Network Of General Practitioners Research Articles

Evolution of Lyme Borreliosis Epidemiology in Primary Care and Hospital Settings in France During the COVID-19 Pandemic.

Background: Lyme borreliosis (LB) remains a public health concern in France despite improved patient management and medical care. Stay-at-home restrictions during the COVID-19 pandemic, which affected participation in outdoor recreational activities and disrupted access to health care services, may have impacted the risk of developing LB. Methods: We analyzed data from two general practitioner networks in France (Sentinel Network and an electronic medical records database [EMR]) and the national hospital discharge database to describe LB epidemiology in 2020-2021 and compare it to previous years. Google Trends' search volume was used to evaluate the association between the population's interest in LB and the evolving epidemiology. Results: Annual LB incidence rates in primary care decreased from 104 cases/100,000 population in 2018 to 71/100,000 in 2021 and from 82/100,000 to 60/100,000 according to Sentinel Network and EMR, respectively. Google Trends' search volume for "Lyme" followed a similar trend, one year earlier. Annual hospitalizations were stable from 2012-2019 (1.6/100,000 on average) and declined to 1.3/100,000 in 2020 and 1.1/100,000 in 2021. This decline was observed primarily in adults (e.g., 3.4/100,000 in 2017-2019 to 1.8/100,000 in 2020-2021 for 70-79 years of age). Changes in regional incidence rates in primary care from 2017-2019 to 2020-2021 ranged from -75% to 208%. Hospitalizations decreased in all regions except in Bretagne. Conclusions: The estimated LB incidence decreased in 2020 and 2021 compared with previous years but this change may not be related to COVID-19. The incidence decrease observed in primary care could result from reduced population interest in LB, leading to lower care-seeking behavior. The decrease in LB hospitalizations may be explained by changes in clinical practice. Surveillance systems are critical to understand the evolution of LB epidemiology. However, external factors impacting incidence estimates should be considered.

General practitioners’ perspectives on relocating care: a Dutch interview study

BackgroundHealthcare systems around the world are facing significant challenges because higher costs and an increase in demand for care has not been matched by a corresponding growth in the health workforce. Without reform, healthcare systems are unsustainable. Relocating care, such as from hospitals to general practices, is expected to make a key contribution to ensuring healthcare remains sustainable. Relocating care has a significant impact upon general practitioners (GPs). Therefore, we investigated which care, according to GPs, could be relocated and under which conditions.MethodGPs were recruited through Nivel’s GPs network on eHealth and innovation, located in the Netherlands. One exploratory focus group and 12 in-depth interviews were conducted. Interview transcripts were analyzed using the qualitative research principles of thematic analysis.ResultsAccording to the participants, some diagnostic and follow-up care could be relocated from hospitals to GPs once certain prerequisites are fulfilled. An important condition of relocating care from the hospital to the GP is that GPs have sufficient time to take over these tasks. The types of care that can be relocated from the GP to other settings are those questions where the medical knowledge of the GP can offer nothing extra or where problems in navigating the health system cause patients to either turn to, or stay with, their GP.ConclusionCare should first be relocated from the GP to other settings before attempting to organize the relocation of care from the hospital to the GP. When this, and other conditions are met, some diagnostic and follow-up care can be relocated from the hospital to the GP.

Trends in low-value GP care during the COVID-19 pandemic: a retrospective cohort study

