General Practice Consultations Research Articles

Preconception health and care policies and guidelines in the UK and Ireland: a scoping review

BackgroundPreconception health and care strategies can substantially improve maternal and infant outcomes, and thus optimise intergenerational health. Given the burden of high-risk preconception health and social risk factors, as well as the absence of a review of preconception health and care policies and recommendations in the UK and Ireland since 2013, an update is now warranted. We undertook a scoping review to assess the nature of and summarise preconception health and care strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland. MethodsSearches were conducted on May 4–May 18, 2022, on Google Advanced, OpenAire, NICE, ProQuest, and relevant public health websites. The methodological process was informed by Arksey and O'Malley's work (2005) and the updated guidance for conducting Joanna Briggs Institute scoping reviews (2021). This review included grey literature resources focusing on preconception health and care in adults of reproductive age (18–44 years) as addressed in strategies, policies, guidelines, frameworks, and recommendations across the UK and Ireland. Searches on services provided in Northern Ireland, as a case study, were done and supplemented by audits with key stakeholders. Resources were included only if published, reviewed, or updated during or after 2011. Data were extracted using Microsoft Excel (MSO 365, version 2209) and NVivo (version 2020), with 10% or more of the data being double-coded, and presented using a narrative approach with thematic analysis. FindingsRelevant strategies, policies, guidelines, frameworks, and recommendations addressing preconception health and care were found (n=277). Themes included behavioural (eg, folic acid intake and smoking) and biomedical health (eg, mental and physical health conditions) and wider determinants of health (eg, ethnicity and deprivation). These themes were usually embedded within documents on other topics, rather than being the stand-alone focus. Resources also highlighted the importance of preconceptual counselling and the need for improved access to care and multidisciplinary collaborations. InterpretationFocused efforts are needed to implement identified strategies, policies, guidelines, frameworks, and recommendations. Online platforms, schools, general practitioner consultation rooms, pharmacies, and community centres are some of the avenues suitable to promote awareness of preconception health, facilitating informed decision-making about parenthood for all individuals and encouraging risk reduction. FundingDepartment for the Economy Northern Ireland, and National Institute for Health and Social Care Research Southampton Biomedical Research Centre (IS-BRC-1215-20004).

Prescription of benzodiazepines and Z-drugs among older patients in primary care: a French, national, cohort study.

In France, general practitioners (GPs) prescribe benzodiazepines and Z-drugs (BZD/ZDs) widely, and especially to older adults. Several characteristics of patients and/or GPs linked to BZD/ZD overprescription have been described in the general population but not among older patients in primary care. To estimate the proportion of GP consultations by patients aged 65 and over that resulted in a BZD/ZD prescription, and determine whether any GP-related factors predicted BZD/ZD overprescription in this setting. We analyzed sociodemographic and practice-related GP characteristics, and aggregated data on consultations recorded prospectively by 117 GPs in a database between 2000 and 2010. Next, we used logistic regression models to look for factors potentially associated with BZD/ZD overprescription (defined as an above-median prescription rate). The GPs' mean age at inclusion was 47.4 (7.1), and 87.9% were male. During the study period, the median (95% confidence interval) proportion of consultations with patients aged 65 and over resulting in a BZD/ZD prescription was 21.8% (18.1-26.1) (range per GP: 5-34.1%). In a multivariable analysis, a greater number of chronic disease (OR [95% CI] = 2.10 [1.22-3.64]), a greater number of drugs prescribed per consultation (5.29 [2.72-10.28]), and shorter study participation were independently associated with BZD/ZD overprescription. BZD/ZD overprescription was associated with a greater chronic disease burden and the number of drugs prescribed per consultation but not with any sociodemographic or practice-related GP characteristics. Targeted actions are needed to help GPs limit their prescription of BZD/ZDs to older patients with multiple comorbidities and polypharmacy.

