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Moreno-Vásquez M, Vidal-Alaball J, Saez M, Barceló MA. Impacts of COVID-19 on clinical indicators and mortality in patients with chronic conditions in Catalonia, Spain: A retrospective population-based cohort study. J Glob Health 2024; 14:05020. [PMID: 38900506 DOI: 10.7189/jogh.14.05020] [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: 06/21/2024] Open
Abstract
Background The reallocation of health care services during the coronavirus disease 2019 (COVID-19) pandemic disrupted the continuity of primary care. This study examines the repercussions of the COVID-19 pandemic on clinical indicators within the Catalan population, emphasising individuals with chronic conditions. It provides insights into mortality and transfer rates considering intersectional perspectives. Methods We designed a retrospective, observational population-based cohort study based on routinely collected data from January 2015 to June 2021 for all individuals available in the Information System for Research in Primary Care (Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP)), the largest public primary care database in Catalonia, Spain. We included 6 301 095 individuals, constituting 81.6% of Catalonia's population in 2020. To perform a repeated measurements analysis of the indicators, we focussed on individuals who had one or more indicators in both the pre-pandemic (January 2015 to March 2020) and pandemic periods (March 2020 to June 2021), and those diagnosed with type 2 diabetes mellitus (T2D), high blood pressure, and heart failure. We selected key clinical indicators for analysis, including systolic and diastolic blood pressure, body mass index (BMI), cholesterol (total, high, and low-density lipoprotein), triglycerides, glycosylated haemoglobin, the Barthel index, and cardiovascular risk (Registre Gironí del cor (REGICOR) index). Results Mortality and transfer rates increased during the pandemic, contributing to a decline in the active population in the public health system. We also observed a reduction in pandemic period prevalence of patients with chronic conditions: -26.7% for heart failure, -15.1% for high blood pressure, and -14.6% for T2D. In both pre-pandemic and pandemic periods, 1 632 013 subjects had at least one clinical indicator record. Clinical indicators worsened in patients diagnosed with chronic conditions during the pandemic. Most indicators worsened, with differences between men and women (+9.4% vs +3.7% for the REGICOR index and -14.1% vs -16.6% for the Barthel index in men and in women, respectively), and to a similar extent (or greater in some cases) in individuals without these conditions. Conclusions We used longitudinal data to assess the repercussions of the COVID-19 pandemic on population health while considering a wide range of clinical indicators and socioeconomic determinants. Our analysis shows a deterioration in clinical indicators during the pandemic, particularly in cardiometabolic factors, underscoring the importance of continuous primary care for individuals with chronic conditions.
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Affiliation(s)
- Manuel Moreno-Vásquez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Manresa, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Manresa, Barcelona, Spain
- Health Promotion in Rural Areas Research Group, Gerencia d'Atenció Primària i a la Comunitat de la Catalunya Central, Institut Català de la Salut, Manresa, Barcelona, Spain
- Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Barcelona, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria A Barceló
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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Ares-Blanco S, Guisado-Clavero M, Del Rio LR, Larrondo IG, Fitzgerald L, Murauskienė L, López NP, Perjés Á, Petek D, Petrazzuoli F, Petricek G, Sattler M, Saurek-Aleksandrovska N, Senn O, Seifert B, Serafini A, Sentker T, Ticmane G, Tiili P, Torzsa P, Valtonen K, Vaes B, Vinker S, Adler L, Assenova R, Bakola M, Bayen S, Brutskaya-Stempkovskaya E, Busneag IC, Divjak AĆ, Peña MD, Díaz E, Domeyer PR, Feldmane S, Gjorgjievski D, Gómez-Johansson M, de la Fuente ÁG, Hanževački M, Hoffmann K, Ільков О, Ivanna S, Jandrić-Kočić M, Karathanos VT, Üçüncü EK, Kirkovski A, Knežević S, Korkmaz BÇ, Kostić M, Krztoń-Królewiecka A, Kozlovska L, Nessler K, Gómez-Bravo R, Peña MPA, Lingner H. Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study. Eur J Public Health 2024; 34:402-410. [PMID: 38326993 PMCID: PMC10990533 DOI: 10.1093/eurpub/ckad224] [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] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.
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Affiliation(s)
- Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Marina Guisado-Clavero
- Investigation Support Multidisciplinary Unit for Primary care and Community North Area of Madrid, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Lourdes Ramos Del Rio
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ileana Gefaell Larrondo
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Louise Fitzgerald
- Member of Irish College of General Practice (MICGP), Member of Royal College of Physician (MRCSI), Dublin, Ireland
| | - Liubovė Murauskienė
- Department of Public Health, Institute of Health Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Naldy Parodi López
- Närhälsan Kungshöjd Health Centre, Gothenburg, Sweden; Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ábel Perjés
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ferdinando Petrazzuoli
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Goranka Petricek
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | | | | | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Bohumil Seifert
- Charles University, First Faculty of Medicine, Institute of General Practice, Prague, Czech Republic
| | - Alice Serafini
- Azienda Unità Sanitaria Locale di Modena, Laboratorio EduCare, University of Modena and Reggio Emilia, Modena, Italy
| | - Theresa Sentker
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
| | - Gunta Ticmane
- Department of Family Medicine at Riga Stradiņš University, Riga, Latvia; Member of the board of the Rural Family Doctors’ Association of Latvia, Latvia
| | - Paula Tiili
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa. University of Helsinki, Helsinki, Finland
| | - Péter Torzsa
- Department of Family Medicine at the University of Semmelweis, Budapest, Hungary
| | - Kirsi Valtonen
- Communicable Diseases and Infection Control Unit, City of Vantaa, Vantaa, Finland
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Shlomo Vinker
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. WONCA Europe President, Israel
| | - Limor Adler
- Department of Family Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Radost Assenova
- Department Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Maria Bakola
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Science, University of Ioannina, Ioannina, Greece
| | - Sabine Bayen
- Department of General Practice, University of Lille, Lille, France
| | | | | | | | - Maryher Delphin Peña
- Department of Geriatric Medicine, Hôpitaux Robert Schuman, Luxembourg, Luxembourg
| | - Esperanza Díaz
- Pandemic Center, Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway; Norwegian National Institute of Public Health, Bergen, Norway
| | | | - Sabine Feldmane
- Department of Family Medicine, Rīga Stradins University, Riga, Latvia
| | | | | | | | - Miroslav Hanževački
- Department of Family Medicine “Andrija Stampar” School of Public Health, School of Medicine, University of Zagreb, Croatia; Health Centre Zagreb West, Croatia
| | - Kathryn Hoffmann
- Department of General Practice and Primary Care, Med. University of Vienna, Vienna, Austria
| | - Оксана Ільков
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | - Shushman Ivanna
- Department of Family Medicine and Outpatient Care, Medical Faculty 2, Uzhhorod National University, Uzhhorod, Ukraine
| | | | - Vasilis Trifon Karathanos
- Laboratory of Hygiene and Epidemiology, Medical Department, Faculty of Health Sciences, University of Ioannina- Greece; GHS, Larnaca, Cyprus
| | - Erva Kirkoç Üçüncü
- Department of Family Medicine, Prof. Dr Cemil Tascioglu City Hospital, Istanbul, Turkey
| | - Aleksandar Kirkovski
- Faculty of Medicine, Ss. Cyril and Methodius University, Skopje, North Macedonia
| | | | | | - Milena Kostić
- Health Center “Dr Đorđe Kovačević”, Lazarevac, Belgrade, Serbia
| | | | - Liga Kozlovska
- Department of Family Medicine of Riga Stradins University, Riga, Latvia; President of the Rural Family Doctors' Association of Latvia
| | - Katarzyna Nessler
- Department of Family Medicine UJCM at Uniwersytet Jagielloński - Collegium Medicum, Kraków, Poland
| | - Raquel Gómez-Bravo
- CHNP, Rehaklinik, 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, Luxembourg University, Luxembourg, Luxembourg
| | - María Pilar Astier Peña
- Technical Advisor for Quality and Safety, Territorial Healthcare Quality Unit, Territorial Healthcare Direction of Camp de Tarragona, Healthcare Institut of Catalonia, Health Departament, Generalitat de Catalunya GIBA-IIS-Aragón, Catalunya, Spain; Chair of Patient Safety Working Party of semFYC (Spanish Society for Family and Community Medicine) and Quality and Safety in Family Medicine of WONCA World (Global Family Doctors), Board Member of WONCA World and SECA (Spanish Society for Healthcare Quality), Spain
| | - Heidrun Lingner
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
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Taylor JA, McDaniel CE, Stevens CA, Jacob-Files E, Acquilano SC, Freyleue SD, Bode R, Erdem G, Felman K, Lauden S, Bruce ML, Leyenaar JK. Direct Admission Program Implementation: A Qualitative Analysis of Variation Across Health Systems. Pediatrics 2024; 153:e2023063569. [PMID: 38533563 DOI: 10.1542/peds.2023-063569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES Direct admission (DA) to the hospital has the potential to improve family satisfaction and timeliness of care by bypassing the emergency department. Using the RE-AIM implementation framework, we sought to characterize variation across health systems in the reach, effectiveness, adoption, and implementation of a DA program from the perspectives of parents and multidisciplinary clinicians. METHODS As part of a stepped-wedge cluster randomized trial to compare the effectiveness of DA to admission through the emergency department, we evaluated DA rates across 69 clinics and 3 health systems and conducted semi-structured interviews with parents and clinicians. We used thematic analysis to identify themes related to the reach, effectiveness, adoption, and implementation of the DA program and applied axial coding to characterize thematic differences across sites. RESULTS Of 2599 hospitalizations, 171 (6.6%) occurred via DA, with DA rates varying 10-fold across health systems from 0.9% to 9.3%. Through the analysis of 137 interviews, including 84 with clinicians and 53 with parents, we identified similarities across health systems in themes related to perceived program effectiveness and patient and family engagement. Thematic differences across sites in the domains of program implementation and clinician adoption included variation in transfer center efficiency, trust between referring and accepting clinicians, and the culture of change within the health system. CONCLUSIONS The DA program was adopted variably, highlighting unique challenges and opportunities for implementation in different hospital systems. These findings can inform future quality improvement efforts to improve transitions to the hospital.
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Affiliation(s)
- Jordan A Taylor
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Corrie E McDaniel
- Seattle Children's Hospital, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | | | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Seneca D Freyleue
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Ryan Bode
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
| | - Guliz Erdem
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
| | - Kristyn Felman
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Stephanie Lauden
- Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State College of Medicine, Columbus, Ohio
- University of Colorado, Department of Pediatrics, Denver, Colorado
| | - Martha L Bruce
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Health Children's, Lebanon, New Hampshire
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
- Dartmouth Health Children's, Lebanon, New Hampshire
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Matovelle P, Oliván-Blázquez B, Domínguez-García M, Casado-Vicente V, Pascual de la Pisa B, Magallón-Botaya R. Health Outcomes for Older Patients with Chronic Diseases During the First Pandemic Year. Clin Interv Aging 2024; 19:385-397. [PMID: 38464598 PMCID: PMC10924748 DOI: 10.2147/cia.s444716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background Worldwide, chronic diseases are prevalent among the older adults, significantly affecting their health and healthcare system. The COVID-19 pandemic exacerbated these challenges, disrupting healthcare services. Our study assesses the impact on older individuals with chronic diseases who were not infected with COVID-19, analyzing comorbidities, medication use, mortality rates, and resource utilization using real data from Aragon, Spain. Methods A retrospective observational study, conducted in Aragon, Spain, focused on individuals aged 75 and older with at least one chronic disease, who were not infected of COVID-19. The research used actual data collected during three distinct periods: the first covered the six months prior to the pandemic, the second the six months after the lockdown, and the third the period between six and twelve months. Key variables included socio-demographics, comorbidities, clinical parameters, medication use, and health services utilization. Results We included 128.130 older adults. Mean age was 82.88 years, with 60.3% being women. The most common chronic diseases were hypertension (73.2%), dyslipidemia (52.5%), and dorsopathies (31.5%). More than 90% had more than 2 conditions. A notable decline in new chronic disease diagnoses was observed, particularly pronounced in the six to twelve months period after lockdown. Although statistically significant differences were observed in all clinical variables analyzed, they were considered clinically irrelevant. Furthermore, a decrease in healthcare services utilization and medication prescriptions was reported. Conclusion Our study highlights a decrease in new chronic disease diagnoses, ongoing reductions in healthcare utilization, and medication prescriptions for older adults with pre-existing chronic conditions, unaffected by COVID-19.
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Affiliation(s)
- Priscila Matovelle
- Department of Geriatrics, San Juan de Dios Hospital, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0005, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Marta Domínguez-García
- Primary Care Research Unit (GAIAP), Aragon Health Research Institute (IISA), Zaragoza, Spain
- Aragonese Healthcare Service, Zaragoza, Spain
| | - Verónica Casado-Vicente
- Parquesol Primary Care Center, Valladolid, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Beatriz Pascual de la Pisa
- Santa María de Gracia Primary Care, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0015, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Group B21-20R, Health Research Institute of Aragon (IISA), Zaragoza, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), RD21/0016/0005, Zaragoza, Spain
- Parquesol Primary Care Center, Valladolid, Spain
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Guisado-Clavero M, Astier-Peña MP, Gómez-Bravo R, Ares-Blanco S. Open data for monitoring COVID-19 in Spain: Descriptive study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:80-87. [PMID: 37088686 PMCID: PMC10073586 DOI: 10.1016/j.eimce.2023.04.003] [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: 04/03/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 04/09/2023]
Abstract
BACKGROUND The indicators of the pandemic have been based on the total number of diagnosed cases of COVID-19, the number of people hospitalized or in intensive care units, and deaths from the infection. The aim of this study is to describe the available data on diagnostic tests, health service used for the diagnosis of COVID-19, case detection and monitoring. METHOD Descriptive study with review of official data available on the websites of the Spanish health councils corresponding to 17 Autonomous Communities, 2 Autonomous cities and the Ministry of Health. The variables collected refer to contact tracing, technics for diagnosis, use of health services and follow-up. RESULTS All regions of Spain show data on diagnosed cases of COVID-19 and deaths. Hospitalized cases and intensive care admissions are shown in all regions except the Balearic Islands. Diagnostic tests for COVID-19 have been registered in all regions except Madrid region and Extremadura, with scarcely information on what type of test has been performed (present in 7 CCAA), requesting service and study of contacts. CONCLUSIONS The information available on the official websites of the Health Departments of the different regions of Spain are heterogeneous. Data from the use of health service or workload in Primary Care, Emergency department or Out of hours services are almost non-existent.