BackgroundSeveral studies showed that during the pandemic patients have refrained from visiting their general practitioner (GP). This resulted in medical care being delayed, postponed or completely forgone. The provision of low-value care, i.e. care which offers no net benefit for the patient, also could have been affected. We therefore assessed the impact of the COVID-19 restrictions on three types of low-value GP care: 1) imaging for back or knee problems, 2) antibiotics for otitis media acuta (OMA), and 3) repeated opioid prescriptions, without a prior GP visit.MethodsWe performed a retrospective cohort study using registration data from GPs part of an academic GP network over the period 2017–2022. The COVID-19 period was defined as the period between April 2020 to December 2021. The periods before (January 2017 to April 2020) and after the COVID-19 period (January 2022 to December 2022) are the pre- and post-restrictions periods. The three clinical practices examined were selected by two practicing GPs from a top 30 of recommendations originating from the Dutch GP guidelines, based on their perceived prevalence and relevance in practice (van Dulmen et al., BMC Primary Care 23:141, 2022). Multilevel Poisson regression models were built to examine changes in the incidence rates (IR) of both registered episodes and episodes receiving low-value treatment.ResultsDuring the COVID-19 restrictions period, the IRs of episodes of all three types of GP care decreased significantly. The IR of episodes of back or knee pain decreased by 12%, OMA episodes by 54% and opioid prescription rate by 13%. Only the IR of OMA episodes remained significantly lower (22%) during the post-restrictions period. The provision of low-value care also changed. The IR of imaging for back or knee pain and low-value prescription of antibiotics for OMA both decreased significantly during the COVID-restrictions period (by 21% and 78%), but only the low-value prescription rate of antibiotics for OMA remained significantly lower (by 63%) during the post-restrictions period. The IR of inappropriately repeated opioid prescriptions remained unchanged over all three periods.ConclusionsThis study shows that both the rate of episodes as well as the rate at which low-value care was provided have generally been affected by the COVID-19 restrictions. Furthermore, it shows that the magnitude of the impact of the restrictions varies depending on the type of low-value care.This indicates that deimplementation of low-value care requires tailored (multiple) interventions and may not be achieved through a single disruption or intervention alone.

Clinician- and Patient-Identified Solutions to Reduce the Fragmentation of Post-ICU Care in Australia

BackgroundCritical care survivors experience multiple care transitions, with no formal follow-up care pathway. Research QuestionWhat are the potential solutions to improve the communication between treating teams and integration of care following an Intensive Care Unit (ICU) admission – from the perspective of patients, their caregivers, intensivists, and General Practitioners (GPs) from diverse socioeconomic areas? Study Design& Methods: Qualitative design using semi-structured interviews with intensivists, GPs, and patients and caregivers. Framework Analysis was used to analyse data, and to identify solutions to improve the integration of care post-hospital discharge. Patients were previously mechanically ventilated for >24 hours in ICU and had access to a video-enabled device. Clinicians were recruited from hospital networks and a state-wide GP network. ResultsForty-six interviews with clinicians, patients and caregivers were completed (15 Intensivists, 8 GPs, 15 patients and 8 caregivers). Three higher-level feedback loops were identified, that comprised of ten themes. Feedback loop 1: ICU and primary care collaboration: 1. Developing collaborative relationships between the ICU and primary care, 2. Providing interprofessional education and resources to support primary care, 3. Improving role clarity for patient follow-up care; Feedback loop 2: Developing mechanisms for improved communication across the care continuum: 4. Timely, concise information sharing with primary care on post-ICU recovery, 5. Survivorship focused information sharing across the continuum of care, 6. Empowering patients and caregivers in self-management; 7. Creation of a care coordinator role for survivors; and Feedback loop 3: Learning from post-ICU outcomes to improve future care: 8. Developing comprehensive post-ICU care pathways, 9. Enhancing support for patients after hospital, 10. Integration of post-ICU outcomes within the ICU to improve clinician morale and understanding. InterpretationPractical solutions to enhance the quality of survivorship for critical care survivors and their caregivers were identified. These themes are mapped to a novel conceptual model that includes key feedback loops for health system improvements and foci for future interventional trials to improve ICU survivorship outcomes.

Inherent Attitudes or Misplaced Policies? Explaining COVID-19 Vaccine Hesitancy in Romania

hesitancy toward COVID-19 vaccines was not particularly high in Romania at the beginning of the vaccination campaign. Nevertheless, the country became one of the laggards in the European Union in terms of vaccination rates. We aim to provide an empirical explanation for this phenomenon based on a representative survey conducted in November–December 2021. We test the influence of various factors on vaccine hesitancy, such as personal experiences with the disease, trust in relevant institutions, general worldviews, and the contact with certain institutions, such as the Romanian Orthodox Church, and general practitioners. Furthermore, we find that three COVID-specific cognitive factors played a crucial role in this respect, namely the evaluation of anti-COVID state measures, belief in COVID-related conspiracy theories, and, especially, fears of negative effects of COVID-19 vaccines. The high explanatory power of these three factors also shows that low vaccination rates were not inevitable consequences of some “inherent” attitudinal characteristics widespread in the Romanian society; on the contrary, vaccine hesitancy has developed as an unfortunate side effect of weak crisis management, as the government and relevant state institutions failed to properly utilize key organizational resources, such as the national network of general practitioners, and proved to be unable to dissipate fears and countervail the spread of conspiracy theories, while emergency measures did not resonate enough among the Romanian public.

Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting.

Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control.

High prevalence of burnout syndrome in Czech general practitioners: A cross-sectional survey

ObjectiveA wide range in prevalence rates of burnout among general practitioners (GPs) has been reported in various regions, with an increasing trend. This nationwide cross-sectional study aimed to estimate the prevalence and associated determinants of burnout in Czech GPs. Methods1000 randomly selected physicians from the Czech Society of General Practitioners (through a pseudorandom number generator) were emailed an online survey based on the Maslach Burnout Inventory – Human Services Survey. Data collection was performed between January and February 2023. Results331 questionnaires were obtained (227 females and 104 males, mean age – 49.9 years, the mean number of registered patients – 1951). 21.8 % of GPs scored a high level of burnout in all three of its dimensions and 23.9 % in no dimension at all. The most prevalent dimension was reduced personal accomplishment (PA, 56.2 %) followed by emotional exhaustion (EE, 50.2 %) and depersonalization (DP, 40.5 %). Reaching burnout in all three dimensions was significantly more frequent in males and in GPs registering a number of patients above the median. Increasing age and years of practice were protective factors for DP but risk factors for reduced PA. Employed GPs had lower EE scores than GP practice owners. The respondents' basic characteristics reflected their presence among Czech GPs, which testifies against selection bias. ConclusionsThe high rate of burnout (∼22 %) should be addressed by promoting personal resources along with the perception of the importance of GPs in society. A sufficiently dense network of GPs should allow them to register a lower number of patients.

Heavy menstrual bleeding in adolescents: incidence, diagnostics, and management practices in primary care

BackgroundHeavy menstrual bleeding (HMB), self-reported by 37% of adolescents, can be the first sign of a bleeding disorder (BD) during adolescence. The Dutch general practitioner (GP) guideline demands laboratory diagnostics and referral for patients at risk for a BD. How often adolescents consult the GP for HMB and which diagnostic and management strategies are used are unknown. ObjectivesThis study aims to estimate the incidence of HMB in adolescents in primary care and to identify diagnostic and management practices for HMB, considering the HMB GP guideline. MethodsRetrospective analyses of a GP network database containing over 200 Dutch GPs were performed. Adolescents aged 10 to 21 years, with a new diagnosis of HMB between 2010 and 2020, and a 6-month follow-up were eligible. The incidence rate and diagnostic and therapeutic strategy data were extracted. ResultsWe identified 1879 new diagnoses of HMB in adolescents. The average incidence rate was 7.91 per 1000 person-years. No diagnostic studies were performed in 67%. Laboratory studies were mainly restricted to hemoglobin levels (31%). Full coagulation screening occurred in 1.3%, and ferritin levels in 10%. Medication was prescribed in 65%; mostly hormonal treatment (56%) and/or nonsteroidal antiinflammatory drugs (NSAIDs) (18%). The referral rate was higher after >2 follow-up visits (6.7%) vs after 1 GP visit for HMB (1.6%; Odds ratio: 8.8; 95% CI: 5.1-15), mostly to gynecologists (>85%). ConclusionAccording to this GP database study, few adolescents visit their GP with HMB despite its high self-reported incidence. Most adolescents were prescribed hormonal contraception without further diagnostics. Referral was rare and mostly occurred after multiple follow-up visits.

Increase in incidence of anorexia nervosa among 10- to 14-year-old girls: A nationwide study in the Netherlands over four decades.

