Seven-day access to NHS primary care: how does England compare with Europe?

Characteristics and patient pathways of Lyme disease patients: a retrospective analysis of hospital episode data in England and Wales (1998-2015)

Background

Lyme disease is a tick-borne disease of increasing global importance. There is scant information on Lyme disease patient demographics in England and Wales, and how they interact with the National Health Service (NHS). Our aims were to explore the demographic characteristics of Lyme disease patients within the Hospital Episode Statistics (HES) and Patient Episode Database for Wales (PEDW), and to describe patient pathways.

Methods

Data from 1st January 1998 to 31st December 2015 was retrieved from the two administrative hospital datasets (HES and PEDW), based on patients coded with Lyme disease. Information was collected on demographic characteristics, home address and case management. Incidence rates were calculated, and demographics compared to the national population.

Results

Within HES and PEDW, 2361 patients were coded with Lyme disease. There was a significant increase (p < 0.01) in incidence from 0.08 cases/100,000 in 1998, to 0.53 cases/100,000 in 2015. There was a bimodal age distribution, patients were predominantly female, white and from areas of low deprivation. New cases peaked annually in August, with higher incidence rates in southern central and western England. Within hospital admission data (n = 2066), most cases were either referred from primary care (28.8%, n = 596) or admitted via accident and emergency (A&E) (29.5%, n = 610). This population entering secondary care through A&E suggest a poor understanding of the recommended care pathways for symptoms related to Lyme disease by the general population.

Conclusions

These data can be used to inform future investigations into Lyme disease burden, and patient management within the NHS. They provide demographic information for clinicians to target public health messaging or interventions.

The response of health systems to after-hours primary cares in Iran and the selected countries

BACKGROUND

After-hours primary care often involves care required for medical conditions managed outside hospitals by a general practitioner. After-hours care aims at meeting the urgent needs of patients who cannot wait to visit their general practitioner in office hours.

AIM

The present study aims at comparing the after-hours primary cares in Iran, Turkey, the United States, the Netherlands, Australia, and the United Kingdom.

METHOD

This is a descriptive-comparative study comparing after-hours primary cares in Iran and selected countries in 2019. Considering the research purpose, data pertaining to each country were collected from valid information sources and the countries were compared based on the comparative table. A framework analysis was used for data analyses.

RESULTS

The results were stated regarding the model type, dominant model, payments mechanism, the support of insurance organizations, service tariffs, private sector participation, and participation of primary care general practitioners in each country.

CONCLUSIONS

Different countries are using diverse policies to enhance patients' access to general practitioners in out-of-office hours. In Iran, however, due to the lack of specific policies to access after-hour primary cares, people have to use expensive hospital and private cares. An essential step in solving this problem is the availability of general practitioner services at primary care level.