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Affiliation(s)
- Marina Guisado-Clavero
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del área norte de la Comunidad de Madrid, Madrid, Spain
| | - María Pilar Astier-Peña
- Centro de Salud Univérsitas, Servicio Aragonés de Salud, Zaragoza, Spain; GdT de Seguridad del paciente de semFYC y del GdT de Calidad y Seguridad de WONCA, Zaragoza, Spain
| | - Raquel Gómez-Bravo
- Research Group Self-Regulation and Health, Institute for Health and Behaviour, Department of Behavioural and CognitiveSciences, Faculty of Humanities, Education, and Social Sciences, Universidad de Luxemburgo, Luxembourg, Luxembourg
| | - Sara Ares-Blanco
- Centro de Salud Federica Montseny, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
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Ghanbari‐Jahromi M, Kharazmi E, Bastani P, Shams M, Marzaleh MA, Amin Bahrami M. Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review. Health Sci Rep 2024; 7:e1881. [PMID: 38384975 PMCID: PMC10879648 DOI: 10.1002/hsr2.1881] [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: 09/23/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
Background and Aims Continuous routine care is necessary to prevent long-term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic. Methods All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method. Results Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient-side factors and health system-side factors. Patient-side factors including psychological, individual and social, disease-related, and health system-side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic. Conclusion Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.
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Affiliation(s)
- Mohadeseh Ghanbari‐Jahromi
- Department of Healthcare Management, Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Erfan Kharazmi
- Department of Healthcare Management, Health Human Resources Research Center, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Peivand Bastani
- College of Business, Government and LawFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Mesbah Shams
- Department of Internal Medicine, Endocrinology and Metabolism Research CenterShiraz University of Medical SciencesShirazIran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Mohammad Amin Bahrami
- Department of Healthcare Management, Health Human Resources Research Center, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
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7
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Moreno Caballero B, Castell Alcalá MV, Gutiérrez Misis A. [Cardiovascular prevention in primary care in crisis situations: multicenter comparative study before, during and after the SARS-COVID-19 pandemic]. Aten Primaria 2024; 56:102778. [PMID: 37806071 PMCID: PMC10568233 DOI: 10.1016/j.aprim.2023.102778] [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: 07/10/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE To assess whether the appearance of a crisis situation such as the one caused by the SARS-COV-2 pandemic, together with the organizational changes adopted in Primary Care, have influenced the implementation of cardiovascular preventive activities in patients aged 40 to 74 years. DESIGN Retrospective multicenter descriptive study for three years (2019-2022) in Primary Care. SETTING 35 health centers of the Primary Care of the Northern Assistance Directorate of Madrid. PARTICIPANTS 1008 patients of both sexes between 40 and 74 years with diagnosed of hypertension, Diabetes Mellitus and/or dyslipidemia. METHOD The variables analyzed from the computerized clinical history were lifestyle activities (consumption of tobacco, alcohol, consumption of Mediterranean diet and exercise) considering 3 of the 4 parameters optimal; examination data (blood pressure record) and analytical record (glycemia, hbA1c, total cholesterol, HDL, LDL)considering 4 of the 5 parameters optimal. Differences are analyzed between based pre-pandemic (03/15/2019-03/14/2020), pandemic (03/15/2020-03/14/2021), and transition (03/15/2022-03/14/2022). STATISTICAL ANALYSIS MC Nemar's test to compare the main variables between the study periods. RESULTS Data from 1008 patients are collected. The registration of preventive activities on lifestyle was 180 patients (17.9%) (IC95%: 0,155-0,204) in pre-pandemic, 29 patients (2.9%) (IC 95%: 0,019-0,041) in pandemic and 55 patients (5.5%) (IC 95%: 0,041-0,070) in the transition stage (p < 0.05). Exploration was registered in 393 patients (39%) (IC95%: 0,360-0,421) in the pre-pandemic, 133 patients 13,2% (IC 95%: 0,112-0,154) in the pandemic, and 218 patients (21,6%) (IC 95%: 0,191-0,243) in the transition (p < 0.05). The analytical record was 33 patients (3.3%) (IC955: 0,023-0,046), 10 patients (1%) (IC95%: 0,005-0,018) and 23 patients (2.3%) (IC95%: 0,015-0,034) respectively in each phase with one (P < 0.05). CONCLUSIONS Activities on lifestyle, physical examination, and laboratory test as part of the cardiovascular prevention strategy are scarce in the prepandemic period and decrease drastically during the pandemic, at the first level of care.
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Affiliation(s)
- Bárbara Moreno Caballero
- Centro de salud Guayaba. Dirección Asistencial Centro. Servicio Madrileño de Salud, Madrid, España.
| | - M Victoria Castell Alcalá
- Centro de salud Dr. Castroviejo. Dirección Asistencial Norte. Servicio Madrileño de Salud, Madrid, España; Instituto de Investigación Hospital Universitario La Paz. (IdiPAZ), Madrid, España; Departamento de Medicina. Unidad Clínica Departamental de Medicina de Familia. Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España
| | - Alicia Gutiérrez Misis
- Instituto de Investigación Hospital Universitario La Paz. (IdiPAZ), Madrid, España; Departamento de Medicina. Unidad Clínica Departamental de Medicina de Familia. Facultad de Medicina. Universidad Autónoma de Madrid, Madrid, España
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8
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Bousquat A, Giovanella L, Facchini L, Mendonça MHM, Nedel FB, Cury G, dos Santos Mota PH, Schenkman S, Chueiri PS, Alves MCGP. The Brazilian primary health care response to the COVID-19 pandemic: individual and collective approaches. Front Public Health 2023; 11:1212584. [PMID: 38145080 PMCID: PMC10748390 DOI: 10.3389/fpubh.2023.1212584] [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: 04/26/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Objectives Brazil's PHC wide coverage has a potential role in the fight against COVID, especially in less developed regions. PHC should deal with COVID-19 treatment; health surveillance; continuity of care; and social support. This article aims to analyze PHC performance profiles during the pandemic, in these axes, comparing the five Brazilian macro-regions. Methods A cross-sectional survey study was carried out, using stratified probability sampling of PHC facilities (PHCF). A Composite Index was created, the Covid PHC Index (CPI). Factor analysis revealed that collective actions contrastingly behaved to individual actions. We verified differences in the distributions of CPI components between macro-regions and their associations with structural indicators. Results Nine hundred and seven PHCF participated in the survey. The CPI and its axes did not exceed 70, with the highest value in surveillance (70) and the lowest in social support (59). The Individual dimension scored higher in the South, whereas the Collective dimension scored higher in the Northeast region. PHCF with the highest CPI belong to municipalities with lower HDI, GDP per capita, population, number of hospitals, and ICU beds. Conclusion The observed profiles, individually and collectively-oriented, convey disputes on Brazilian health policies since 2016, and regional structural inequalities.
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Affiliation(s)
- Aylene Bousquat
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | | | - Luiz Facchini
- Department of Social Medicine, Faculty of Medicine, Federal University of Pelotas, Pelotas, Brazil
| | | | - Fulvio Borges Nedel
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Geraldo Cury
- Department of Social and Preventive Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Simone Schenkman
- Department of Politics, Management and Health, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Patricia Sampaio Chueiri
- Faculdade Israelita de Ciências da Saúde Albert Einstein Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Maria Cecilia Goi Porto Alves
- Department of Health, Institute of Health, Government of the State of São Paulo, Institute of Health, São Paulo, Brazil
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Gomezelj MC, Miroševič Š, Tajki AV, Bunc KT, Van Poel E, Willems S, Klemenc-Ketiš Z. The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study. BMC PRIMARY CARE 2023; 24:255. [PMID: 38031008 PMCID: PMC10687777 DOI: 10.1186/s12875-023-02209-z] [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: 12/27/2022] [Accepted: 11/13/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. METHODS A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables. RESULTS From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012). CONCLUSION Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.
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Affiliation(s)
- Maja Cvetko Gomezelj
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia.
| | - Špela Miroševič
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Alina Verdnik Tajki
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Ksenija Tušek Bunc
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, Medical Faculty, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Ljubljana, Slovenia
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10
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Li X, Song Y, Hu B, Chen Y, Cui P, Liang Y, He X, Yang G, Li J. The effects of COVID-19 event strength on job burnout among primary medical staff. BMC Health Serv Res 2023; 23:1212. [PMID: 37932737 PMCID: PMC10629111 DOI: 10.1186/s12913-023-10209-z] [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: 06/27/2023] [Accepted: 10/25/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND As a global pandemic, The Corona Virus Disease 2019 (COVID-19) has brought significant challenges to the primary health care (PHC) system. Health professionals are constantly affected by the pandemic's harmful impact on their mental health and are at significant risk of job burnout. Therefore, it is essential to gain a comprehensive understanding of how their burnout was affected. The study aimed to examine the relationship between COVID-19 event strength and job burnout among PHC providers and to explore the single mediating effect of job stress and work engagement and the chain mediating effect of these two variables on this relationship. METHODS Multilevel stratified convenience sampling method was used to recruit 1148 primary medical staff from 48 PHC institutions in Jilin Province, China. All participants completed questionnaires regarding sociodemographic characteristics, COVID-19 event strength, job stress, work engagement, and job burnout. The chain mediation model was analyzed using SPSS PROCESS 3.5 Macro Model 6. RESULTS COVID-19 event strength not only positively predicted job burnout, but also indirectly influenced job burnout through the mediation of job stress and work engagement, thereby influencing job burnout through the "job stress → work engagement" chain. CONCLUSIONS This study extends the application of event systems theory and enriches the literature about how the COVID-19 pandemic impacted PHC medical staff job burnout. The findings derived from our study have critical implications for current and future emergency response and public policy in the long-term COVID-19 disease management period.
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Affiliation(s)
- Xinru Li
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Yiwen Song
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Bingqin Hu
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Yitong Chen
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Peiyao Cui
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Yifang Liang
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Xin He
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Guofeng Yang
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China
| | - Jinghua Li
- School of Public Health, Jilin University, NO.1163 Xinmin Street, Changchun, Jilin Province, China.
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Miró Catalina Q, Femenia J, Fuster-Casanovas A, Marin-Gomez FX, Escalé-Besa A, Solé-Casals J, Vidal-Alaball J. Knowledge and Perception of the Use of AI and its Implementation in the Field of Radiology: Cross-Sectional Study. J Med Internet Res 2023; 25:e50728. [PMID: 37831495 PMCID: PMC10612005 DOI: 10.2196/50728] [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: 07/11/2023] [Revised: 08/31/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Artificial Intelligence (AI) has been developing for decades, but in recent years its use in the field of health care has experienced an exponential increase. Currently, there is little doubt that these tools have transformed clinical practice. Therefore, it is important to know how the population perceives its implementation to be able to propose strategies for acceptance and implementation and to improve or prevent problems arising from future applications. OBJECTIVE This study aims to describe the population's perception and knowledge of the use of AI as a health support tool and its application to radiology through a validated questionnaire, in order to develop strategies aimed at increasing acceptance of AI use, reducing possible resistance to change and identifying possible sociodemographic factors related to perception and knowledge. METHODS A cross-sectional observational study was conducted using an anonymous and voluntarily validated questionnaire aimed at the entire population of Catalonia aged 18 years or older. The survey addresses 4 dimensions defined to describe users' perception of the use of AI in radiology, (1) "distrust and accountability," (2) "personal interaction," (3) "efficiency," and (4) "being informed," all with questions in a Likert scale format. Results closer to 5 refer to a negative perception of the use of AI, while results closer to 1 express a positive perception. Univariate and bivariate analyses were performed to assess possible associations between the 4 dimensions and sociodemographic characteristics. RESULTS A total of 379 users responded to the survey, with an average age of 43.9 (SD 17.52) years and 59.8% (n=226) of them identified as female. In addition, 89.8% (n=335) of respondents indicated that they understood the concept of AI. Of the 4 dimensions analyzed, "distrust and accountability" obtained a mean score of 3.37 (SD 0.53), "personal interaction" obtained a mean score of 4.37 (SD 0.60), "efficiency" obtained a mean score of 3.06 (SD 0.73) and "being informed" obtained a mean score of 3.67 (SD 0.57). In relation to the "distrust and accountability" dimension, women, people older than 65 years, the group with university studies, and the population that indicated not understanding the AI concept had significantly more distrust in the use of AI. On the dimension of "being informed," it was observed that the group with university studies rated access to information more positively and those who indicated not understanding the concept of AI rated it more negatively. CONCLUSIONS The majority of the sample investigated reported being familiar with the concept of AI, with varying degrees of acceptance of its implementation in radiology. It is clear that the most conflictive dimension is "personal interaction," whereas "efficiency" is where there is the greatest acceptance, being the dimension in which there are the best expectations for the implementation of AI in radiology.
