly differ across periods (+4.5 days (95% CI -20.5 to +29.5)), while median time-to-treatment was shorter during the pandemic (-0.7 days (95% CI -1.1 to -0.3)). CONCLUSIONS Collectively, our findings of a significant reduction in cancer diagnoses and increase in intensive care admissions provide initial insight into the changes that occurred to childhood, teenage and young adult cancer diagnostic pathways during the first wave of the pandemic.
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Affiliation(s)
- Defne Saatci
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Jason Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anthony Harnden
- Department of Primary Health Care, Oxford University, Oxford, UK
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Luu T. Reduced Cancer Screening Due to Lockdowns of the COVID-19 Pandemic: Reviewing Impacts and Ways to Counteract the Impacts. Front Oncol 2022; 12:955377. [PMID: 35965514 PMCID: PMC9372444 DOI: 10.3389/fonc.2022.955377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has created disruptions in health services in general and cancer screening and diagnostic services in particular, leading to diminished cancer screening participation rates. This paper aims to seek insights into impacts that the pandemic has had on cancer screening, impacts that reduced cancer screening may have in the long run, and how to address such impacts. The paper demonstrates that reduced cancer screening in the pandemic is likely to result in enhanced demands for cancer screening in the new normal, enhanced demands for resources to address such demands, and poor prognosis due to stage migration of cancer diseases. Some measures are recommended for counteracting these impacts.
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Smith CF, Nicholson BD, Hirst Y, Fleming S, Bankhead CR. Primary care practice and cancer suspicion during the first three COVID-19 lockdowns in the UK: a qualitative study. Br J Gen Pract 2022; 72:BJGP.2021.0719. [PMID: 35940883 PMCID: PMC9377348 DOI: 10.3399/bjgp.2021.0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly affected UK primary care, and as a result the route to cancer diagnosis for many patients. AIM To explore how the pandemic affected primary care practice, in particular cancer suspicion, referral, and diagnosis, and how this experience evolved as the pandemic progressed. DESIGN AND SETTING Seventeen qualitative interviews were carried out remotely with primary care staff. METHOD Staff from practices in England that expressed an interest in trialling an electronic safety-netting tool were invited to participate. Remote, semi-structured interviews were conducted from September 2020 to March 2021. Data analysis followed a thematic analysis and mind-mapping approach. RESULTS The first lockdown was described as providing time to make adjustments to allow remote and minimal-contact consultations but caused concerns over undetected cancers. These concerns were realised in summer and autumn 2020 as the participants began to see higher rates of late-stage cancer presentation. During the second and third lockdowns patients seemed more willing to consult. This combined with usual winter pressures, demands of the vaccine programme, and surging levels of COVID-19 meant that the third lockdown was the most difficult. New ways of working were seen as positive when they streamlined services but also unsafe if they prevented GPs from accessing all relevant information and resulted in delayed cancer diagnoses. CONCLUSION The post-pandemic recovery of cancer care is dependent on the recovery of primary care. The COVID-19 pandemic has highlighted and exacerbated vulnerabilities in primary care but has also provided new ways of working that may help the recovery.