This primary care study examined time trends in the incidence of anorexia nervosa (AN) and bulimia nervosa (BN) in the Netherlands across four decades. A nationwide network of general practitioners, serving approximately 1% of the total Dutch population, recorded newly diagnosed patients with AN and BN in their practices from 1985 to 2019 (2,890,978 person-years). DSM-IV diagnostic criteria were consistently used and the same psychiatrist was responsible for the final diagnostic decision. Incidence rates (IRs) were calculated for: the total population (all ages), females overall, and females per 5-year age category. Time trends in IRs were analyzed using JoinPoint regression analyses. In four decades, the incidence of AN among 10- to 14-year-old females increased significantly from 8.6 to 38.6 per 100,000 person-years (average period percentage change [APPC] = 56.7; 95% confidence interval [CI] = 6.5-130.6. The overall incidence of AN was stable, with IRs ranging from 6.0 (95% CI = 4.3-8.1) to 8.4 (95% CI = 6.4-10.8). The IR of BN decreased significantly from 8.7 (95% CI = 6.7-11.0) to 3.2 (95% CI = 2.0-4.9) in the 2000s, before leveling off in the 2010s (IR 3.2; 95% CI = 2.0-4.8). The incidence of AN among 10- to 14-year-old girls increased significantly over four decades. Both biological and sociocultural factors, for example, early pubertal timing and the impact of social media, might explain this. In other age groups and overall, the incidence of AN remained stable. The significant decrease of the incidence of BN in the previous decades halted in the last decade. An important finding of the present study is that for 10- to 14-year-old girls, the risk for developing anorexia nervosa has increased significantly over 40 years. More healthcare facilities for younger people are needed, and prevention programs could include social media use. For bulimia nervosa, the general decrease in the occurrence of new cases has halted in the 2010s.

S11-5 Recruitment of physically inactive adults to participate in the standardized program Jackpot.fit. Which strategies within the health system work?

Abstract Purpose The Jackpot.fit program was developed by the Austrian health insurance funds and the organized sport with the aim of offering a standardized training for physically inactive adults. The first semester is free of charge. The original idea was that health insurance companies would use different strategies to recruit participants and that organized sports would offer the standardized program in local sports clubs. In this context, we wanted to investigate which recruitment strategies work well. Methods In one region of the province of Styria (Austria), we wanted to offer a dense network of Jackpot.fit classes, as the sports program was to take place close to home. Adults who signed up for Jackpot.fit received an online questionnaire. One question asked: “How did you find out about Jackpot.fit?” Ten answers were available for selection, with multiple responses possible. Responses could be categorized into four areas: Information from the health care system, from the community, from the sports clubs, and from friends/acquaintances. The questionnaire was sent to 394 persons and 133 (34%) completed it (mean age 56 ± 9 years, 73% women). Results One health insurance company sent letters to its insured, which was the most successful strategy (mentioned by 33 participants = approximately 25%). The second best strategy is word of mouth through friends/acquaintances (28 participants). Other good recruitment strategies are the community newspaper (23 participants), and activities of the sports club trainer (19 participants). 437 general practitioners working within a 10 km radius of a Jackpot.fit course were informed in writing about Jackpot.fit and were asked to inform their inactive patients participating in Jackpot.fit. However, of the 133 participants, only 3 indicated that their primary care physician informed them about the program. Conclusion Health insurance companies can successfully recruit physically inactive adults with a letter to a standardized sports club program near their home. Community information channels and word of mouth have also been successful. Although the network of general practitioners working in the region is dense, written information about the program was not a successful recruitment strategy. Therefore, different recruitment approaches by different actors seem to work best.

Parental Objective, Subjective, and Contextual Socioeconomic Status and Children's Mental Health in Iran: The Mediating Effect of the Subjective Measure

Background: Children from lower socioeconomic status (SES) households are at greater risk for mental illnesses. Socioeconomic status has different dimensions: Objective SES, subjective SES, and contextual SES. Evidence suggests that subjective SES partially mediates the impact of objective SES on mental health. However, these hypotheses have not been tested in Middle Eastern cultures, including Iran. Objectives: We aimed to investigate: (1) if there is an association between parental objective, subjective, and contextual SES measures and their children's mental health in a network of general practitioners' clients, (2) if such an association exists for objective or contextual indicators, is it partially or fully mediated through subjective measure? and (3) if such an association exists, is it affected by children's age? Methods: We assessed 1,103 parent-child pairs in the general practitioners' network of clients. The child's mental health was assessed by the Strengths and Difficulties Questionnaire (SDQ) and parental objective SES by education level, subjective SES by the MacArthur scale, and contextual SES by the household neighborhood. Linear regression models were used to investigate the impact of different SES measures on the SDQ score both bivariately and adjusted for each other. A mediation analysis was performed for objective SES' indirect effect on SDQ score through subjective SES. Results: We found a significant association between objective and subjective SES and the SDQ score, which remained significant after adjusting for each other. Both objective and subjective measures had a small effect size (Cohen's f-squared = 0.03). There was no association between contextual SES and SDQ scores in our sample. Conclusions: Socioeconomic status impacts children and adolescents' mental health. However, SES is a multi-dimensional concept. Further research considering different dimensions is needed to understand the interplay of these dimensions in different cultures and contexts. Addressing such exploratory questions may help pave the way for detecting and addressing these social determinants in primary care settings.