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Affiliation(s)
- Queralt Miró Catalina
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Joaquim Femenia
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Aïna Fuster-Casanovas
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
| | - Francesc X Marin-Gomez
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Anna Escalé-Besa
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
| | - Jordi Solé-Casals
- Data and Signal Processing group, Faculty of Science, Technology and Engineering, University of Vic-Central University of Catalonia, Vic, Spain
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Josep Vidal-Alaball
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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Jiménez-Carrillo M, González-Rábago Y, González Miguel R, Baza Bueno M. [From face-to-face consultation to teleconsultation: Primary health care professionals' experiences in the Basque Country during the pandemic]. Aten Primaria 2023; 55:102702. [PMID: 37437478 PMCID: PMC10345852 DOI: 10.1016/j.aprim.2023.102702] [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: 03/28/2023] [Revised: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVE To explore the perceptions of Primary Health Care (PHC) professionals on changes in consultation modalities and their impact on PHC fundamentals during the pandemic. DESIGN Qualitative exploratory research conducted between October and November, 2021. LOCATION Four urban and one rural primary health care centers with different socioeconomic profiles in the threeterritories of the Basque Country. PARTICIPANTS Forty-six professionals from different categories of the PHC team and health centre directors. METHOD Purposive sampling. Five focus groups and fourin-depth interviews. Thematic analysis with the support of the Atlas.ti programme. Triangulation of results among the research team. RESULTS Experiences with the development of teleconsultation appear to be directly conditioned by the pandemic context in its different phases and by the PC situation. The professionals identified communication barriers, as well as potentialities of its use that require adequate training and evaluation. Risks of inequity were perceived in the use of teleconsultations that could be affecting the quality of care. Longitudinality was assessed as a facilitating factor and problems of coordination and communication through teleconsultation between care levels were identified. CONCLUSIONS The replacement of face-to-face consultation by teleconsultation had an impact on fundamental aspects of PHC such as quality, accessibility, equity, coordination and longitudinality. Teleconsultation in PHC should always be evaluated considering the specific circumstances and contexts of its implementation.
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Affiliation(s)
- Marta Jiménez-Carrillo
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España; Instituto de Investigación Sanitaria Biocruces Bizkaia, España.
| | - Yolanda González-Rábago
- Grupo de Investigación en Determinantes Sociales de la Salud y Cambio Demográfico-OPIK, Bizkaia, España; Departamento de Sociología y Trabajo Social, Universidad del País Vasco UPV/EHU, Bizkaia, España
| | - Raquel González Miguel
- OSI Donostialdea, Unidad de Atención Primaria Pasajes San Pedro-Bidebieta, Gipuzkoa, Bizkaia, España
| | - Mikel Baza Bueno
- Instituto de Investigación Sanitaria Biocruces Bizkaia, España; OSI Barrualde-Galdakao, Atención Primaria de Arrigorriaga, Bizkaia, España
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Barzegari J, Raeissi P, Hashemi SM, Aryan Khesal A, Reisi N. Delivering Primary Health Care (PHC) Services for Controlling NCDs During the COVID-19 Pandemic: A Scoping Review. JOURNAL OF PREVENTION (2022) 2023; 44:579-601. [PMID: 37495870 DOI: 10.1007/s10935-023-00733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 07/28/2023]
Abstract
Non-communicable diseases (NCDs) are the leading cause of death worldwide. NCDs also increase mortality from COVID-19 and primary health care (PHC) services are an important component in the prevention and control of long-term NCDs. The main goal of the present study was to review primary healthcare services for the NCDs patients via primary healthcare network during COVID-19 pandemic. In this scoping review, Search engines including PubMed, Scopus, and Science-direct up to 1st February 2022 were searched to identify studies regarding primary care services for NCDs patients via primary health care during COVID-19 pandemic. A total of 42 studies met the inclusion criteria and were included in our analysis. 24 studies were about the status and changes of primary health services for NCDs patients in PHC settings, while 18 studies focused on adaptive strategies used during COVID-19 in different countries including United States, Canada, United Kingdom, Portugal, Georgia, South Africa, Thailand, Mexico, India, Kenya, Guatemala and Saudi Arabia. These strategies included remote monitoring, follow up, consultation, empowerment and educational services as well as home visiting Disruption of NCDs services in PHC during the COVID-19 pandemic was observed in different countries, which highlights the urgency of attention of researchers and policy-makers to development of appropriate and adaptive policies to improve PHC service coverage and its quality during the pandemics.
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Affiliation(s)
- Javad Barzegari
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Pouran Raeissi
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran.
| | - Seyed- Masoud Hashemi
- Department of Anesthesiology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Aidin Aryan Khesal
- Department of Health Services Management, School of Health Services Management and Medical Information Science, Iran University of Medical Sciences, No. 6, Rashid Yasemi St. Vali -e Asr Ave, P.O Box: 1996713883, Tehran, Iran
| | - Nahid Reisi
- Department of Pediatric Hematology and Oncology, Faculty of Medicine, Child Growth and Development Research Center and Isfahan Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Knutsen Glette M, Ludlow K, Wiig S, Bates DW, Austin EE. Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis. BMJ Open 2023; 13:e071828. [PMID: 37730402 PMCID: PMC10514639 DOI: 10.1136/bmjopen-2023-071828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DESIGN Systematic review with meta-synthesis. DATA SOURCES Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus. ELIGIBILITY CRITERIA Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis. RESULTS Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services. CONCLUSION Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Kristiana Ludlow
- Centre for Health Services Research, The University of Queensland School of Psychology, Saint Lucia, Queensland, Australia
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - David Westfall Bates
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, New South Wales, Australia
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Alghamdi A, Ramsay AIG, Abrams R, Bailey JV. The impact of COVID-19 on patient engagement with primary healthcare: lessons from the saudi primary care setting. BMC PRIMARY CARE 2023; 24:177. [PMID: 37674122 PMCID: PMC10483780 DOI: 10.1186/s12875-023-02131-4] [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: 03/12/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND There have been significant achievements in controlling COVID-19 in Saudi Arabia (SA), but as in most healthcare settings worldwide, health services have been seriously disrupted. Also, with pandemic control measures such as lockdowns and curfews, and innovations such as digital health services, the delivery of primary healthcare (PHC) services has dramatically changed. However, little is known about patients' experiences of PHCs during the pandemic, their views on the pandemic-related interventions in SA, and patient views on impact on their medical care. METHODS Qualitative semi-structured online interviews were conducted for twenty-four Saudi patients across SA aged 18 and above who were diverse in terms of age, gender, education and health status. Data were analysed using thematic analysis yielding four major themes as an impact of COVID-19 on patient engagement with PHCs. RESULTS The COVID-19 pandemic has had profound mixed impacts on patient engagement with PHC in SA. Fear of infection or of breaking lockdown rules has negatively impacted the utilisation of PHCs but positively changed patients' attitudes towards seeking medical help for self-limiting conditions. The pandemic has also negatively impacted routine preventive care at PHCs, especially for patients with long-term health conditions. The mandatory use of some digital health services in SA that existed pre-pandemic has provided patients with a perception of better care during the pandemic. Yet, a lack of awareness of optional digital health services, such as virtual clinics, hindered optimal use. Despite pandemic-related disruption of patient engagement with PHCs, the reduced waiting time in PHC centres and healthcare providers' communication and empathy during the pandemic contributed to patients' perceptions of better care compared to pre-pandemic. However, patients living outside the main cities in SA perceived care quality as less good during the pandemic compared to PHCs in the main cities in SA. CONCLUSION The lessons learned from patients' experiences and views of PHCs during the pandemic were beneficial in promoting patient engagement with PHCs. The digital health services mandated in response to the pandemic have accelerated digital health innovation in SA and allowed patients to recognise the benefits of digital health. This has huge potential for increasing continuous patient engagement with PHCs. Yet, patients' experiences of digital health services during the pandemic are essential for informing appropriate implementation and utilisation of e-health services. Patients' positive experiences of PHCs during the pandemic, such as the reduction in waiting times and the perception of improved healthcare providers' professionalism, communication and empathy, can be built on to sustain engagement with PHC services. These findings might have significance for clinicians and policymakers to support patient engagement with PHCs, particularly in healthcare systems like SA that struggle with the overuse of emergency departments (EDs) for PHC-treatable conditions.
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Affiliation(s)
- Alaa Alghamdi
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK.
- Department of Family and Community Medicine, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Angus I G Ramsay
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Ruth Abrams
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Surrey, UK
| | - Julia V Bailey
- Department of Primary Care and Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
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Lozano-Corona R, Reyes-Monroy JA, Lara-González V, Anaya-Ayala JE, Dardik A, Hinojosa CA. Revascularization prevents amputation among patients with diabetic foot during the COVID-19 era. Vascular 2023; 31:729-736. [PMID: 35311392 DOI: 10.1177/17085381221079108] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The COVID-19 pandemic has led to significant changes in healthcare systems that impact the management of chronic diseases such as diabetic foot (DF). We hypothesized that lack of access to healthcare would increase the severity of disease and lead to worse outcomes. METHODS The medical records of patients with DF were reviewed to determine demographic data and outcomes including wound healing, major amputation (MA), and death. Groups were divided into the pre-COVID-19 era (15 March 2019-15 March 2020) and the COVID-19 era (16 March 2020-16 March 2021); multivariable logistic analysis was performed to identify risk factors for MA. RESULTS 261 patients with DF were included, 163 in the pre-COVID-19 era and 98 during the COVID-19 era. Patients in the COVID-19 presented with increased cardiovascular disease (19 vs 7%, p = 0.01), increased mean HbA1C (9.1 ± 2.1 vs 8.2 ± 2.1, p = 0.008) and higher WIFI-IV stage (78 vs 53%, p ≤ 0.0001). Patients with DF in the COVID-19 era were more likely to require MA (41 vs 21%, p ≤ 0.0001). Revascularization (OR = 0.12; 95% CI, 0.038-0.38) was a protective factor to reduce MA. CONCLUSIONS MA among DF patients increased two-fold during the COVID-19 era. Revascularization avoids MA in diabetic patients even during the COVID-19 pandemic, suggesting that revascularization should be performed when possible.
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Affiliation(s)
- Rodrigo Lozano-Corona
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - José A Reyes-Monroy
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - Viridiana Lara-González
- Department of Surgery, Hospital Regional Licenciado Adolfo Lopez Mateos (Instituto de Seguridad y Servicios de Salud de los Trabajadores del Estado), Mexico City, Mexico
| | - Javier E Anaya-Ayala
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Carlos A Hinojosa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
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17
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Dupraz J, Zuercher E, Peytremann-Bridevaux I. Impact of the COVID-19 pandemic on the quality of diabetes care: Insights from longitudinal data in Switzerland. Prim Care Diabetes 2023:S1751-9918(23)00092-X. [PMID: 37147223 PMCID: PMC10150189 DOI: 10.1016/j.pcd.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/07/2023]
Abstract
In this population-based cohort study on diabetes care, self-reported quality indicators measured just before (2019) and during (2021) the COVID-19 pandemic were comparable, apart from a modest increase in seasonal influenza immunization and a small decline in patient-centeredness of care in 2021.
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Affiliation(s)
- Julien Dupraz
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
| | - Emilie Zuercher
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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18
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García I, Martínez O, López-Paz JF, Salgueiro M, Rodríguez AA, Zorita J, García-Sanchoyerto M, Amayra I. Health-related quality of life (HRQoL) and psychological impact of the COVID-19 pandemic on patients with myasthenia gravis. Intractable Rare Dis Res 2023; 12:88-96. [PMID: 37287657 PMCID: PMC10242395 DOI: 10.5582/irdr.2023.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023] Open
Abstract
The aim of this study was to compare the effects of the pandemic on health-related quality of life (HRQoL), anxious-depressive symptoms, feelings of loneliness, and fear of COVID-19 between people with myasthenia gravis (MG) and healthy controls. We also wanted to know in which group the variable fear of COVID-19 interfered the most with the results. This cross-sectional study involved 60 people with MG and 60 healthy controls. Participants using an online platform completed a sociodemographic questionnaire, the Short Form-36 Health Survey (SF-36), the Hospital Anxiety and Depression Scale (HADS), the revised UCLA Loneliness Scale and the Fear of COVID19 Scale (FCV- 19S). The MG group reported worse levels in HRQoL indicators (p = 0.043- <.001), more severe anxiety-depressive symptoms (p = 0.002), and greater fear of COVID-19 (p < 0.001), but there were no differences in feelings of loneliness (p = 0.002). Furthermore, after controlling for the effect of the fear of COVID-19 variable, the differences remained for physical health indicators, but not for the most of psychosocial indicators (Social Functioning p = 0.102, η2p = 0.023; Role Emotional p = 0.250, η2p = 0.011; and HADS Total p = 0.161, η2p = 0.017). The harmful effect of the COVID-19 pandemic was greater in the MG group, and the perceived fear of COVID-19 had also a greater impact among this group, which has increased its negative effect on their psychosocial health.
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Affiliation(s)
- Irune García
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Spain
| | - Oscar Martínez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Spain
| | | | - Monika Salgueiro
- Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/ EHU. Spain
| | | | - Janire Zorita
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Spain
| | | | - Imanol Amayra
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Spain
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19
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Qi C, Osborne T, Bailey R, Cooper A, Hollinghurst JP, Akbari A, Crowder R, Peters H, Law RJ, Lewis R, Smith D, Edwards A, Lyons RA. Impact of COVID-19 pandemic on incidence of long-term conditions in Wales: a population data linkage study using primary and secondary care health records. Br J Gen Pract 2023; 73:e332-e339. [PMID: 37105743 PMCID: PMC9997656 DOI: 10.3399/bjgp.2022.0353] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/25/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has directly and indirectly had an impact on health service provision owing to surges and sustained pressures on the system. The effects of these pressures on the management of long-term or chronic conditions are not fully understood. AIM To explore the effects of COVID-19 on the recorded incidence of 17 long-term conditions. DESIGN AND SETTING This was an observational retrospective population data linkage study on the population of Wales using primary and secondary care data within the Secure Anonymised Information Linkage (SAIL) Databank. METHOD Monthly rates of new diagnosis between 2000 and 2021 are presented for each long-term condition. Incidence rates post-2020 were compared with expected rates predicted using time series modelling of pre-2020 trends. The proportion of annual incidence is presented by sociodemographic factors: age, sex, social deprivation, ethnicity, frailty, and learning disability. RESULTS A total of 5 476 012 diagnoses from 2 257 992 individuals are included. Incidence rates from 2020 to 2021 were lower than mean expected rates across all conditions. The largest relative deficit in incidence was in chronic obstructive pulmonary disease corresponding to 343 (95% confidence interval = 230 to 456) undiagnosed patients per 100 000 population, followed by depression, type 2 diabetes, hypertension, anxiety disorders, and asthma. A GP practice of 10 000 patients might have over 400 undiagnosed long-term conditions. No notable differences between sociodemographic profiles of post- and pre-2020 incidences were observed. CONCLUSION There is a potential backlog of undiagnosed patients with multiple long-term conditions. Resources are required to tackle anticipated workload as part of COVID-19 recovery, particularly in primary care.