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Affiliation(s)
| | - Brian D Nicholson
- GP and National Institute for Health and Care Research academic clinical lecturer
| | - Yasemin Hirst
- Institute of Epidemiology and Health, University College London, London
| | - Susannah Fleming
- Nuffield Department of Primary Care Sciences, University of Oxford, Oxford
| | - Clare R Bankhead
- Nuffield Department of Primary Care Sciences, University of Oxford, Oxford
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48
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Mentrasti G, Cantini L, Zichi C, D'Ostilio N, Gelsomino F, Martinelli E, Chiari R, La Verde N, Bisonni R, Cognigni V, Pinterpe G, Pecci F, Migliore A, Aimar G, De Vita F, Traisci D, Spallanzani A, Martini G, Nicolardi L, Cona MS, Baleani MG, Rocchi MLB, Berardi R. Alarming Drop in Early Stage Colorectal Cancer Diagnoses After COVID-19 Outbreak: A Real-World Analysis from the Italian COVID-DELAY Study. Oncologist 2022; 27:e723-e730. [PMID: 35815922 PMCID: PMC9438923 DOI: 10.1093/oncolo/oyac129] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/05/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has triggered the disruption of health care on a global scale. With Italy tangled up in the pandemic response, oncology care has been largely diverted and cancer screenings suspended. Our multicenter Italian study aimed to evaluate whether COVID-19 has impacted access to diagnosis, staging, and treatment for patients newly diagnosed with colorectal cancer (CRC), compared with pre-pandemic time. METHODS All consecutive new CRC patients referred to 8 Italian oncology institutions between March and December 2020 were included. Access rate and temporal intervals between date of symptoms onset, radiological and cytohistological diagnosis, treatment start and first radiological evaluation were analyzed and compared with the same months of 2019. RESULTS A reduction (29%) in newly diagnosed CRC cases was seen when compared with 2019 (360 vs 506). New CRC patients in 2020 were less likely to be diagnosed with early stage (stages I-II-III) CRC (63% vs 78%, P < .01). Gender and sidedness were similar regardless of the year. The percentage of tumors with any mutation among BRAF, NRAS, and KRAS genes were significantly different between the 2 years (61% in 2020 vs 50% in 2019, P = .04). Timing of access to cancer diagnosis, staging, and treatment for patients with CRC has not been negatively affected by the pandemic. Significantly shorter temporal intervals were observed between symptom onset and first oncological appointment (69 vs 79 days, P = .01) and between histological diagnosis and first oncological appointment (34 vs 42 days, P < .01) during 2020 compared with 2019. Fewer CRC cases were discussed in multidisciplinary meetings during 2020 (38% vs 50%, P = .01). CONCLUSIONS Our data highlight a significant drop in CRC diagnosis after COVID-19, especially for early stage disease. The study also reveals a remarkable setback in the multidisciplinary management of patients with CRC. Despite this, Italian oncologists were able to ensure diagnostic-therapeutic pathways proper operation after March 2020.
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Affiliation(s)
- Giulia Mentrasti
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Luca Cantini
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Clizia Zichi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | | | - Fabio Gelsomino
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Erika Martinelli
- UOC Oncologia ed Ematologia, Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Rita Chiari
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Nicla La Verde
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | - Renato Bisonni
- Department of Oncology, Ospedale Augusto Murri di Fermo, Fermo, Italy
| | - Valeria Cognigni
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giada Pinterpe
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Federica Pecci
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Antonella Migliore
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Giacomo Aimar
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Francesca De Vita
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Torino, Italy
| | - Donatella Traisci
- Medical Oncology, ASL2 Abruzzo, Ospedale San Pio da Pietralcina, Vasto, Italy
| | - Andrea Spallanzani
- Division of Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giulia Martini
- UOC Oncologia ed Ematologia, Dipartimento di Medicina di Precisione, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Linda Nicolardi
- Medical Oncology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | - Maria Silvia Cona
- Department of Oncology, Ospedale Luigi Sacco, ASST Fatebenefratelli Sacco, Milano, Italy
| | | | | | - Rossana Berardi
- Department of Medical Oncology, Università Politecnica delle Marche, AOU Ospedali Riuniti di Ancona, Ancona, Italy
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White J, Cavenagh D, Byles J, Mishra G, Tooth L, Loxton D. The experience of delayed health care access during the COVID 19 pandemic in Australian women: A mixed methods exploration. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1384-e1395. [PMID: 34423499 PMCID: PMC8653352 DOI: 10.1111/hsc.13546] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 07/02/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
Delayed health care access is a potential collateral effect of pandemic conditions, health rationing strategies and social distancing responses. We investigated experiences of delayed health care access in Australian women during COVID-19. A mixed methods study used quantitative and free-text data from the Australian Longitudinal Study on Women's Health COVID-19 survey 4 (health care access or delay). Logistic regression models were used to estimate factors associated with delaying access to general practitioners (GPs), specialists and allied health services. Free-text comments were analysed thematically, employing a process of constant comparison. COVID-19 survey 4 was completed by 8,200 women and 2,727 provided free-text comments. Of the women who needed the health service, 25% (1,268/5,071) delayed seeing their GP, 23.6% (570/1,695) delayed seeing a specialist and 45% (791/1,757) delayed use of an allied health service. Younger age was most significantly associated with delaying attendance. Women born 1989-95 were significantly more likely to delay compared to women born 1946-51 (OR (95% CI): GP = 0.28 (0.22, 0.35)); Specialist = 0.65 (0.45, 0.92; Allied Health = 0.59 (0.42, 0.82)). Women born 1973-78 were also likely to delay GP visits (0.69, (0.58, 0.83)). Four qualitative themes emerged including: (1) Challenges negotiating care during a pandemic; (2) Ongoing uncertainty towards accessing health care when a specialist delays an appointment; (3) Accessing health care (or not) using Telehealth and (4) Managing complex care needs. COVID-19 has had a significant effect on access to health care. Women delayed seeking help for cancer screening, mental health, and other health conditions involving chronic and complex needs for health and social care. While there is a need to rationalise and optimise health access during a pandemic, our outcomes suggest a need for public health campaigns that clarify how to access care, engage with telehealth and respond to missed appointments.