The role of area level social deprivation on childhood and adolescent consultation rate in primary care: a population based, cohort study

BackgroundStudies show that children and adolescents in the most socially deprived areas (SDA) consult their general practitioner (GP) more often than those in the least socially deprived areas (Non-SDA). Given that GPs see a wide range of diseases, it is important to know which clinical diagnoses are shaped by socioeconomic factors. The primary objective was to determine the association between area level social deprivation and consultation rates in a pediatric population. The secondary objective was to explore this association across a wide range of clinical diagnoses.MethodsA cohort study using the Rijnmond Primary Care Database (RPCD) was conducted. Between 2013 and 2020, a total of 69,861 patients aged 0 to 17 years registered with a GP were analysed. A consultation was defined as patient contact and entry of a diagnosis using the International Classification of Primary Care (ICPC-1) code. Associations between consultation rates, ICPC-1 codes and area level social deprivation were explored using a Poisson regression model. The incidence risk ratio (IRR) and 95% confidence interval (CI) were reported.ResultsOver the 7-year study period the consultation rate of the study population was 3.8 per person-years. The top 5 reasons for children and adolescents to consult their GP was related to skin, respiratory, general unspecified, musculoskeletal and digestive symptoms or diagnoses. Consultation rate was higher in SDA group compared to Non-SDA group (IRR 1.20, 95% CI 1.19–1.20). Consultation rate for ICPC-1 code related to pregnancy and family planning was significantly lower in SDA group compared to Non-SDA group. Upon further exploration of this code, SDA group were less likely to consult for oral contraception and more likely to contact a GP for induced termination of pregnancy compared to Non-SDA group (IRR 0.36; 95% CI 0.33–0.44 and IRR 2.94; 95% CI 1.58–5.46 respectively).ConclusionsOverall, SDA group had higher GP consultation rates for the majority of clinical diagnoses except for pregnancy and family planning. In this latter category, adolescent females in SDA consulted less frequently for oral contraception. This study illustrates the need to understand the underlying health seeking behaviors of children and adolescents at different development phases of their lives.

Daytime contacts and general practitioner consultations, and pain as a reason for encounter in children with cerebral palsy; a Norwegian national registry linkage study

Aim The aim of this study was to compare the prevalence of daytime contacts and consultations, and pain as a reason for encounter (RFE) with a general practitioner (GP), in children with cerebral palsy (CP) (cases) to that of the general paediatric population (controls). Methods The study linked the Norwegian Directorate of Health’s database for the control and reimbursement of health expenses, and the Norwegian Quality and Surveillance Registry for Cerebral Palsy, including children born from 1996 to 2012 in the period 2006 to 2018. All daytime contacts were included. International Classification for Primary Care was applied for RFE. Results Cases accounted for 0.46% of all daytime contacts and 0.27% of all daytime consultations, the latter corresponding with the estimated national prevalence of CP. GPs registered more administrative contact and coded pain as an RFE less frequently in consultations with cases (6%) than with controls (12%). Interpretation Children with CP did not consult GPs more than the general paediatric population did. In consultations, GPs should ask for pain even if the child with CP or parent does not address pain. The local multidisciplinary team should encourage the family to consider consulting a GP if the child is in pain. KEY MESSAGES Prevalence of GP consultations in children with CP is similar to that of children in the general population. GPs perform more administrative work for children with CP than for their other paediatric patients. GPs code pain as an RFE less frequently in consultations with children with CP than in consultations with children in the general population.

Environmentally friendly inhalers: issues for the general practice consultation

Wilkinson AJK, Menzies-Gow A, Sawyer M, et al. (2021) S26 An assessment of short-acting β2-agonist (SABA) use and subsequent greenhouse gas (GHG) emissions in five European countries and the consequence of their potential overuse for asthma in the UK. Thorax 76, A19.

Remote Consultations in General Practice - A Systematic Review.