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Affiliation(s)
- Cathy Qi
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Tim Osborne
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Alison Cooper
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Joe P Hollinghurst
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
| | - Ruth Crowder
- Directorate of Primary Care and Mental Health, Health and Social Services Group, Welsh Government, Cardiff
| | - Holly Peters
- Centre for Medical Education, Cardiff University, Cardiff
| | - Rebecca-Jane Law
- Technical Advisory Cell, Health and Social Services Group, Welsh Government, Cardiff
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, PRIME Centre Wales, Bangor University, Bangor
| | - Deb Smith
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Adrian Edwards
- Wales COVID-19 Evidence Centre, Division of Population Medicine, Cardiff University, Cardiff
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea
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20
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Medina M, Mora N, Coma E, Mas A. [Evolution of the screening and control quality indicators of patients with type 2 diabetes mellitus over 16 years (2007-2022)]. Aten Primaria 2023; 55:102588. [PMID: 36889129 PMCID: PMC9992944 DOI: 10.1016/j.aprim.2023.102588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Manuel Medina
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
| | - Núria Mora
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España
| | - Ermengol Coma
- Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Barcelona, España.
| | - Ariadna Mas
- Direcció d'Atenció Primària, Institut Català de la Salut (ICS), Barcelona, España
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21
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Joulaei H, Foroozanfar Z, Ziaee A, Hooshyar D, Loolia M, Azadian F, Fatemi M. Delay in Regular Visits of Chronic Disease Patients and Its Associated Factors during the COVID-19 Pandemic. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:176-186. [PMID: 36895456 PMCID: PMC9989245 DOI: 10.30476/ijms.2022.93944.2529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 03/16/2022] [Accepted: 04/26/2022] [Indexed: 03/11/2023]
Abstract
Background Chronic patients need regular follow-ups. During the COVID-19 pandemic, these regular visits can be affected. The delay of chronic patients and its contributing factors in their periodic visits during the COVID-19 pandemic are examined here. Methods This cross-sectional study was conducted between February and June 2021, in Fars, Iran. Two hundred and eighty-six households with at least one chronic patient were recruited. Then, several trained questioners called the studied households and asked about the studied variables. The dependent variable was the number of delays in regular visits during the COVID-19 pandemic. The results were analyzed through Poisson regression by SPSS Statistics version 22 and GraphPad Prism software version 9. A significance level of 0.05 was considered for this study. Results Out of 286 households 113 (73.4%) fathers, 138 (70.1%) mothers, and 17 (58.6%) children in the households reported delayed referral. In fathers, referring to the health center was significantly associated with a decrease in the number of delays (P=0.033). The higher age of the householder (P=0.005), the higher number of children (P=0.043), and having a family physician (P=0.007) in the mothers' group, also the number of children in households (P=0.001) in the children group were significantly associated with increasing the number of delays. Conclusion COVID-19 pandemic not only creates direct harmful effects but also adversely affects people in danger of chronic diseases. Delays in follow-ups are taken into account as a major challenge during the COVID-19 pandemic. This issue is not limited to rural or urban residency.
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Affiliation(s)
- Hassan Joulaei
- Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zohre Foroozanfar
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Ziaee
- Department of Neuroscience, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Dariush Hooshyar
- Student Research Committee, School of Medicine, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | - Fatemeh Azadian
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Fatemi
- HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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22
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Perelló M, Rio-Aige K, Rius P, Bagaría G, Jambrina AM, Gironès M, Pérez-Cano FJ, Rabanal M. Changes in prescription drug abuse during the COVID-19 pandemic evidenced in the Catalan pharmacies. Front Public Health 2023; 11:1116337. [PMID: 36866090 PMCID: PMC9971931 DOI: 10.3389/fpubh.2023.1116337] [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: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 02/16/2023] Open
Abstract
Introduction The impact of a pandemic on the mental health of the population is to be expected due to risk factors such as social isolation. Prescription drug abuse and misuse could be an indicator of the impact of the COVID-19 pandemic on mental health. Community pharmacists play an important role in addressing prescription drug abuse by detecting signs and behaviors that give a clearer indication that a drug abuse problem exists. Methods A prospective observational study to observe prescription drug abuse was conducted from March 2020 to December 2021 to compare with data obtained in the previous 2 years, through the Medicine Abuse Observatory, the epidemiological surveillance system set up in Catalonia. Information was obtained through a validated questionnaire attached on a web-based system and data collection software. A total of 75 community pharmacies were enrolled in the program. Results The number of notifications during the pandemic period (11.8/100.000 inhabitants) does not indicate a significant change compared with those from pre-pandemic period, when it was 12.5/100.000 inhabitants. However, the number of notifications during the first wave when lockdown was in place stood at 6.1/100,000 inhabitants, significantly lower than in both the pre-pandemic and the whole of the pandemic periods. Regarding the patient's profile, it was observed that the proportion of younger patients (<25 and 25-35) rose in contrast to older ones (45-65 and >65). The use of benzodiazepines and fentanyl increased. Conclusions This study has made it possible to observe the impact of the pandemic caused by COVID-19 on the behavior of patients in terms of use of prescription drugs through analysis of the trends of abuse or misuse and by comparing them with the pre-pandemic period. Overall, the increased detection of benzodiazepines has pointed out stress and anxiety generated by the pandemic.
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Affiliation(s)
- Maria Perelló
- Council of the Pharmacist's Association of Catalonia, Barcelona, Spain,Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain
| | - Karla Rio-Aige
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain,Institute of Research in Nutrition and Food Safety (INSA), Santa Coloma de Gramenet, Spain
| | - Pilar Rius
- Council of the Pharmacist's Association of Catalonia, Barcelona, Spain
| | - Guillermo Bagaría
- Council of the Pharmacist's Association of Catalonia, Barcelona, Spain
| | - Anna M. Jambrina
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain,Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, Barcelona, Spain
| | - Montse Gironès
- Council of the Pharmacist's Association of Catalonia, Barcelona, Spain
| | - Francisco José Pérez-Cano
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain,Institute of Research in Nutrition and Food Safety (INSA), Santa Coloma de Gramenet, Spain,*Correspondence: Francisco José Pérez-Cano ✉
| | - Manel Rabanal
- Physiology Section, Department of Biochemistry and Physiology, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain,Institute of Research in Nutrition and Food Safety (INSA), Santa Coloma de Gramenet, Spain,Directorate-General for Healthcare Planning and Regulation, Ministry of Health, Government of Catalonia, Barcelona, Spain
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23
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Van Poel E, Collins C, Groenewegen P, Spreeuwenberg P, Bojaj G, Gabrani J, Mallen C, Murauskiene L, Šantrić Milićević M, Schaubroeck E, Stark S, Willems S. The Organization of Outreach Work for Vulnerable Patients in General Practice during COVID-19: Results from the Cross-Sectional PRICOV-19 Study in 38 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3165. [PMID: 36833862 PMCID: PMC9960761 DOI: 10.3390/ijerph20043165] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic disproportionately affected vulnerable populations' access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practices during COVID-19. Linear mixed model analyses with practices nested in countries were performed on the data of 4982 practices from 38 countries. A 4-item scale on outreach work was constructed as the outcome variable with a reliability of 0.77 and 0.97 at the practice and country level. The results showed that many practices set up outreach work, including extracting at least one list of patients with chronic conditions from their electronic medical record (30.1%); and performing telephone outreach to patients with chronic conditions (62.8%), a psychological vulnerability (35.6%), or possible situation of domestic violence or a child-rearing situation (17.2%). Outreach work was positively related to the availability of an administrative assistant or practice manager (p < 0.05) or paramedical support staff (p < 0.01). Other practice and country characteristics were not significantly associated with undertaking outreach work. Policy and financial interventions supporting general practices to organize outreach work should focus on the range of personnel available to support such practice activities.
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Affiliation(s)
- Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
- Department of Sociology, Department of Human Geography, Utrecht University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands
| | - Gazmend Bojaj
- Management of Health Institutions and Services, Heimerer College, 10000 Prishtina, Kosovo
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | | | - Liubove Murauskiene
- Public Health Department, Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | | | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen-Nürnberg, Germany
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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24
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Solanes-Cabús M, Paredes E, Limón E, Basora J, Alarcón I, Veganzones I, Conangla L, Casado N, Ortega Y, Mestres J, Acezat J, Deniel J, Cabré JJ, Ruiz DS, Sánchez M, Illa A, Viñas I, Montero JJ, Cantero FX, Rodriguez A, Martín F, Baré M, Ripollés R, Castellet M, Lozano J, Sisó-Almirall A. Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1600. [PMID: 36674354 PMCID: PMC9866570 DOI: 10.3390/ijerph20021600] [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: 11/20/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.
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Affiliation(s)
- Mònica Solanes-Cabús
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Onze de Setembre, Institut Català de la Salut, 25005 Lleida, Spain
| | - Eugeni Paredes
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Onze de Setembre, Institut Català de la Salut, 25005 Lleida, Spain
| | - Esther Limón
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Ronda Prim, Mataró, Institut Català de la Salut, 08302 Barcelona, Spain
| | - Josep Basora
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- IDIAP Jordi Gol, Institut Català de la Salut, 08007 Barcelona, Spain
| | - Iris Alarcón
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Service Dreta i Muntanya Barcelona, Institut Català de la Salut, 08007 Barcelona, Spain
| | - Irene Veganzones
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- School of Medicine, Vic University, 08500 Barcelona, Spain
| | - Laura Conangla
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Badalona Centre, Institut Català de la Salut, 08911 Barcelona, Spain
| | - Núria Casado
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Nova Lloreda, Badalona Serveis Assistencials, 08917 Barcelona, Spain
| | - Yolanda Ortega
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Salou, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Jordi Mestres
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Sanllehy, Institut Català de la Salut, 08024 Barcelona, Spain
| | - Jordi Acezat
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Casernes, Institut Català de la Salut, 08030 Barcelona, Spain
| | - Joan Deniel
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Multiprofessional Teaching Unit of Primary Care in Catalunya Central, Institut Català de la Salut, 08272 Barcelona, Spain
| | - Joan Josep Cabré
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Reus-1, Institut Català de la Salut, 43202 Tarragona, Spain
| | - Daniel Sánchez Ruiz
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Sardenya, ACEBA, 08025 Barcelona, Spain
| | - Marcos Sánchez
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Les Corts, CAPSBE, 08028 Barcelona, Spain
| | - Aroa Illa
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Celrà, Institut Català de la Salut, 17460 Girona, Spain
| | - Ignasi Viñas
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Montilivi-Vilaroja, Institut Català de la Salut, 17003 Girona, Spain
| | - Juan José Montero
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Rocafonda, Institut Català de la Salut, 08304 Barcelona, Spain
| | - Francesc Xavier Cantero
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Igualada Urbà, Institut Català de la Salut, 08700 Barcelona, Spain
| | - Anna Rodriguez
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Santa Eugènia de Berga, Institut Català de la Salut, 08507 Barcelona, Spain
| | - Francisco Martín
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Healthcare Research Support Unit, Departament of Primary Care Camp de Tarragona, Institut Català de la Salut, 43202 Tarragona, Spain
| | - Montserrat Baré
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Creu Alta, Institut Català de la Salut, 08208 Barcelona, Spain
| | - Rosa Ripollés
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Temple, Institut Català de la Salut, Terres de l’Ebre, 43500 Tarragona, Spain
| | - Montse Castellet
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Dr. Joan Mirabell, Institut Català de la Salut, 08006 Barcelona, Spain
| | - Joan Lozano
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
| | - Antoni Sisó-Almirall
- Family Phisician, Exective Board of the Catalan Society of Family and Community Medicine (CAMFiC), 08009 Barcelona, Spain
- Primary Care Center Les Corts, CAPSBE, 08028 Barcelona, Spain
- Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
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25
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Mora N, Fina F, Méndez-Boo L, Cantenys R, Benítez M, Moreno N, Balló E, Hermosilla E, Fàbregas M, Guiriguet C, Cos X, Rodoreda S, Mas A, Lejardi Y, Coma E, Medina M. "Decline and uneven recovery from 7 common long-term conditions managed in the Catalan primary care after two pandemic years: an observational retrospective population-based study using primary care electronic health records". BMC PRIMARY CARE 2023; 24:9. [PMID: 36641483 PMCID: PMC9840158 DOI: 10.1186/s12875-022-01935-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND The incidence of chronic diseases during the COVID-19 pandemic has drastically been reduced worldwide due to disruptions in healthcare systems. The aim of our study is to analyse the trends in the incidence of 7 commonly managed primary care chronic diseases during the last 2 years of the COVID-19 pandemic in Catalonia. METHODS We performed an observational retrospective population-based study using data from primary care electronic health records from January 2018 to August 2022 (5.1 million people older than 14 years). We divided the study period into two: a pre-pandemic period (before 14 March 2020) and a pandemic period. We performed a segmented regression analysis of daily incidence rates per 100,000 inhabitants of 7 chronic diseases: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD), heart failure (HF), hypertension and hypercholesterolemia. In addition, we compared annual incidence between pandemic years (2020, 2021 and 2022) and 2019. Associated incidence rate ratios (IRR) were also calculated. Finally, we estimated the number of expected diagnoses during the pandemic period using data from 2019 and we compared it with the observed data. RESULTS We analysed 740,820 new chronic diseases' diagnoses. Daily incidence rates of all 7 chronic diseases were drastically interrupted on 14 March 2020, and a general upward trend was observed during the following months. Reductions in 2020 were around 30% for all conditions except COPD which had greater reductions (IRR: 0.58 [95% CI: 0.57 to 0.6]) and HF with lesser drops (IRR: 0.86 [95% CI: 0.84 to 0.88]). Some of the chronic conditions have returned to pre-pandemic diagnosis levels, except asthma, COPD and IHD. The return to pre-pandemic diagnosis levels compensated for the drops in 2020 for T2DM and HF, but not for hypertension which presented an incomplete recovery. We also observed an excess of hypercholesterolemia diagnoses of 8.5% (95%CI: 1.81% to 16.15%). CONCLUSIONS Although primary care has recovered the pre-pandemic diagnosis levels for some chronic diseases, there are still missing diagnoses of asthma, COPD and IHD that should be addressed.