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Affiliation(s)
- Jennifer White
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Dominic Cavenagh
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Julie Byles
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
| | - Gita Mishra
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Leigh Tooth
- School of Public HealthFaculty of MedicineThe University of QueenslandHerstonAustralia
| | - Deborah Loxton
- Centre for Women’s Health ResearchFaculty of Health and MedicineUniversity of NewcastleNewcastleAustralia
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50
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Lee-Ying R, O'Sullivan DE, Gagnon R, Bosma N, Stewart RN, Railton C, Tilley D, Alimohamed N, Basappa N, Cheng T, Kolinsky M, Karim S, Ruether D, North S, Yip S, Danielson B, Heng D, Brenner D. Stage migration of testicular germ cell tumours in Alberta, Canada, during the COVID-19 pandemic: a retrospective cohort study. CMAJ Open 2022; 10:E633-E642. [PMID: 35790231 PMCID: PMC9262347 DOI: 10.9778/cmajo.20210285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND An absence of screening recommendations and the rapid progression of testicular germ cell tumours (TGCTs) offer a perspective on the potential impact of the COVID-19 pandemic on cancer presentations. We evaluated the presenting cancer stages of TGCTs in a real-world population before and during the pandemic to assess stage migration. METHODS We performed a retrospective review of all new patients with TGCT diagnoses in Alberta, Canada, from Dec. 31, 2018, to Apr. 30, 2021, using the Alberta Cancer Registry. Because potential changes in staging should not occur instantaneously, we used a 6-month lag time from Apr. 1, 2020, for seminomas, and a 3-month lag time for nonseminomas, to compare initial cancer stages at presentation before and during the pandemic. We evaluated monthly rates of presentation by stage and histology. Exploratory outcomes included the largest tumour dimension, tumour markers and, for advanced disease, risk category and treatment setting. RESULTS Of 335 patients with TGCTs, 231 were diagnosed before the pandemic and 104 during the pandemic (using a lag time). In total, 18 (7.8%) patients diagnosed before the pandemic presented with stage III disease, compared to 16 (15.4%) diagnosed during the pandemic (relative risk 1.97, 95% confidence interval [CI] 1.05-3.72). We observed no significant differences for secondary outcomes. Without a lag time, the rate ratio for a stage II presentation decreased significantly during the pandemic (0.40, 95% CI 0.21-0.72). INTERPRETATION We observed signs of TGCT stage migration during the COVID-19 pandemic, driven by a decline in stage II disease and a potential rise in stage III disease. Management of TGCTs should remain a priority, even during a global pandemic.
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Affiliation(s)
- Richard Lee-Ying
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dylan E O'Sullivan
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Richard Gagnon
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta.
| | - Nicholas Bosma
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Rebecca N Stewart
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Cindy Railton
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Derek Tilley
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Nimira Alimohamed
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Naveen Basappa
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Tina Cheng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Michael Kolinsky
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Safiya Karim
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Dean Ruether
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Scott North
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Steven Yip
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Brita Danielson
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Daniel Heng
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
| | - Darren Brenner
- Department of Oncology (Lee-Ying, O'Sullivan, Gagnon, Stewart, Railton, Tilley, Alimohamed, Cheng, Karim, Ruether, Yip, Heng, Brenner), University of Calgary, Tom Baker Cancer Centre, Calgary, Alta.; BC Cancer Agency-Victoria (Bosma), Victoria, BC; Department of Oncology (Basappa, Kolinsky, North, Danielson), University of Alberta, Cross Cancer Institute, Edmonton, Alta
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