Remote consultations in general practice can be very useful form of telemedicine, which is basically a way to exchange medical information to improve the clinical health of patients when the patient and their general practitioner (GP) are not on the same place at the same time. This concept was developed in the 1980s to provide health care to patients who lived in remote areas. We were interested in researching what kind of remote consultations are available in general practice and what is the usage of these methods. We used four keywords - remote consultation and general practice or family medicine or primary care - and we searched in four different scientific databases: Medline-PubMed, Scopus, Web of Science and IEEX Xplore. We used a PRISMA diagram to identify studies and search the four main databases, we investigated 48 full text articles and when we applied our inclusion and exclusion criteria, 12 studies were included in this systematic review. This systematic review covers the topics of remote consultation versus a traditional or classic physical consultation. Studies have shown its importance prior to the COVID-19 pandemic, and its value while in the mist of the pandemic then caring for infected patients. We have found that remote consultation is necessary, but it must be an improvement on the previous system. Teleconsultations can reduce the number of visits, especially during lockdown situations, with both patients and GPs satisfied with the method, but we should not forget that a physical consultation cannot be fully replaced by a remote consultation due to the limitations of the latter.

BNT162b2 COVID-19 vaccination uptake, safety, effectiveness and waning in children and young people aged 12-17 years in Scotland.

BackgroundThe two-dose BNT162b2 (Pfizer-BioNTech) vaccine has demonstrated high efficacy against COVID-19 disease in clinical trials of children and young people (CYP). Consequently, we investigated the uptake, safety, effectiveness and waning of the protective effect of the BNT162b2 against symptomatic COVID-19 in CYP aged 12–17 years in Scotland.MethodsThe analysis of the vaccine uptake was based on information from the Turas Vaccination Management Tool, inclusive of Mar 1, 2022. Vaccine safety was evaluated using national data on hospital admissions and General Practice (GP) consultations, through a self-controlled case series (SCCS) design, investigating 17 health outcomes of interest. Vaccine effectiveness (VE) against symptomatic COVID-19 disease for Delta and Omicron variants was estimated using a test-negative design (TND) and S-gene status in a prospective cohort study using the Scotland-wide Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) surveillance platform. The waning of the VE following each dose of BNT162b2 was assessed using a matching process followed by conditional logistic regression.FindingsBetween Aug 6, 2021 and Mar 1, 2022, 75.9% of the 112,609 CYP aged 16–17 years received the first and 49.0% the second COVID-19 vaccine dose. Among 237,681 CYP aged 12–15 years, the uptake was 64.5% and 37.2%, respectively. For 12–17-year-olds, BNT162b2 showed an excellent safety record, with no increase in hospital stays following vaccination for any of the 17 investigated health outcomes. In the 16–17-year-old group, VE against symptomatic COVID-19 during the Delta period was 64.2% (95% confidence interval [CI] 59.2–68.5) at 2–5 weeks after the first dose and 95.6% (77.0–99.1) at 2–5 weeks after the second dose. The respective VEs against symptomatic COVID-19 in the Omicron period were 22.8% (95% CI -6.4–44.0) and 65.5% (95% CI 56.0–73.0). In children aged 12–15 years, VE against symptomatic COVID-19 during the Delta period was 65.4% (95% CI 61.5–68.8) at 2–5 weeks after the first dose, with no observed cases at 2–5 weeks after the second dose. The corresponding VE against symptomatic COVID-19 during the Omicron period were 30.2% (95% CI 18.4–40.3) and 81.2% (95% CI 77.7–84.2). The waning of the protective effect against the symptomatic disease began after five weeks post-first and post-second dose.InterpretationDuring the study period, uptake of BNT162b2 in Scotland has covered more than two-thirds of CYP aged 12–17 years with the first dose and about 40% with the second dose. We found no increased likelihood of admission to hospital with a range of health outcomes in the period after vaccination. Vaccination with both doses was associated with a substantial reduction in the risk of COVID-19 symptomatic disease during both the Delta and Omicron periods, but this protection began to wane after five weeks.FundingUK Research and Innovation (Medical Research Council); Research and Innovation Industrial Strategy Challenge Fund; Chief Scientist's Office of the Scottish Government; Health Data Research UK; National Core Studies – Data and Connectivity.