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Affiliation(s)
- Núria Mora
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Francesc Fina
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Leonardo Méndez-Boo
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Roser Cantenys
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Mència Benítez
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.22061.370000 0000 9127 6969Equip d’Atenció Primària de Gòtic, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Nemesio Moreno
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Elisabet Balló
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Eduardo Hermosilla
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.452479.9Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
| | - Mireia Fàbregas
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Carolina Guiriguet
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain ,grid.22061.370000 0000 9127 6969Equip d’Atenció Primària de Gòtic, Institut Català de la Salut (ICS), Barcelona, Spain ,grid.5841.80000 0004 1937 0247Universitat de Barcelona, Barcelona, Spain
| | - Xavier Cos
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain ,grid.22061.370000 0000 9127 6969DAP_Cat Research Group, Gerència Territorial Barcelona Ciutat, Institut Català de la Salut, Barcelona, Spain ,grid.7080.f0000 0001 2296 0625Universitat Autònoma de Barcelona, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBERDEM, ISCIII , Madrid, Spain
| | - Sara Rodoreda
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ariadna Mas
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Yolanda Lejardi
- grid.22061.370000 0000 9127 6969Direcció Assistencial d’Atenció Primària i a la Comunitat, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Ermengol Coma
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
| | - Manuel Medina
- grid.22061.370000 0000 9127 6969Primary Care Services Information Systems (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007 Barcelona, Spain
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Aoki T, Sugiyama Y, Mutai R, Matsushima M. Impact of Primary Care Attributes on Hospitalization During the COVID-19 Pandemic: A Nationwide Prospective Cohort Study in Japan. Ann Fam Med 2023; 21:27-32. [PMID: 36690482 PMCID: PMC9870632 DOI: 10.1370/afm.2894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/25/2022] [Accepted: 09/30/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE During a pandemic, when there are many barriers to providing preventive care, chronic disease management, and early response to acute common diseases for primary care providers, it is unclear whether primary care attributes contribute to reducing hospitalization. We aimed to examine the association between core primary care attributes and total hospitalizations during the COVID-19 pandemic. METHODS We conducted a nationwide prospective cohort study during the pandemic using a representative sample of the Japanese adult population aged 40 to 75 years. Primary care attributes (first contact, longitudinality, coordination, comprehensiveness, and community orientation) were assessed using the Japanese version of Primary Care Assessment Tool (JPCAT). The primary outcome measure was any incidence of hospitalization during a 12-month period from May 2021 through April 2022. RESULTS Data from 1,161 participants were analyzed (92% follow-up rate). After adjustment for possible confounders, overall primary care attributes (assessed by the JPCAT total score) were associated in a dose-dependent manner with a decrease in hospitalizations (odds ratio [OR] = 0.37, 95% CI, 0.16-0.83 for the highest score quartile, compared with no usual source of care). All associations between each domain score of the JPCAT and hospitalization were statistically significant when comparing the highest quartile with no usual source of care. CONCLUSIONS Our study revealed that the provision of primary care, particularly high-quality primary care, was associated with decreased total hospitalization, even during a pandemic when there are many barriers to providing usual medical care. These findings support policies that seek to strengthen primary care systems during and after the COVID-19 pandemic.
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Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Tokyo, Japan
| | - Rieko Mutai
- Department of Adult Nursing, The Jikei University School of Nursing, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
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27
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Solberg LI, Carlin CS, Peterson KA. COVID-19 Impacts on Primary Care Clinic Care Management Processes. Ann Fam Med 2023; 21:40-45. [PMID: 36690491 PMCID: PMC9870648 DOI: 10.1370/afm.2910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/18/2022] [Accepted: 10/10/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota. RESULTS There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.6% and 2.1%) from 2017 to 2019 and from 2019 to 2021. In 2021, CMP scores were lower in small medical groups than in large medical groups in 2017 (66.1% vs 78.5%, P <.001), a similar difference to that in 2017. Care management process scores were also lower in clinics in urban areas compared with rural areas (73.9% vs 79.0%, P <.001), but overall scores in all subgroups were higher in 2021 than in 2017. This improvement occurred despite reports from 55% of clinic leaders that the pandemic had been very or extremely disruptive. CONCLUSIONS Although quite disrupted by the pandemic, care management processes for chronic disease care in these resilient primary care clinics actually increased from 2019 to 2021, at least in clinics that were part of large organizations. However, that was not true for clinics from smaller groups and perhaps for other areas of care.
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28
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Burden of COVID-19 infection and lockdown measures on individuals with chronic diseases in Saudi Arabia: A national population-based study. J Infect Public Health 2022; 15:1531-1539. [PMID: 36434997 PMCID: PMC9674401 DOI: 10.1016/j.jiph.2022.11.019] [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: 07/12/2022] [Revised: 10/15/2022] [Accepted: 11/15/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The recent COVID-19 crisis has placed a huge strain on the global health and economy. The toll of the damage on the human society exceeds the morbidity and mortality of the pandemic and the associated burden, considering the multidimensional impact on all aspects of life. OBJECTIVES The present study assessed the specific impact of COVID-19 on individuals with chronic diseases including the Years Lost for Disability (YLD) burden of COVID-19 infection, and multidimensional impact on the disease management, adaptive lifestyle, and socioeconomic dimensions. METHOD A national, population-based cross-sectional study was conducted among adult Saudi population. An internet-based questionnaire was used to collect sociodemographic characteristics, medical history, impact of COVID-19 lockdown on the management of the chronic disease, adaptive lifestyle, and impact of COVID-19 on family members. Additionally, data regarding eventual COVID-19 infection, severity and management were collected. YLD was estimated and normalized per 100,000 persons. RESULT Having a chronic disease was not associated with a greater risk of COVID-19 (relative risk [RR]=0.83, p = 0.153); however, it was associated with higher risk of declined physical activity (RR=1.30, p < 0.0001), deteriorated eating habit (RR=1.20, p = 0.002), sleep quality (RR=1.25, p < 0.0001), and overall health perception (RR=1.61, p < 0.0001), loss of family members due to COVID-19 (RR=1.96, p = 0.0001), and impacted household income (RR=1.11, p = 0.010). In case of COVID-19 infection, having a chronic disease was associated with increased risk of hospitalization (RR=5.04, p = 0.005) and having a moderate-to-severe form of COVID-19 (RR=6.00, p = 0.013). The overall YLD was estimated to be 17.7 per 100,000 individuals, and there was no significant difference between individuals with chronic diseases and those without. CONCLUSION COVID-19 entailed a substantial burden on the Saudi society in 2020, and individuals with preexisting chronic diseases suffered more important multidimensional impact, which need further research to assess the real impact of the pandemic and draw the pertinent lessons from the experience for future possible epidemics.
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29
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Yan YY, Ge JL, Fan TY, Wang HT, Gu YF, Xiao X, Du ZH, Sun XM. Tasks of COVID-19 prevention and control management teams at primary health care facilities in mainland China: a nationwide online cross-sectional survey. BMC PRIMARY CARE 2022; 23:110. [PMID: 35524166 PMCID: PMC9075923 DOI: 10.1186/s12875-022-01703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 04/07/2022] [Indexed: 11/12/2022]
Abstract
Background This research aimed to investigate the tasks performed by Coronavirus Disease 2019(COVID-19) prevention and control management teams at primary healthcare (PHC) facilities during COVID-19 pandemic across the mainland China. Methods An online survey was performed and COVID-19 prevention and control management teams at PHC facilities were invited to participate in this research. The top 7 most important tasks in the three different periods of COVID-19 containment were selected and ranked. Participations of tasks were surveyed. Results A total of 998 valid responses (an effective rate of 99.11%) were collected. The respondents were divided into Group A (≤5 respondents within each PHC facility, n1 = 718) and Group B (> 5 respondents within each PHC facility, n2 = 280). The consensus was selected from top 7 most important tasks including screening at travel centers/intervals and screening at entry centers, at-home/centralized quarantine management, transferring, pre-examination/triage and fever sentinel surveillance clinic/fever clinic. Pre-examination/triage and fever sentinel surveillance clinic/fever clinic works became more significant in the regular prevention and control period. Adjusted analysis found that team members of Group A with a college, undergraduate college and graduate school educational background were less involved in pre-examination/triage works (aOR: 0.28; 95%CI: 0.09-0.86, P = 0.026; aOR: 0.30; 95%CI: 0.10-0.90, P = 0.031; aOR: 0.21; 95%CI: 0.05-0.82, P = 0.024). Those who were over the median age were twice more likely to be engaged in managing fever sentinel surveillance of clinic/fever clinic visitors (aOR: 2.18; 95%CI: 1.16-4.08, P = 0.015). Those being specialized in nursing and other specialties were less likely to participate in fever sentinel surveillance of clinic/fever clinic works (aOR: 0.44; 95%CI: 0.24-0.81, P = 0.009; aOR: 0.30; 95%CI: 0.16-0.58, P < 0.001). Those came from central and western China were less likely to participate in centralized quarantine management (aOR: 0.61; 95%CI: 0.38-0.98, P = 0.042; aOR: 0.64; 95%CI: 0.42-0.97, P = 0.037). Team members came from central and western China were twice less likely to participate in screening at travel centers/intervals (aOR: 1.75; 95%CI: 1.14-2.70, P = 0.011; aOR: 1.63; 95%CI: 1.07-2.48, P = 0.024). Conclusion In mainland China, team members of COVID-19 prevention and control at PHC facilities are mainly responsible for screening, quarantine, transferring and monitoring during the COVID-19 pandemic. Pre-examination/triage and the fever sentinel surveillance clinic/fever clinic were gradually valued. Team members with lower educational background are competent in pre-examination/triage works, but more experienced general practitioners are more likely to be in charge of fever sentinel surveillance clinic/fever clinics work. The necessity of COVID-19 prevention and control management teams to participate in screening at travel centers/intervals is subjected to further discussions. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01703-0.
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Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15329. [PMID: 36430047 PMCID: PMC9690243 DOI: 10.3390/ijerph192215329] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.
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Affiliation(s)
- Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University, 6535 XN Nijmegen, The Netherlands
| | | | - Liubove Murauskiene
- Department of Public Health, Faculty of Medicine, University of Vilnius, 03101 Vilnius, Lithuania
| | - Antoni Peris
- Castelldefels Agents de Salut (Casap), 08860 Castelldefels, Spain
| | - Benoit Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Emil L. Sigurdsson
- Department of family medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Ganem F, Bordas A, Folch C, Alonso L, Montoro-Fernandez M, Colom-Cadena A, Mas A, Mendioroz J, Asso L, Anton A, Pumarola T, González MV, Blanco I, Soler-Palacín P, Soriano-Arandes A, Casabona J. The COVID-19 Sentinel Schools Network of Catalonia (CSSNC) project: Associated factors to prevalence and incidence of SARS-CoV-2 infection in educational settings during the 2020-2021 academic year. PLoS One 2022; 17:e0277764. [PMID: 36395191 PMCID: PMC9671345 DOI: 10.1371/journal.pone.0277764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022] Open
Abstract
The Sentinel Schools project was designed to monitor and evaluate the epidemiology of COVID-19 in Catalonia, gathering evidence for health and education policies to inform the development of health protocols and public health interventions to control of SARS-CoV-2 infection in schools. The aim of this study was to estimate the prevalence and incidence of SARS-CoV-2 infections and to identify their determinants among students and staff during February to June in the academic year 2020-2021. We performed two complementary studies, a cross-sectional and a longitudinal component, using a questionnaire to collect nominal data and testing for SARS-CoV-2 detection. We describe the results and perform a univariate and multivariate analysis. The initial crude seroprevalence was 14.8% (95% CI: 13.1-16.5) and 22% (95% CI: 18.3-25.8) for students and staff respectively, and the active infection prevalence was 0.7% (95% CI: 0.3-1) and 1.1% (95% CI: 0.1-2). The overall incidence for persons at risk was 2.73 per 100 person-month and 2.89 and 2.34 per 100 person-month for students and staff, respectively. Socioeconomic, self-reported knowledge, risk perceptions and contact pattern variables were positively associated with the outcome while sanitary measure compliance was negatively associated, the same significance trend was observed in multivariate analysis. In the longitudinal component, epidemiological close contact with SARS-CoV-2 infection was a risk factor for SARS-CoV-2 infection while the highest socioeconomic status level was protective as was compliance with sanitary measures. The small number of active cases detected in these schools suggests a low transmission among children in school and the efficacy of public health measures implemented, at least in the epidemiological scenario of the study period. The major contribution of this study was to provide results and evidence that help analyze the transmission dynamic of SARS-CoV-2 and evaluate the associations between sanitary protocols implemented, and measures to avoid SARS-CoV-2 spread in schools.