Epidemiology of Lyme Borreliosis in France in Primary Care and Hospital Settings, 2010-2019.

Introduction: Lyme borreliosis (LB) is a growing public health concern requiring accurate and comprehensive epidemiological knowledge to inform health care interventions. This study compared the epidemiology of LB in primary care and hospital settings, using for the first time in France three sources of data, and highlighted specific populations at higher risk of developing LB. Methods: This study analyzed data from general practitioner networks (i.e., Sentinel network, Electronic Medical Records [EMR]) and the national hospital discharge database to describe the LB epidemiology from 2010 to 2019. Results: The average annual incidence rates of LB in primary care increased from 42.3 cases/100,000 population in 2010-2012 to 83.0/100,000 in 2017-2019 for the Sentinel Network and 42.7/100,000 to 74.6/100,000 for the EMR, following a marked rise in 2016. The annual hospitalization rate remained stable from 2012 to 2019 fluctuating between 1.6 and 1.8 hospitalizations/100,000. Women were more likely to present with LB in primary care setting compared with men (male-to-female incidence rate ratio [IRR] = 0.92), whereas men were predominant among hospitalizations (IRR = 1.4), with the largest discordance among adolescents aged 10-14 years (IRR = 1.8) and adults aged 80 years and older (IRR = 2.5). In 2017-2019, the average annual incidence rate peaked among persons aged 60-69 years in primary care (>125/100,000) and aged 70-79 years among hospitalized patients (3.4/100,000). A second peak occurred in children aged 0-4 or 5-9 years depending on sources. Incidence rates in Limousin and the north-eastern regions were the highest for both primary care and hospital settings. Conclusions: Analyses showed disparities in the evolution of incidence, sex-specific incidence rates, and predominant age groups between primary care and hospital settings that merit further exploration.

Integrated surveillance of human respiratory viruses in addition to SARS-CoV-2 in a public testing facility in the Netherlands

SARS-CoV-2 prevention measures impact the circulation of other respiratory viruses. Surveillance in the network of general practitioners is hampered by widespread testing for SARS-CoV-2 in public testing facilities. To evaluate integrated community surveillance of SARS-CoV-2 and other respiratory viruses and describe epidemiological trends. Respiratory surveillance was set up within an existing SARS-CoV-2 public testing facility. Community-dwelling (a)symptomatic persons provided consent for completion of a questionnaire and additional testing on residual material from swabs taken for SARS-CoV-2 RT-PCR (Allplex Seegene). Daily, a random subset was tested for sixteen respiratory viruses by multiplex realtime PCRs (Seegene). Between October 6th (week 40) 2021 and April 22nd (week 16) 2022, 3,969 subjects were tested. The weekly median age ranged from 23 to 39 years. The prevalence of respiratory symptoms ranged from 98.5% (week 40) to 27.4% (week 1). The prevalence of detection of any respiratory virus (including SARS-CoV-2), ranged from 19.6% in week 49 to 75.3% in week 14. SARS-CoV-2 prevalence ranged from 2.2% (week 40) to 63.3% (week 14). Overall, SARS-CoV-2 was detected most frequently (27.3%), followed by rhinoviruses (14.6%, range 3.5-47.8%) and seasonal coronaviruses (3.7%, range 0-10.4%, mostly 229E and OC43). Influenzavirus was detected in 3.0% of participants from week 6 onwards. Integrated respiratory viral surveillance within public testing facilities is feasible and informative. Prevalences may be affected by changes in SARS-CoV-2 prevention and testing policies. Population characteristics help to interpret trends over time. Integrated surveillance may inform policymakers and hospitals for adequate response measures during respiratory seasons.

Agreement of and discussion with clients about Undetectable equals Untransmissible among general practitioners in Australia: a cross-sectional survey.