Prenatal and early postnatal exposure to air pollution associations with primary care and prescription usage

BACKGROUND AND AIM: Health consequences of air pollution in early life have been mostly studied in hospital settings, with less focus put on primary care and prescribed medications. The aim of this study was to investigate general practitioner (GP) consultations and prescriptions dispensed following exposure in utero and in the first year of life to the Hazelwood coal mine fire, a severe air pollution episode lasting six weeks. METHODS: The Victorian Perinatal Data Collection was linked to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme for a cohort of children born in the Latrobe Valley, Australia between March 2012 and December 2015. Modelled estimates of fire-related PM2.5 exposure were assigned at the residential address at birth. The total numbers of GP visits and of prescriptions of antibiotics, asthma inhalers and steroid skin creams dispensed in the first year of life or in the year following the fire were extracted for children exposed in utero and in infancy (<1 year old), respectively. Negative binomial regression models estimated associations between each outcome and exposure to fire-related PM2.5, with adjustment made for potential confounders. RESULTS: Higher levels of PM2.5 in utero were associated with increased asthma inhalers dispensed (IRR=1.07, 95%CI=1.00-1.14 per 100µg/m³ of cumulative PM2.5; IRR=1.27, 95%CI=1.01-1.58 per 50µg/m3 of peak 24-h PM2.5) in infancy. Surprisingly, a cumulative exposure >25 µg/m³ in infancy was linked to fewer GP visits (IRR=0.83, 95%CI=0.68-0.99) in the year following the fire. CONCLUSIONS: Our findings indicate that prenatal exposure to time-limited severe air pollution could be linked with increased need of asthma medications in infancy. They also suggest that such exposure in infancy could be associated with less GP consultations following extreme events, which could be due to increased needs of specialised and hospital care. KEYWORDS: Particulate matter; Long-term exposure; Infections; Asthma

Barriers and Facilitators to the Initiation of Injectable Therapies for Type2 Diabetes Mellitus: A Mixed Methods Study.

IntroductionInitiation of injectable therapies in type 2 diabetes (T2D) is often delayed, however the reasons why are not fully understood.MethodsA mixed methods study performed in sequential phases. Phase 1: focus groups with people with T2D (injectable naïve [n = 12] and experienced [n = 5]) and healthcare professionals (HCPs; nurses [n = 5] and general practitioners (GPs) [n = 7]) to understand their perceptions of factors affecting initiation of injectables. Phase 2: video-captured GP consultations (n = 18) with actor-portrayed patient scenarios requiring T2D treatment escalation to observe the initiation in the clinical setting. Phase 3: HCP surveys (n = 87) to explore external validity of the themes identified in a larger sample.ResultsFocus groups identified patients’ barriers to initiation; fear, lack of knowledge and misconceptions about diabetes and treatment aims, concerns regarding lifestyle restrictions and social stigma, and feelings of failure. Facilitators included education, good communication, clinician support and competence. HCP barriers included concerns about weight gain and hypoglycaemia, and limited consultation time. In simulated consultations, GPs performed high-quality consultations and recognised the need for injectable initiation in 9/12 consultations where this was the expert recommended option but did not provide support for initiation themselves. Survey results demonstrated HCPs believe injectable initiation should be performed in primary care, although many practitioners reported inability to do so or difficulty in maintaining skills.ConclusionPeople with T2D have varied concerns and educational needs regarding injectables. GPs recognise the need to initiate injectables but lack practical skills and time to address patient concerns and provide education. Primary care nurses also report difficulties in maintaining these skills. Primary care HCPs initiating injectables require additional training to provide practical demonstrations, patient education and how to identify and address concerns. These skills should be concentrated in the hands of a small number of primary care providers to ensure they can maintain their skills.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13300-022-01306-z.

Association between continuity of primary care and both prescribing and adherence of common cardiovascular medications: a cohort study among patients in England

ObjectivesTo investigate whether better continuity of care is associated with increased prescribing of clinically relevant medication and improved medication adherence.SettingRandom sample of 300 000 patients aged 30+ in 2017 within...