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Affiliation(s)
- Fabiana Ganem
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Anna Bordas
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Cinta Folch
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
| | - Lucia Alonso
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Marcos Montoro-Fernandez
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
| | - Andreu Colom-Cadena
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
| | - Ariadna Mas
- Direcció Assistencial d’Atenció Primària i Comunitària, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Jacobo Mendioroz
- Subdirecció general de Vigilància i Resposta a Emergències de l’Agència de Salut Pública de Catalunya, Departament de Salut, Catalonia, Spain
| | - Laia Asso
- Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Catalonia, Spain
| | - Andres Anton
- Microbiology Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Tomàs Pumarola
- Microbiology Department, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Maria Victoria González
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Institut D’Investigació en Ciències de La Salut Germans Trias i Pujol (IGTP), Badalona, Catalonia, Spain
| | - Ignacio Blanco
- Microbiology Department, Laboratori Clínic Metropolitana Nord, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Institut D’Investigació en Ciències de La Salut Germans Trias i Pujol (IGTP), Badalona, Catalonia, Spain
| | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Casabona
- Centre of Epidemiological Studies on Sexually Transmitted Infections and AIDS of Catalonia (CEEISCAT), Health Department, Government of Catalonia, Badalona, Spain
- Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Publica, Universitat Autònoma de Barcelona, Bellaterra, Spain
- Institut d’Investigació Germans Trias i Pujol (IGTP), Badalona, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
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Lavikainen P, Lamidi ML, Repo T, Inglin L, Martikainen J, Laatikainen T. Effects of COVID-19 Pandemic and Lockdown on Monitoring and Treatment Balance of Finnish Coronary Heart Disease and Type 2 Diabetes Patients. Clin Epidemiol 2022; 14:1363-1373. [PMID: 36387927 PMCID: PMC9664920 DOI: 10.2147/clep.s387461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/27/2022] [Indexed: 02/17/2024] Open
Abstract
PURPOSE We aimed to examine the effect of the COVID-19 pandemic and lockdown on monitoring and treatment balance of Finnish coronary heart disease (CHD) and type 2 diabetes (T2D) patients. PATIENTS AND METHODS We used data from the electronic health records on 1604 CHD and 10,136 T2D patients aged 18‒85 years in Eastern Finland. Measurement and levels of low-density lipoprotein cholesterol (LDL) of CHD patients and glycated haemoglobin (HbA1c) of T2D patients were assessed monthly during January 2019-June 2021. Interrupted time-series analysis design was utilized to examine the effect of the lockdown on proportion of patients monitored and treatment balance. RESULTS Reductions in frequencies of LDL testing of CHD and HbA1c testing of T2D patients were observed during the national lockdown. Downward trend in average LDL was observed from January 2019 until June 2021. Average HbA1c values increased from January 2019 to March 2020 with an additional increase by 2.04 mmol/mol (0.80 to 3.29) in April 2020. However, there was a downward trend in monthly average HbA1c during the lockdown until June 2021 with an additional change in level by 0.61 mmol/mol (95% CI 0.06 to 1.16) in July 2020. CONCLUSION The lockdown decreased the frequency of monitoring among both CHD and T2D patients. Meanwhile, monthly average LDL had a steadily improving pattern in CHD patients during the follow-up while temporary worsening in HbA1c in patients with T2D was observed at the time of the lockdown. The lockdown may have introduced selection in patients who had their treatment outcomes monitored. Better self-management of risk factors among patients is also possible.
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Affiliation(s)
- Piia Lavikainen
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Marja-Leena Lamidi
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Teppo Repo
- Department of Geographical and Historical Studies, University of Eastern Finland, Joensuu, Finland
| | - Laura Inglin
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | | | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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da Silva BRG, Corrêa APDV, Uehara SCDSA. Primary health care organization in the Covid-19 pandemic: scoping review. Rev Saude Publica 2022; 56:94. [PMID: 36383807 PMCID: PMC9635848 DOI: 10.11606/s1518-8787.2022056004374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Mapping available scientific evidence on the organization of primary health care services and professionals during the Covid-19 pandemic. METHODS This is a scoping review that followed the Joanna Briggs Institute method. Articles published in Portuguese, Spanish, and English from January 2020 to January 2021 in the CINAHL, Lilacs, Medline, PubMed, and Web of Science databases were included. RESULTS We selected 24 articles that presented the reorganization of primary health care services and professionals to care suspected or confirmed Covid-19 cases. Coordination measures to tackle this disease in primary health care help to control its infection, especially by the active search for respiratory symptoms, the detection of new cases, and the monitoring of confirmed cases. CONCLUSION This study presents an overview of how primary health care services and professionals organized themselves to tackle the Covid-19 pandemic, addressing adjustments in infrastructure and care flows, such as establishing specific Covid-19 care units, separating infected and non-infected patients, using telemedicine as an alternative modality of care, and monitoring cases by applications and phone.
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Affiliation(s)
- Breno Ribeiro Gonçalves da Silva
- Universidade Federal de São CarlosCentro de Ciências Biológicas e da SaúdeDepartamento de EnfermagemSão CarlosSPBrasil Universidade Federal de São Carlos. Centro de Ciências Biológicas e da Saúde. Departamento de Enfermagem. Graduação em Enfermagem. São Carlos, SP, Brasil
| | - Ana Paula de Vechi Corrêa
- Universidade Federal de São CarlosCentro de Ciências Biológicas e da SaúdeDepartamento de EnfermagemSão CarlosSPBrasil Universidade Federal de São Carlos. Centro de Ciências Biológicas e da Saúde. Departamento de Enfermagem. Programa de Pós-Graduação em Enfermagem. São Carlos, SP, Brasil
| | - Sílvia Carla da Silva André Uehara
- Universidade Federal de São CarlosCentro de Ciências Biológicas e da SaúdeDepartamento de EnfermagemSão CarlosSPBrasil Universidade Federal de São Carlos. Centro de Ciências Biológicas e da Saúde. Departamento de Enfermagem. São Carlos, SP, Brasil
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Bellini B, Nreu B, Francesconi P, Mannucci E. Covid-19 pandemic, diabetes and glycemic control: Results of a retrospective cohort study of 230.000 persons with diabetes in tuscany. Nutr Metab Cardiovasc Dis 2022; 32:2588-2593. [PMID: 36064691 PMCID: PMC9356641 DOI: 10.1016/j.numecd.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic affected the processes of routine care for chronic patients due to disrupted delivery care. The aim of the present study is to verify the COVID-19 pandemic effects on diabetes control and management. METHODS AND RESULTS The study was designed as a retrospective observational study, performed on two cohorts of patients with diabetes in 2019 and 2020. Data used for the analyses were gathered from administrative and laboratory databases, which do not include any sensible information on COVID-19. The Tuscany Regional Health Agency is data controller for current administrative databases and has been working to produce available information for policy decision-making. In 2020, in comparison with 2019, a relevant reduction of the number of patients measuring HbA1c was observed during the March-April lockdown, and again during the second pandemic wave in Autumn. A similar pattern was observed for specialist visits for diabetes, for which the introduction of televisits only partly compensated for the reduction of traditional office visits. The number of patients receiving drugs for diabetes each week in 2020 was very similar to 2019. The mean HbA1c values and the proportion of HbA1c values > 8% for each week, were higher during the 2020 Spring and Autumn lockdown. CONCLUSION COVID-19 pandemic negatively impacts diabetes management, reducing specialist visits and HbA1c determinations during the first and second pandemic wave. Despite a satisfactory continuity in pharmacological treatment, short-term impairment of average glycemic control was detected, particularly in Autumn.
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Affiliation(s)
| | - Besmir Nreu
- Diabetology, Careggi Hospital, Florence, Italy; University of Florence, Italy.
| | | | - Edoardo Mannucci
- Diabetology, Careggi Hospital, Florence, Italy; University of Florence, Italy
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Yacoub V, Carletti V, Grilli D, Morgani C, Palazzetti P, Zullo MA, Luffarelli P, Valensise HCC, Schiavi MC. Quality of life and sexual function analysis in a group of Italian postmenopausal women after COVID-19 vaccination. Gynecol Endocrinol 2022; 38:988-991. [PMID: 36203336 DOI: 10.1080/09513590.2022.2132224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
AIM The aim of the study was to evaluate the impact of SARS-CoV-2 vaccination on quality of life, psychological aspect and sexual life in a group of Italian postmenopausal women during the COVID-19 pandemic. METHODS The study was a prospective, observational analysis of postmenopausal women before and after the COVID-19 vaccination. The population previously answered different questionnaires, such as the Female Sexual Function Index (FSFI), the Female Sexual Distress Scale (FSDS), the 36-Item Short Form Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Twelve weeks after the end of the vaccine cycle, these women were invited to complete the same questionnaires by e-mail to evaluate if vaccination coverage could positively impact the quality of life of postmenopausal women. The Patient Impression of Global Improvement (PGI-I) after three months of treatment was also calculated. RESULTS A total of 114 patients were reported. The median age was 60.96 (52-66) years. Mean sexual intercourses/month increased from 1.28 ± 1.23 to 4.21 ± 1.80 (p = 0.001). The FSFI increased (19.22 ± 3.31 vs 29.24 ± 4.21, p < 0.0001) and the FSDS decreased significantly (20.12 ± 5.23 vs 9.32 ± 5.55, p < 0.0001) 12 weeks after vaccination coverage. The SF-36 increased from 64.23 ± 11.76 to 82.21 ± 10.24 (p < .0001) and the HADS questionnaire improved significantly from 9.3 ± 2.73 to 5.1 ± 1.34 after the COVID-19 vaccine execution (p<.0001). CONCLUSIONS The spread of COVID-19 vaccine coverage positively influenced sexual function, quality of life and psychological aspect in postmenopausal women.
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Affiliation(s)
- Veronica Yacoub
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Valerio Carletti
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
| | - Debora Grilli
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Sandro Pertini" Hospital, Rome, Italy
| | - Claudia Morgani
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Sandro Pertini" Hospital, Rome, Italy
| | | | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, "Campus Biomedico" University, Rome, Italy
| | - Herbert Carmelo Carlo Valensise
- Department of Obstetrics and Gynecology, "Tor Vergata" University, Rome, Italy
- Department of Obstetrics and Gynecology, "Casilino" Hospital, Rome, Italy
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Guisado-Clavero M, Astier-Peña MP, Gómez-Bravo R, Ares-Blanco S. [Open data for monitoring COVID-19 in Spain: descriptive study]. Enferm Infecc Microbiol Clin 2022; 42:S0213-005X(22)00191-4. [PMID: 36249470 PMCID: PMC9554340 DOI: 10.1016/j.eimc.2022.10.002] [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: 04/03/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The indicators of the pandemic have been based on the total number of diagnosed cases of COVID-19, the number of people hospitalized or in intensive care units, and deaths from the infection. The aim of this study is to describe the available data on diagnostic tests, health service used for the diagnosis of COVID-19, case detection and monitoring. METHOD Descriptive study with review of official data available on the websites of the Spanish health councils corresponding to 17 Autonomous Communities, 2 Autonomous cities and the Ministry of Health. The variables collected refer to contact tracing, technics for diagnosis, use of health services and follow-up. RESULTS all regions of Spain show data on diagnosed cases of COVID-19 and deaths. Hospitalized cases and intensive care admissions are shown in all regions except the Balearic Islands. Diagnostic tests for COVID-19 have been registered in all regions except Madrid region and Extremadura, with scarcely information on what type of test has been performed (present in 7 CCAA), requesting service and study of contacts. CONCLUSIONS The information available on the official websites of the Health Departments of the different regions of Spain are heterogeneous. Data from the use of health service or workload in Primary Care, Emergency department or Out of hours services are almost non-existent.
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Affiliation(s)
- Marina Guisado-Clavero
- Técnica de Salud de la Unidad Docente Multiprofesional de Atención Familiar y Comunitaria del área norte de la Comunidad de Madrid, España
| | - María Pilar Astier-Peña
- Médica de familia. Centro de Salud Universitas del Servicio Aragonés de Salud (Zaragoza, España). GdT de Seguridad del paciente de semFYC y del GdT de Calidad y Seguridad de WONCA, Zaragoza, España
| | - Raquel Gómez-Bravo
- Research Group Self-Regulation and Health. Institute for Health and Behaviour. Department of Behavioural and Cognitive, Sciences. Faculty of Humanities, Education, and Social Sciences, Universidad de Luxemburgo, Luxemburgo
| | - Sara Ares-Blanco
- Médica de familia. Centro de Salud Federica Montseny, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, España. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Salcedo ED, Alaball JV. [Accessibility and Digital Divide, the 2.0 Inverse Care Law]. Aten Primaria 2022; 54:102485. [PMID: 36241337 PMCID: PMC9568681 DOI: 10.1016/j.aprim.2022.102485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Esther Díaz Salcedo
- Centre de Atenció Primària Canyelles (ABS Roquetes-Canyelles), Gerència Territorial de la Metropolitana Sud, Canyelles, Institut Català de la Salut, Barcelona, España
| | - Josep Vidal Alaball
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, SantFruitós de Bages, Spain,Unitat de Suport a La Recerca de La Catalunya Central, Fundació Institut Universitari Per a La Recerca a L’Atenció Primària de Salut Jordi Gol I Gurina, 08272, Sant Fruitós de Bages, Spain,Faculty of Medicine, University of Vic - Central University of Catalonia, Vic, Spain
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Impacto de la pandemia de COVID-19 en la asistencia sanitaria prestada desde la Atención Primaria en un área sanitaria. Semergen 2022; 48:e41-e43. [PMID: 35589490 PMCID: PMC9050782 DOI: 10.1016/j.semerg.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/06/2022] [Accepted: 04/15/2022] [Indexed: 11/24/2022]
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Wright WL, White PA, Welsh M, Cutting K. Evaluating the effect of COVID-19 on quality measures of patients with type 2 diabetes in two family nurse practitioner-owned clinics. J Am Assoc Nurse Pract 2022; 34:1090-1097. [PMID: 36044349 DOI: 10.1097/jxx.0000000000000768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic necessitated lockdowns resulting in the disruption of access to primary care. A family nurse practitioner (NP)-owned practice shifted many visits to telehealth to provide care to all their patients including those with chronic illness . The purpose of this project was to evaluate the impact of the pandemic on selected diabetes quality measures and adherence to national diabetes guidelines in two previously well-performing NP-owned primary care clinics. LOCAL PROBLEM Previous quality improvement studies demonstrated high performing metrics for their patients with type 2 diabetes mellitus (DM). The evaluation of the patients with type 2 DM was necessary to assess the care being delivered in the practice. METHODS A retrospective record review and analysis of 179 patients older than 18 years was implemented during the early days of the pandemic. Demographic data, process, and outcome measures for diabetes care were collected and compared with previous data from 2013 to 2017 to identify gaps in care. INTERVENTIONS Telehealth was implemented to deliver care to patients because of the lockdown. The evaluation of these metrics during the period where telehealth was being used to provide care was warranted to evaluate the status of patients with type 2 DM. RESULTS Patients with type 2 DM receiving care with telehealth demonstrated worsening A1cs and other quality care measures, including fewer ophthalmology evaluations. CONCLUSION While access to telehealth was important for these patients with type 2 DM, the findings demonstrated that the COVID-19 pandemic had a negative impact on diabetes quality measures. While these may have also reflected the challenges of adhering to lifestyle interventions during this stressful time, telehealth alone may not be an adequate delivery mechanism for primary care for those with type 2 DM.