The message of undetectable HIV viral load equals untransmissible (U=U) is important to reduce HIV stigma. We examined Australian general practitioner (GP)s' agreement of and discussion with clients about U=U. We conducted an online survey through GP networks from April to October 2022. All GPs working within Australia were eligible. Univariable and multivariable logistic regression analyses were performed to identify factors associated with: (1) agreement of U=U; and (2) discussing U=U with clients. Of 703 surveys, 407 were included in the final analysis. Mean age was 39.7years (s.d.: 8.4). Most GPs (74.2%, n =302) agreed with U=U, but only 33.9% (n =138) had ever discussed U=U with clients. Key barriers to discussing U=U were lack of relevant client presentations (48.7%), lack of understanding about U=U (39.9%), and difficulty identifying those who would benefit from U=U (6.6%). Agreement with U=U was associated with greater odds of discussing U=U (adjusted odds ratio (AOR) 4.75, 95% confidence interval (CI): 2.33-9.68), younger age (AOR 0.96 per additional year of age, 95%CI: 0.94-0.99), and extra training in sexual health (AOR 1.96, 95%CI: 1.11-3.45). Discussing U=U was associated with younger age (AOR 0.97, 95%CI: 0.94-1.00), extra training with sexual health (AOR 1.93, 95%CI: 1.17-3.17), and negatively associated with working in a metropolitan or suburban area (AOR 0.45, 95%CI: 0.24-0.86). Most GPs agreed with U=U, but most had not discussed U=U with their clients. Concerningly, one in four GPs were neutral or disagreed with U=U, suggesting that further qualitative research to understand this finding, and implementation research to promote U=U among Australian GPs, is urgently needed.

BT01: Results of a pilot optional e‐triage teledermatology advice and guidance pathway for equivocal lesions as an alternative to 2‐week wait referrals in two large general practitioner networks in a city

BT01: Results of a pilot optional e‐triage teledermatology advice and guidance pathway for equivocal lesions as an alternative to 2‐week wait referrals in two large general practitioner networks in a city

Pertussis surveillance results from a French general practitioner network, France, 2017 to 2020.

IntroductionIn France, three complementary surveillance networks involving hospitals and paediatrician practices currently allow pertussis surveillance among infants (<1 year old) and children (1–12 years old). Data on incidences among adolescents (13–17 years old) and adults (≥ 18 years) are scarce. In 2017, a sentinel surveillance system called Sentinelles network, was implemented among general practitioners (GPs).AimThe purpose of Sentinelles network is to assess pertussis incidence, monitor the cases’ age distribution and evaluate the impact of the country’s vaccination policy. We present the results from the first 4 years of this surveillance.MethodsGPs of the French Sentinelles network reported weekly numbers of epidemiologically or laboratory-confirmed cases and their characteristics.ResultsA total of 132 cases were reported over 2017–2020. Estimated national incidence rates per 100,000 inhabitants were 17 (95% confidence interval (CI): 12–22) in 2017, 10 (95% CI: 6–14) in 2018, 15 (95% CI: 10–20) in 2019 and three (95% CI: 1–5) in 2020. The incidence rate was significantly lower in 2020 than in 2017–2019. Women were significantly more affected than men (83/132; 63% of women, p = 0.004); 66% (87/132) of cases were aged 15 years or over (median age: 31.5 years; range: 2 months–87 years). Among 37 vaccinated cases with data, 33 had received the recommended number of doses for their age.ConclusionsThese results concur with incidences reported in other European countries, and with studies showing that the incidences of several respiratory diseases decreased in 2020 during the COVID-19 pandemic. The results also suggest a shift of morbidity towards older age groups, and a rapid waning of immunity after vaccination, justifying to continue this surveillance.

Syndromic surveillance: A key component of population health monitoring during the first wave of the COVID-19 outbreak in France, February-June 2020.