Are children living with obesity more likely to consult their general practitioner for knee pain? Longitudinal analysis of linked primary care and National Child Measurement Programme (NCMP) records.

ObjectivesMore than one in four 11-year-old children in England are living with obesity. The implications for future musculoskeletal health remain unclear. We assessed whether general practitioner consultations for knee pain were more likely among children with obesity, and how this varied by sex, ethnic background, and area-level deprivation. ApproachOf 61,478 11-year-old NCMP participants (2013-19), we linked 60,723 (98.8%) to their primary care records. 58,761 children (50.9% male) had no recorded knee pain consultation (including arthralgia and Osgood-Schlatter’s disease) prior to the NCMP measurement date. We calculated the proportion with a consultation for knee pain by ethnic-adjusted weight status (underweight<2nd; overweight≥91st; obese≥98th centile), sex, ethnic background and Index of Multiple Deprivation quintile. We studied time to first general practitioner consultation for knee pain after the NCMP date by fitting Cox proportional hazards models, estimating mutually-adjusted hazard ratios (aHRs) and 95% confidence intervals (CI) for boys and girls separately. ResultsWe identified 2503 (4.3%) children with at least one consultation for knee pain after the NCMP date. Boys were more likely to consult than girls (mean difference 1.5%; 95% CI: 1.2,1.9). Median time to first knee pain consultation was 1.88 years (IQR: 0.94,2.93). In adjusted analyses, boys with underweight (aHR 0.16; 95% CI: 0.05,0.51), from South Asian ethnic backgrounds (0.80; 0.69,0.92) and living in less deprived areas (Wald test statistic: 11.41; p-value=0.0223) were less likely, and those from Black ethnic backgrounds (1.31; 1.13,1.51) more likely, to consult with knee pain. Girls from South Asian ethnic backgrounds (0.70; 0.59,0.84) and those living in less deprived areas (15.44; p-value=0.0039) were less likely, and those with a BMI considered obese (1.30; 1.10,1.54) more likely to do so. ConclusionAdolescent girls, but not boys, living with obesity are more likely to consult their general practitioner with knee pain. Ethnic differences in knee pain consultations merit further study. Linkage of primary care and NCMP records enables greater understanding of health service utilisation by children by weight status and demographic characteristics.

The potential role of community pharmacy staff in reducing patient delay in consulting with symptoms of rheumatoid arthritis: a qualitative study

BackgroundRheumatoid arthritis (RA) is a chronic inflammatory arthritis which can cause joint damage and reduced quality of life. Early treatment of RA within 3 months of symptom onset is associated with improved clinical outcomes. However, this window of opportunity is often missed. One important contributing factor is patients with symptoms of RA delaying consulting their general practitioner (GP). Previous research indicates that patients with inflammatory arthritis are likely to visit pharmacies for advice before consulting their GP. Therefore, pharmacists are well positioned to identify patients with symptoms of early inflammatory arthritis and signpost them appropriately. This research examines community pharmacy staff’s knowledge, perceptions, and approaches to management of patients presenting with symptoms of RA in order to identify training needs and other opportunities for intervention to enhance the role of pharmacy staff in the pathway to care.MethodsSemi-structured interviews were conducted with 19 community pharmacy staff in the West Midlands (UK), during a 12-month period (2017–2018). The interviews were audio-recorded, transcribed, and analyzed using thematic analysis facilitated by NVivo 12.ResultsThere was considerable variation in knowledge and perceptions of RA and the need for early treatment amongst pharmacists and other pharmacy staff. The potential role of pharmacists and other pharmacy staff in reducing delay in help-seeking was also discussed. Four themes emerged from thematic analysis: (1) Variations in perceptions and knowledge about RA. (2) The role of the pharmacy in increasing public awareness about RA. (3) The role of the pharmacy staff in facilitating access to the GP. (4) Practical considerations for pharmacy-based interventions.ConclusionVariability in knowledge and perceptions of RA amongst pharmacists, and amongst other pharmacy staff will affect effective signposting of suspected RA cases. This study identifies opportunities for enhanced training of community pharmacists and other pharmacy staff in relation to inflammatory arthritis as well as other pharmacy-based interventions, such as public awareness campaigns about RA and other musculoskeletal conditions. Together with existing referral services and other pharmacy-based initiatives this could result in enhanced signposting to GP consultation or other appropriate NHS services for inflammatory symptoms and reduced treatment delay.