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Affiliation(s)
- Wendy L Wright
- Wright & Associates Family Healthcare, Amherst, New Hampshire
- Wright & Associates Family Healthcare, Concord, New Hampshire
- Partners in Healthcare Education, LLC, Bedford, New Hampshire
| | - Patricia A White
- Tan Chingfen Graduate School of Nursing, University of Massachusetts (UMass) Chan Medical School, Worcester, Massachusetts
| | - Meredith Welsh
- White River Family Practice, White River Junction, Vermont
| | - Kelly Cutting
- CareWell Urgent Care, and Worcester State University Health Services, Worcester, Massachusetts
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Moons P, Goossens E, Luyckx K, Kovacs AH, Andresen B, Moon JR, Van De Bruaene A, Rassart J, Van Bulck L. The COVID-19 pandemic as experienced by adults with congenital heart disease from Belgium, Norway, and South Korea: impact on life domains, patient-reported outcomes, and experiences with care. Eur J Cardiovasc Nurs 2022; 21:620-629. [PMID: 34927192 PMCID: PMC8755276 DOI: 10.1093/eurjcn/zvab120] [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: 09/21/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 01/31/2023]
Abstract
AIMS The coronavirus disease-2019 (COVID-19) pandemic poses significant challenges to many groups within societies, and especially for people with chronic health conditions. It is, however, unknown whether and how the pandemic has thus far affected the physical and mental health of patient populations. Therefore, we investigated how the pandemic affected the lives of adults with congenital heart disease (CHD), compared pre- and peri-pandemic patient-reported outcome measures (PROMs) and a patient-reported experience measure (PREM), and investigated whether having had COVID-19 impacted pre-/peri-pandemic differences of the PROMs and PREM. METHODS AND RESULTS As part of the ongoing APPROACH-IS II project, we longitudinally surveyed 716 adults with CHD from Belgium, Norway, and South Korea. Pre-pandemic measures were administered from August 2019 to February 2020 and the peri-pandemic surveys were completed September 2020-April 2021. The majority of patients indicated that their social lives (80%), mental health (58%), and professional lives/education (51%) were negatively impacted by the pandemic. Patients felt worried (65%), were afraid (55%), reported the pandemic felt 'close' to them (53%), and were stressed (52%). However, differences between pre- and peri-pandemic scores on the PROMs and PREM were negligibly small (Cohen's d < 0.20). Across measures, 5.8-15.8% of patients demonstrated changes (improved or worsened scores) that exceeded the minimal clinically important difference. There were no difference-in-differences for PROMs and PREM between patients who did vs. did not have COVID-19. CONCLUSIONS Although the COVID-19 pandemic has been disruptive in many ways, pre- to peri-pandemic changes in PROMs and PREM of adults with CHD were negligibly small.
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Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, Division of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Koen Luyckx
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Adrienne H Kovacs
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Brith Andresen
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Ju Ryoung Moon
- Department of Nursing, Samsung Medical Center, Seoul, South Korea
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jessica Rassart
- Research Foundation Flanders (FWO), Brussels, Belgium
- KU Leuven School Psychology and Development in Context, KU Leuven, Leuven, Belgium
| | - Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35, Box 7001, B-3000 Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
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Wikström K, Linna M, Laatikainen T. The impact of the COVID-19 pandemic on incident cases of chronic diseases in Finland. Eur J Public Health 2022; 32:982-984. [PMID: 35972418 PMCID: PMC9384798 DOI: 10.1093/eurpub/ckac107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The COVID-19 pandemic has caused changes in the availability and use of health services, and disruptions have been reported in chronic disease management. We aimed to study the impact of the pandemic on the incidence of chronic diseases in Finland using register-based data. Incident cases of chronic diseases decreased, except cases of anxiety disorders. The annual reductions ranged from 5% in cases of cancers to over 16% in cases of type 2 diabetes. These findings may be due to diagnostic delays and highlight the importance to ensuring access to health care and the continuity of care in all circumstances.
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Affiliation(s)
- Katja Wikström
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Miika Linna
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Institute of Healthcare Engineering, Management and Architecture, Aalto University, Helsinki, Finland
| | - Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.,Joint Municipal Authority for North Karelia Social and Health Services, Joensuu, Finland
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Tuppin P, Lesuffleur T, Constantinou P, Atramont A, Coatsaliou C, Ferrat E, Canouï-Poitrine F, Debeugny G, Rachas A. Underuse of primary healthcare in France during the COVID-19 epidemic in 2020 according to individual characteristics: a national observational study. BMC PRIMARY CARE 2022; 23:200. [PMID: 35945511 PMCID: PMC9361264 DOI: 10.1186/s12875-022-01792-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022]
Abstract
Background The organization of healthcare systems changed significantly during the COVID-19 pandemic. The impact on the use of primary care during various key periods in 2020 has been little studied. Methods Using individual data from the national health database, we compared the numbers of people with at least one consultation, deaths, the total number of consultations for the population of mainland France (64.3 million) and the mean number of consultations per person (differentiating between teleconsultations and consultations in person) between 2019 and 2020. We performed analyses by week, by lockdown period (March 17 to May 10, and October 30 to December 14 [less strict]), and for the entire year. Analyses were stratified for age, sex, deprivation index, epidemic level, and disease. Results During the first lockdown, 26% of the population consulted a general practitioner (GP) at least once (-34% relative to 2019), 7.4% consulted a nurse (-28%), 1.6% a physiotherapist (-80%), and 5% a dentist (-95%). For specialists, consultations were down 82% for ophthalmologists and 37% for psychiatrists. The deficit was smaller for specialties making significant use of teleconsultations. During the second lockdown, the number of consultations was close to that in 2019, except for GPs (-7%), pediatricians (-8%), and nurses (+ 39%). Nurses had already seen a smaller increase in weekly consultations during the summer, following their authorization to perform COVID-19 screening tests. The decrease in the annual number of consultations was largest for dentists (-17%), physiotherapists (-14%), and many specialists (approximately 10%). The mean number of consultations per person was slightly lower for the various specialties, particularly for nurses (15.1 vs. 18.6). The decrease in the number of consultations was largest for children and adolescents (GPs: -10%, dentists: -13%). A smaller decrease was observed for patients with chronic diseases and with increasing age. There were 9% excess deaths, mostly in individuals over 60 years of age. Conclusions There was a marked decrease in primary care consultations in France, especially during the first lockdown, despite strong teleconsultation activity, with differences according to age and healthcare profession. The impact of this decrease in care on morbidity and mortality merits further investigation.
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[What have we missed because of COVID-19? Missed diagnoses and delayed follow-ups. SESPAS Report 2022]. GACETA SANITARIA 2022; 36 Suppl 1:S36-S43. [PMID: 35781146 PMCID: PMC9244613 DOI: 10.1016/j.gaceta.2022.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/28/2022]
Abstract
La pandemia de COVID-19 y la emergencia de salud pública asociada han afectado a los/las pacientes y a los servicios de salud en lo que respecta a las patologías no relacionadas con la COVID-19. Diversos estudios han evidenciado su desvinculación con los servicios sanitarios, con disminución de las consultas a los servicios de urgencias, de los ingresos hospitalarios de patologías no COVID-19, así como de la incidencia semanal notificada de enfermedades agudas y nuevos diagnósticos en atención primaria. Paralelamente, la pandemia ha tenido efectos directos e indirectos en las personas con enfermedades crónicas; las dificultades de acceso a los servicios sanitarios, la interrupción de la atención, la saturación del propio sistema y su reorientación hacia formatos no presenciales ha reducido la capacidad de prevenir o controlar las enfermedades crónicas, impactando además en los diferentes ámbitos de la vida de las personas, creando nuevas dificultades sociales y económicas, o agravando las preexistentes antes de la pandemia. Todas estas circunstancias se han ido modificando con cada una de las olas epidémicas. Se presenta una revisión de los estudios más relevantes que han ido analizando este problema y se incorporan como estudio de caso los resultados de un estudio observacional retrospectivo realizado en atención primaria en Madrid, que da cobertura sanitaria a una población de más de 6 millones de personas, y cuyo objetivo ha sido analizar la pérdida de nuevos diagnósticos en las patologías más prevalentes, como los problemas comunes de salud mental, enfermedades cardiovasculares y cerebrovasculares, diabetes tipo 2, enfermedad pulmonar obstructiva crónica y tumores de mama y de colon, en la primera y la segunda olas. Se calcularon las tasas de incidencia anual con su intervalo de confianza para cada patología y se comparó la frecuencia mensual de los nuevos códigos registrados entre el 1 de enero y el 31 de diciembre de 2020 con la media mensual de los recuentos observados para los mismos meses en 2016-2019. La tasa de incidencia anual para todos los procesos estudiados disminuyó en 2020, excepto para los trastornos de ansiedad. En relación con la recuperación de los diagnósticos perdidos, la insuficiencia cardiaca es el único diagnóstico que presenta una recuperación por encima de la media después de la primera ola. Para volver a los niveles prepandémicos de diagnóstico y seguimiento de la patología no COVID-19, el sistema sanitario debe reorganizarse y contemplar acciones específicas para los grupos de mayor riesgo.
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Van den Bulck S, Crèvecoeur J, Aertgeerts B, Delvaux N, Neyens T, Van Pottelbergh G, Coursier P, Vaes B. The impact of the Covid-19 pandemic on the incidence of diseases and the provision of primary care: A registry-based study. PLoS One 2022; 17:e0271049. [PMID: 35793324 PMCID: PMC9258821 DOI: 10.1371/journal.pone.0271049] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 06/22/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction
The Covid-19 pandemic had a tremendous impact on healthcare but uncertainty remains about the extent to which primary care provision was affected. Therefore, this paper aims to assess the impact on primary care provision and the evolution of the incidence of disease during the first year of the Covid-19 pandemic in Flanders (Belgium).
Methods
Care provision was defined as the number of new entries added to a patient’s medical history. Pre-pandemic care provision (February 1, 2018–January 31, 2020) was compared with care provision during the pandemic (February 1, 2020-January 31, 2021). A large morbidity registry (Intego) was used. Regression models compared the effect of demographic characteristics on care provision and on acute and chronic diagnoses incidence both prior and during the pandemic.
Results
During the first year of the Covid-19 pandemic, overall care provision increased with 9.1% (95%CI 8.5%;9.6%). There was an increase in acute diagnoses of 5.1% (95%CI 4.2%;6.0%) and a decrease in the selected chronic diagnoses of 12.8% (95% CI 7.0%;18.4%). Obesity was an exception with an overall incidence increase. The pandemic led to strong fluctuations in care provision that were not the same for all types of care and all demographic groups in Flanders. Relative to other groups in the population, the pandemic caused a reduction in care provision for children aged 0–17 year and patients from a lower socio-economic situation.
Conclusion
This paper strengthened the claim that Covid-19 should be considered as a syndemic instead of a pandemic. During the first Covid-19 year, overall care provision and the incidence of acute diagnoses increased, whereas chronic diseases’ incidence decreased, except for obesity diagnoses which increased. More granular, care provision and chronic diseases’ incidence decreased during the lockdowns, especially for people with a lower socio-economic status. After the lockdowns they both returned to baseline.