The French syndromic surveillance (SyS) system, SurSaUD®, was one of the systems used to monitor the COVID-19 outbreak. This study described the epidemiological characteristics of COVID-19-related visits to both emergency departments (EDs) and the network of emergency general practitioners known as SOS Médecins (SOSMed) in France from 17 February to 28 June 2020. Data on all visits to 634 EDs and 60 SOSMed associations were collected daily. COVID-19-related visits were identified using ICD-10 codes after coding recommendations were sent to all ED and SOSMed doctors. The time course of COVID-19-related visits was described by age group and region. During the lockdown period, the characteristics of ED and SOSMed visits and hospitalisations after visits were described by age group and gender. The most frequent diagnoses associated with COVID-19-related visits were analysed. COVID-19 SyS was implemented on 29 February and 4 March for EDs and SOSMed, respectively. A total of 170,113 ED and 59,087 SOSMed visits relating to COVID-19 were recorded, representing 4.0% and 5.6% of the overall coded activity with a peak in late March representing 22.5% and 25% of all ED and SOSMed visits, respectively. COVID-19-related visits were most frequently reported for women and those aged 15-64 years, although patients who were subsequently hospitalised were more often men and persons aged 65 years and older. SyS allowed for population health monitoring of the COVID-19 epidemic in France. As SyS has more than 15 years of historical data with high quality and reliability, it was considered sufficiently robust to contribute to defining the post-lockdown strategy.

From Screening to Therapy: Anti-HCV Screening and Linkage to Care in a Network of General Practitioners and a Private Gastroenterology Practice

(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.

What Is the Willingness to Receive Vaccination Against COVID-19 Among the Elderly in Italy? Data From the PASSI d'Argento Surveillance System

Introduction: Italy was one of the earliest countries to experience a severe COVID-19 epidemic and vaccinating the elderly, who constitute 23% of the population and have experienced the highest mortality rates, is a top priority. Estimating prevalences and understanding risk factors for COVID-19 vaccine hesitancy or refusal are important for development of targeted interventions.Methods: We used data from a specially developed COVID-19 module of PASSI D'Argento, an ongoing surveillance system of residents 65+ years of age to measure the prevalence and identify risk factors for hesitancy and refusal to receive the COVID-19 vaccine. We calculated multinomial regression relative risk ratios to examine the association between demographic characteristics, health status, COVID-19 attitudes and experiences and likely vaccine hesitancy and refusal.Results: Of the 1876 respondents, 55% reported they would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, we identified several risk factors in common between the hesitancy group and the refusal group, including not having received vaccination against influenza during the previous flu season (hesitancy: RRR = 2.0; 95% CI 1.4–2.9; refusal: RRR = 12.1; 95%CI 7.6–19.4) and lower risk of having had a death from COVID-19 among family or friends (hesitancy: RRR = 4.8; 95%CI 2.0–11.4; refusal: RRR = 15.4; 95%CI 3.7–64.5). The hesitancy group was significantly more likely being worried and they did not know if consequences of the disease would be serious for them.Conclusion: Our findings show the importance of establishing and maintaining active contact between the preventive services, primary care providers and the population because trust is difficult to establish during an emergency like the COVID-19 pandemic. Italian public health is based on a capillary network of general practitioners and having them reach out to their patients who have not previously received influenza vaccine may be a useful strategy for targeting efforts to further encourage uptake of COVID-19 vaccination.

Changes in the profile and therapeutic care of people who use drugs with HCV mono-infection: a retrospective study between 2015 and 2019 from a monocentric tertiary referent center in France.

People who use drugs (PWUDs) are the main group at risk for hepatitis C virus (HCV) transmission and a key population for hepatitis C elimination. Multidisciplinary team (MDT) meetings were set up in France in December 2014 within regional reference centers to supervise the prescriptions and delivery of direct-acting antivirals (DAAs) to optimize the management of HCV infection. The aim of this retrospective study was to analyze the changes in the profile and therapeutic care of PWUDs with HCV mono-infection according to the evolution of MDT meetings in a regional tertiary reference center. Between 2015 and 2019, overall 1912 HCV-infected patients presented at the MDT meetings, 547 were PWUDs with HCV mono-infection treated with DAAs. Five periods were defined according to the evolution of MDT meetings. The profile and management of PWUDs were compared among these five periods. Over time, the frequency of advanced stage of fibrosis decreased from 90.8 to 36.3% (P < 0.001), whereas the therapeutic care of the patients in primary addictology centers and networks of general practitioners increased from 17.4 to 55% (P < 0.001). The frequency of excessive alcohol consumption varied between 9.1 and 30% (P = 0.003) and that of opioid substitution therapy between 42.5 and 70% (P < 0.001). The Sustained virologic response assessed 12 weeks after the end of treatment rate was above 95% for the five periods. Between 2015 and 2019, the changes in the profile and management of PWUDs have followed the evolution of MDT meetings concerning patients with less advanced fibrosis and more therapeutic hepatitis C care made by the primary care centers.