Video Consultations in General Practice: Tendencies and Lessons Learned From the First COVID-19 Lockdown Period

Background Video consultation was urgently introduced in general practice in connection with the COVID-19 pandemic, where a rapid implementation ensured patients’ continued access to their general practitioner (GP). With the Danish lockdown in March 2020, the use of video consultations in general practice increased drastically and then declined significantly shortly after as society gradually reopened. Today, only a small proportion of the total number of consultations in general practice is made up of video consultations, and there is great variation in the scope and use of video consultation among GPs and practice staff. Objective The aim of this paper is to present research findings from a qualitative, interdisciplinary project, investigating GP and patient experiences with video consultations during the first lockdown period in 2020, which might help explain the abovementioned tendencies in relation to scope and implementation variances. Methods The data corpus includes data generated through semistructured interviews with 27 patients and 15 GPs, as well as 8 video recordings of video consultations between GP and patient. Results The patients reported positive experiences with consulting their GP through video, valuing increased convenience and spatial flexibility and wishing for future use of video consultation as either a supplement or an alternative to physical consultation. Video consultation furthermore presented a new communicative context in which both patients and GPs enacted distinct forms of technologically facilitated participation. Conclusions To further the best use of video consultation in future general practice, organizational and individual factors such as renumeration, task delegation, time pressure, and professional identity need to be considered.

Applying a genetic risk score for prostate cancer to men with lower urinary tract symptoms in primary care to predict prostate cancer diagnosis: a cohort study in the UK Biobank

BackgroundProstate cancer is highly heritable, with >250 common variants associated in genome-wide association studies. It commonly presents with non-specific lower urinary tract symptoms that are frequently associated with benign conditions.MethodsCohort study using UK Biobank data linked to primary care records. Participants were men with a record showing a general practice consultation for a lower urinary tract symptom. The outcome measure was prostate cancer diagnosis within 2 years of consultation. The predictor was a genetic risk score of 269 genetic variants for prostate cancer.ResultsA genetic risk score (GRS) is associated with prostate cancer in symptomatic men (OR per SD increase = 2.12 [1.86–2.41] P = 3.5e-30). An integrated risk model including age and GRS applied to symptomatic men predicted prostate cancer (AUC 0.768 [0.739–0.796]). Prostate cancer incidence was 8.1% (6.7–9.7) in the highest risk quintile. In the lowest quintile, prostate cancer incidence was <1%.ConclusionsThis study is the first to apply GRS in primary care to improve the triage of symptomatic patients. Men with the lowest genetic risk of developing prostate cancer could safely avoid invasive investigation, whilst those identified with the greatest risk could be fast-tracked for further investigation. These results show that a GRS has potential application to improve the diagnostic pathway of symptomatic patients in primary care.

GPs' perceptions of teaching methods in shared decision-making training: a qualitative study.

Although shared decision making (SDM) is key to delivering patient-centred care, there are barriers to GPs implementing SDM in practice. SDM training is undergoing development by organisations, including the Royal College of General Practitioners. However, GPs' perceptions of the delivery of SDM training in general practice remain largely unexplored. To explore GPs' perceptions of teaching methods in SDM training. Qualitative study of GPs with teaching roles at the University of Exeter Medical School. Purposive sampling recruited 14 GPs. Semi-structured interviews explored their SDM educational experiences. Data were analysed using thematic framework analysis. Three themes were identified. The GPs described role-play, receiving feedback, and on-the-job learning as modes of delivering SDM training that mostly informed their SDM in clinical practice positively. Learning from knowledgeable individuals and using realistic patient cases were perceived as beneficial components of SDM learning, although most learning occurred implicitly through reflections on their clinical experiences. The GPs identified that their training on SDM should reflect the uncertainty that is present when sharing decisions with patients in real-life general practice consultations. GPs also identified the targeting of individual GPs' SDM learning needs and explanation of the potential benefits of SDM on consultation outcomes as important methods to facilitate the implementation of SDM in practice. To the authors' knowledge, this is the first UK study to explore GPs' perceptions of SDM training and provide recommendations for practice. As SDM occurs in partnership with patients, further research should obtain and incorporate patients' views alongside those of GPs in the evaluation of future programmes.