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Affiliation(s)
- Steve Van den Bulck
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Jonas Crèvecoeur
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
- * E-mail: (SVdB); (JC)
| | - Bert Aertgeerts
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Nicolas Delvaux
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Thomas Neyens
- I-BioStat, Data Science Institute, Hasselt University, Hasselt, Belgium
- Department of Public Health and Primary Care, I-BioStat, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Gijs Van Pottelbergh
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Patrick Coursier
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, Academic Center for General Practice, KU Leuven, Leuven, Belgium
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Palanca A, Quinones-Torrelo C, Girbés J, Real JT, Ampudia-Blasco FJ. Impact of COVID-19 lockdown on diabetes management and follow-up in a broad population in Spain. Eur J Clin Invest 2022; 52:e13771. [PMID: 35313009 PMCID: PMC9111861 DOI: 10.1111/eci.13771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 02/27/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the impact of COVID-19 lockdown on glycaemic control and diabetes follow-up in a Spanish metropolitan area with a total general population of 340,000. METHODS A retrospective real-world study comparing HbA1c testing, an indicator of diabetes control, and mean HbA1c during different COVID-19 restriction periods in 2020 (full lockdown, post-lockdown, partial lockdown) with the same periods in 2019. HbA1c testing was analysed per study period and according to gender, age and clinical setting. Associations between HbA1c testing and different covariables were investigated using logistic regression analysis. Changes in HbA1c were evaluated by repeated measures multivariate analysis of variance (ANOVA). RESULTS During full lockdown, 6847 individuals, of which 56.7% were over 65 and 6.5% below 40, were tested for HbA1c compared to 14,180 in 2019 (OR 0.47, 95% CI:0.46-0.49). Reduction in HbA1c testing was greater among older individuals (OR 0.44, 95% CI:0.42-0.45). No differences were observed for post-lockdown (OR 1.01, 95% CI:0.99-1.04). During partial lockdown, 10,816 individuals had at least one HbA1c measured compared to 12,749 in 2019 (OR 0.84, 95% CI:0.82-0.87). Mean HbA1c during full lockdown was 7.26% (±1.06) compared to 7.50% (±1.14) in 2019 (p < .0001). For gender and across all age groups, HbA1c levels were lower during full lockdown. HbA1c changes were not significantly different during post-lockdown and partial lockdown. CONCLUSIONS COVID-19 restriction measures affected HbA1c testing. During complete lockdown, HbA1c testing decreased by half across all gender and age groups. No deleterious effect on glycaemic control was observed during lockdown and post-lockdown among those tested.
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Affiliation(s)
- Ana Palanca
- Endocrinology and Nutrition Department, Valencia University Clinic Hospital, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,CIBERDEM, CIBER Diabetes and associated metabolic diseases, Madrid, Spain
| | - Carmen Quinones-Torrelo
- Laboratory of Biochemistry and Molecular Pathology, Valencia University Clinic Hospital, Valencia, Spain
| | - Juan Girbés
- Diabetes Unit, Arnau de Vilanova Hospital, Valencia, Spain
| | - José T Real
- Endocrinology and Nutrition Department, Valencia University Clinic Hospital, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,CIBERDEM, CIBER Diabetes and associated metabolic diseases, Madrid, Spain.,Department of Medicine, Medicine Faculty, University of Valencia (UV), Valencia, Spain
| | - F Javier Ampudia-Blasco
- Endocrinology and Nutrition Department, Valencia University Clinic Hospital, Valencia, Spain.,INCLIVA Biomedical Research Institute, Valencia, Spain.,CIBERDEM, CIBER Diabetes and associated metabolic diseases, Madrid, Spain.,Department of Medicine, Medicine Faculty, University of Valencia (UV), Valencia, Spain
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Inglin L, Wikström K, Lamidi ML, Laatikainen T. The adverse effect of the COVID-19 pandemic on health service usage among patients with type 2 diabetes in North Karelia, Finland. BMC Health Serv Res 2022; 22:725. [PMID: 35650580 PMCID: PMC9156619 DOI: 10.1186/s12913-022-08105-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
Aims The COVID-19 pandemic has challenged health systems and their capacity to deliver essential health services while responding to COVID-19. This study examines the pandemic’s impact on health service usage among patients with type 2 diabetes in the North Karelia region, in Finland. Methods This retrospective cohort study used electronic health records of 11,458 type 2 diabetes patients, comprising all primary and specialised care contacts in 2019 and 2020. We analysed diabetes and dental healthcare contacts to primary care nurses, doctors and dentists and all emergency visits in specialised care. We compared healthcare usage in three different periods in 2020 (pre-lockdown [1 January–15 March], lockdown [16 March–31 May], post-lockdown [1 June–31 December]) with the equivalent period in 2019. Results During the lockdown period, the number of diabetes-related contacts decreased significantly but quickly increased again to nearly the same level as in 2019. Overall, healthcare usage was lower in the pandemic year, with proportionally 9% fewer contacts per person (mean 2.08 vs 2.29) and a proportionally 9% lower proportion of patients making any contact (59.9% vs 65.8%). The proportion of remote consultations was similar in both years in the pre-lockdown period (56.3–59.5%) but then increased to 88.0% during the 2020 lockdown. Patterns were similar when analysed by age group and gender. Emergency visits went down significantly at the beginning of the lockdown period, but a “rebound effect” was observed, so after the lockdown, the number of emergency visits in 2020 exceeded the numbers of the previous year. Conclusion Despite the COVID-19 pandemic, diabetes care was continuous, and even elderly patients aged ≥70 years accessed the health services. The delivery of many essential services was facilitated by processes that strongly relied on telemedicine already before the pandemic. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08105-z.
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Foppa L, Alessi J, Nemetz B, de Matos R, Telo GH, Schaan BD. Quality of care in patients with type 1 diabetes during the COVID-19 pandemic: a cohort study from Southern Brazil. Diabetol Metab Syndr 2022; 14:75. [PMID: 35598019 PMCID: PMC9123820 DOI: 10.1186/s13098-022-00845-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 05/10/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Optimal glycemic control is the main goal for patients with diabetes. The results of type 1 diabetes patients' neglected demands during the pandemic can determine a long-term negative clinical, social, and economic impact, and result in worse diabetes control and a higher incidence of chronic complications. Therefore, this study aims to evaluate the impact of the COVID-19 outbreak in the quality of care of patients with type 1 diabetes in Southern Brazil. METHODS Cohort study based on electronic medical records of patients with type 1 diabetes, with scheduled appointments between January 1st 2020, and November 6th 2020, at a university public hospital. The quality indicators used were: assessment of albuminuria and/or serum creatinine, lipid profile, thyroid-stimulating hormone, glycated hemoglobin, retinopathy, and neuropathy. McNemar test was used to analyze categorical variables and the Wilcoxon test for continuous variables. RESULTS Out of 289 patients, 49.5% were women aged 40 ± 12 years old. During the pandemic, 252 patients had at least one face-to-face appointment canceled. The quality of care indicators showed a significant worsening during the COVID-19 pandemic compared to the previous year (p < 0.001). In 2019, 23.2% of the participants had all the indicators evaluated, while in 2020, during the pandemic, only 3.5% had all of them evaluated. CONCLUSION The COVID-19 pandemic hindered the offer of comprehensive and quality care to patients with type 1 diabetes.
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Affiliation(s)
- Luciana Foppa
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil.
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil.
| | - Janine Alessi
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
| | - Betina Nemetz
- Nurse School, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-002, Brazil
| | - Rosimeri de Matos
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
| | - Gabriela Heiden Telo
- Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, 6680, Jardim Botânico, Porto Alegre, RS, 90619-900, Brazil
- Pontifícia Universidade Católica do Rio Grande do Sul, Avenida Ipiranga, Partenon, Porto Alegre, RS, 668190619-900, Brazil
| | - Beatriz D Schaan
- Hospital de Clínicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Porto Alegre, RS, 90035-003, Brazil
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2400, 2º andar, Porto Alegre, RS, 90035-003, Brazil
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Bianchi FP, Stefanizzi P, Trerotoli P, Tafuri S. Sex and age as determinants of the seroprevalence of anti-measles IgG among European healthcare workers: A systematic review and meta-analysis. Vaccine 2022; 40:3127-3141. [PMID: 35491343 DOI: 10.1016/j.vaccine.2022.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The international literature shows good evidence of a significant rate of measles susceptibility among healthcare workers (HCWs). As such, they are an important public health issue. METHODS We conducted a systematic review and meta-analysis to estimate the prevalence of susceptible HCWs in EU/EEA countries and in the UK and to explore the characteristics (sex and age differences) and management of those found to be susceptible. RESULTS Nineteen studies were included in the meta-analysis. The prevalence of measles-susceptible HCWs was 13.3% (95 %CI: 10.0-17.0%). In a comparison of serosusceptible female vs. male HCWs, the RR was 0.92 (95 %CI = 0.83-1.03), and in a comparison of age classes (born after vs. before 1980) the RR was 2.78 (95 %CI = 2.20-3.50). The most recent studies proposed the mandatory vaccination of HCWs. DISCUSSION According to our meta-analysis, the prevalence of serosusceptible European HCWs is 13%; HCWs born in the post-vaccination era seem to be at higher risk. Healthcare professionals susceptible to measles are a serious epidemiological concern. Greater efforts should therefore be made to identify those who have yet to be vaccinated and actively encourage their vaccination.
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Affiliation(s)
| | - Pasquale Stefanizzi
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Paolo Trerotoli
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy
| | - Silvio Tafuri
- Department of Biomedical Science and Human Oncology, Aldo Moro University of Bari, Italy.
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Tuczyńska M, Staszewski R, Matthews-Kozanecka M, Żok A, Baum E. Quality of the Healthcare Services During COVID-19 Pandemic in Selected European Countries. Front Public Health 2022; 10:870314. [PMID: 35646786 PMCID: PMC9133554 DOI: 10.3389/fpubh.2022.870314] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/20/2022] [Indexed: 12/23/2022] Open
Abstract
BackgroundThere are several definitions of the quality of healthcare services. It may be defined as a level of value provided by any health care resource, as determined by some measurement. Scientists use a variety of quality measures to attempt to determine health care quality. They use special indicators or based on a patients' or healthcare professional's perception. This article aims to provide a short review of the available data on the quality of healthcare services in selected European countries during the COVID-19 pandemic.MethodologyThe research was done by the use of online databases such as PubMed, Google Scholar, and Science Direct. All the studies focused on the quality of healthcare services, yet the studies used different methods to measure this quality. In addition, the results of the authors' survey on the assessment of the quality of healthcare services before and during the COVID-19 pandemic were presented.ResultsAmong twelve studies, four were from the United Kingdom and one each of Catalonia, Italy, Sweden, Poland, Netherlands, France, Germany, Belgium. Patients in the United Kingdom felt that the quality of services was good during the pandemic, whereas the quality declined in the other studies cited. The results of our research also revealed a decrease in the quality of healthcare services provided.ConclusionsNevertheless the development of telemedicine has had a positive impact on the quality of healthcare services. The COVID-19 pandemic has undoubtedly affected most European countries' quality of healthcare services.
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Affiliation(s)
- Magdalena Tuczyńska
- Students Scientific Circle of Maxillofacial Orthopaedics and Orthodontics, Poznan University of Medical Sciences, Poznań, Poland
- *Correspondence: Magdalena Tuczyńska
| | - Rafał Staszewski
- Department of Hypertension, Angiology and Internal Medicine, Poznan University of Medical Sciences, Poznań, Poland
| | - Maja Matthews-Kozanecka
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
| | - Agnieszka Żok
- Division of Philosophy of Medicine and Bioethics, Poznan University of Medical Sciences, Poznań, Poland
| | - Ewa Baum
- Department of Social Sciences and the Humanities, Poznan University of Medical Sciences, Poznań, Poland
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Bonnet J, Macioce V, Jalek A, Bouchdoug K, Elleau C, Gras‐Vidal M, Pochic J, Avignon A, Sultan A. Covid-19 lockdown showed a likely beneficial effect on diabetic foot ulcers. Diabetes Metab Res Rev 2022; 38:e3520. [PMID: 35080096 PMCID: PMC9015270 DOI: 10.1002/dmrr.3520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/29/2021] [Accepted: 01/18/2022] [Indexed: 11/11/2022]
Abstract
AIMS During the Covid-19 epidemic, many countries imposed population lockdown. This study aimed to analyse diabetic foot ulcer (DFU) evolution of outpatients between the lockdown period and 1 month after its end. MATERIALS AND METHODS We conducted a prospective, observational, single-centre study without modification of care. All patients who followed up for a DFU in the study centre between 15 April 2020 and 11 May 2020 were included. The baseline assessment occurred 4 weeks after the beginning of lockdown and the follow-up visit 4-6 weeks after easing of lockdown. The primary analysis was based on the Site, Ischaemia, Neuropathy, Bacterial infection, Area, Depth (SINBAD) classification. RESULTS Twenty-seven patients were included, median 69.4 years, and 25 were followed-up at easing of lockdown. The median SINBAD score was 2 (interquartile range 1; 3) at inclusion and 1 (1; 2) at easing of lockdown, with a mean change of -0.32 (95% confidence interval -0.93; 0.29). Seventy-two percent of the population had a stable or improved score between the two visits. The proportion of patients using off-loading footwear was higher among those whose SINBAD score improved compared to those whose score worsened or remained stable (72%, 44% and 28%, respectively). Diabetes type was linked to DFU prognosis. Five patients (20%) were hospitalized during the follow-up period. CONCLUSION Lockdown appears to have had a positive effect on DFU if patients remain under the care of their expert wound centre. We believe this effect is related to better compliance with offloading. The wide use of tele-medicine seems relevant for the follow-up of DFU.
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Affiliation(s)
- Jean‐Baptiste Bonnet
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
- Desbrest Institute of Epidemiology and Public HealthIDESP UMR UA11 INSERMUniversité MontpellierMontpellierFrance
| | - Valérie Macioce
- Clinical Research and Epidemiology UnitCHU MontpellierUniversité MontpellierMontpellierFrance
| | - Abdulkader Jalek
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
- Desbrest Institute of Epidemiology and Public HealthIDESP UMR UA11 INSERMUniversité MontpellierMontpellierFrance
| | - Karim Bouchdoug
- Clinical Research and Epidemiology UnitCHU MontpellierUniversité MontpellierMontpellierFrance
| | - Cécile Elleau
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
| | | | - Julie Pochic
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
| | - Antoine Avignon
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
- Desbrest Institute of Epidemiology and Public HealthIDESP UMR UA11 INSERMUniversité MontpellierMontpellierFrance
| | - Ariane Sultan
- Endocrinology Diabetes DepartmentCHU MontpellierUniversité MontpellierMontpellierFrance
- PhymedexpUniversité de MontpellierInsermCNRSCHRU de MontpellierMontpellierFrance
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