Characterization of Patients with Chronic Obstructive Pulmonary Disease Initiating Single-Inhaler Long-Acting Muscarinic Antagonist/Long-Acting β2-Agonist Dual Therapy in a Primary Care Setting in England.

PurposeTreatment pathways of patients with chronic obstructive pulmonary disease (COPD) receiving single-inhaler dual therapies remain unclear. We aimed to describe characteristics, prescribed treatments, healthcare resource use (HCRU) and costs of patients with COPD who initiated single-inhaler long-acting muscarinic antagonist/long-acting β2-agonist (LAMA/LABA) dual therapy in primary care in England.Patients and MethodsRetrospective study using linked data from Clinical Practice Research Datalink Aurum and Hospital Episode Statistics datasets. Patients with COPD with ≥1 single-inhaler LAMA/LABA prescription between June 2015 and December 2018 (index) were included. Demographic and clinical characteristics, prescribed treatments, HCRU and costs were evaluated in the 12 months pre-index. Data are presented for patients not receiving concomitant inhaled corticosteroids at index (non-triple users).ResultsOf 10,991 patients initiating LAMA/LABA, 9888 were non-triple users, of whom 21.3% (n=2109) received aclidinium bromide/formoterol, 18.1% (n=1785) received indacaterol/glycopyrronium, 12.0% (n=1189) received tiotropium bromide/olodaterol and 48.6% (n=4805) received umeclidinium/vilanterol. Demographic and clinical characteristics were similar across indexed therapies. LAMA monotherapy was the most frequently prescribed respiratory therapy at 12 (18.4–25.8% of patients) and 3 months (23.9–33.7% of patients) pre-index across indexed therapies; 42.5–59.0% of patients were prescribed no respiratory therapy at these time points. COPD-related HCRU during the 12 months pre-index was similar across indexed therapies (general practitioner consultations: 62.0–68.6% patients; inpatient stays: 19.3–26.1% patients). Pre-index COPD-related costs were similar across indexed therapies, with inpatient stays representing the highest contribution. Mean total direct annual COPD-related costs ranged from £805–£1187.ConclusionCharacteristics of patients newly initiating single-inhaler LAMA/LABA dual therapy were highly consistent across indexed therapies. As half of non-triple users were not receiving respiratory therapy one year prior to LAMA/LABA initiation, there may be an opportunity for early optimization of treatment to relieve clinical burden versus current prescribing patterns in primary care in England.

Cost impact of undertaking detection and management of familial hypercholesterolaemia in Australian general practice.

Familial hypercholesterolaemia (FH) can be effectively detected and managed in primary care, but the health economic evidence for this is scarce. The aim of this study was to examine management pathways and cost implications of FH screening and management in Australian general practice. Cost-effectiveness outcomes were projected using a lifetable model. Data was used from 133 patients in 15Australian general practice clinics from an earlier screening and management study. Costing and mortality data were sourced from governmental sources and published literature. Most patients had a regular general practice consultation at baseline (82%), though the proportion seen under a chronic disease management item at follow-up increased to 23%. The median cost of management was $275 perannum in the first year of management. Managing patients with statins up to the age of 60 years yielded an increase of 248,954 life-years at a cost of $759 million, representing a cost per life-year gained of $3047. Screening and management of FH in general practice has the potential for substantial health benefits while requiring relatively modest investments from the health system.

Long COVID: which symptoms can be attributed to SARS-CoV-2 infection?

Long COVID: which symptoms can be attributed to SARS-CoV-2 infection?

FluTracking: Weekly online community based surveillance of influenza-like illness in Australia, 2018 Annual Report.

FluTracking experienced major growth in 2018, with participation numbers increasing 34.1% from 2017. The addition of 16,881 new participants brought the total number of participants for 2018 to 45,532. A majority of participants continued to complete their survey within 24 hours of the email being sent (mean 74.3% responses received in 24 hours). The rate of influenza-like illness (ILI) in 2018 was the lowest since FluTracking commenced in 2007 and was consistently low across all ages. The peak weekly ILI rate was consistent with previous years, occurring during the week ending 19 August. This preceded the peak in laboratory-confirmed influenza notifications by three weeks. During the peak week of FluTracking, 2.1% of unvaccinated, and 1.9% of vaccinated participants reported fever and cough. By the final survey of 2018, 65.6% of participants had received the annual influenza vaccine, compared with 60.2% in 2017. Vaccination rates in participants under five years of age doubled from 23.7% in 2017, to 55.6% in 2018. During the peak four weeks of reported ILI, a lower percentage of participants sought medical care in 2018 compared to 2017 (36.7% and 42.3% respectively), and fewer participants reported a positive laboratory test for influenza (0.8% and 4.8%). Overall the severity of the 2018 season was one of the lowest FluTracking has recorded. Rates of both influenza laboratory notifications and general practitioner (GP) ILI consultations were lower in 2018 than most prior years. We found a reduction in the percentage of FluTracking participants with ILI who were tested for influenza (3.2% compared with 5.0% in 2017), and who visited a medical practitioner (36.7% compared with 42.3% in 2017). The drop in laboratory-confirmed cases and Australian Sentinel Practices Research Network (ASPREN) reported GP consultations concurs with our survey results that 2018 was a milder influenza season than many previous.

Can cases and outbreaks of norovirus in children provide an early warning of seasonal norovirus infection: an analysis of nine seasons of surveillance data in England UK

BackgroundChildren are important transmitters of norovirus infection and there is evidence that laboratory reports in children increase earlier in the norovirus season than in adults. This raises the question as to whether cases and outbreaks in children could provide an early warning of seasonal norovirus before cases start increasing in older, more vulnerable age groups.MethodsThis study uses weekly national surveillance data on reported outbreaks within schools, care homes and hospitals, general practice (GP) consultations for infectious intestinal disease (IID), telehealth calls for diarrhoea and/or vomiting and laboratory norovirus reports from across England, UK for nine norovirus seasons (2010/11–2018/19). Lagged correlation analysis was undertaken to identify lead or lag times between cases in children and those in adults for each surveillance dataset. A partial correlation analysis explored whether school outbreaks provided a lead time ahead of other surveillance indicators, controlling for breaks in the data due to school holidays. A breakpoint analysis was used to identify which surveillance indicator and age group provided the earliest warning of the norovirus season each year.ResultsSchool outbreaks occurred 3-weeks before care home and hospital outbreaks, norovirus laboratory reports and NHS 111 calls for diarrhoea, and provided a 2-week lead time ahead of NHS 111 calls for vomiting. Children provided a lead time ahead of adults for norovirus laboratory reports (+ 1–2 weeks), NHS 111 calls for vomiting (+ 1 week) and NHS 111 calls for diarrhoea (+ 1 week) but occurred concurrently with adults for GP consultations. Breakpoint analysis revealed an earlier seasonal increase in cases among children compared to adults for laboratory, GP and NHS 111 data, with school outbreaks increasing earlier than other surveillance indicators in five out of nine surveillance years.ConclusionThese findings suggest that monitoring cases and outbreaks of norovirus in children could provide an early warning of seasonal norovirus infection. However, both school outbreak data and syndromic surveillance data are not norovirus specific and will also capture other causes of IID. The use of school outbreak data as an early warning indicator may be improved by enhancing sampling in community outbreaks to confirm the causative organism.