Number Of Primary Care Consultations Research Articles

Healthcare utilisation and mortality in people with osteoarthritis in the UK: findings from a national primary care database.

The burden of osteoarthritis (OA) in UK primary care has not been investigated thoroughly. To estimate healthcare use and mortality in people with OA (overall and joint specific). A matched cohort study of adults with an incident diagnosis of OA in primary care were selected for the study using UK national Clinical Practice Research Datalink (CPRD) electronic records. Healthcare utilisation was measured as the annual average number of primary care consultations and admissions to hospital after the index date for any cause and all-cause mortality data in 221 807 people with OA and an equal number of controls (with no OA diagnosis) who were matched to the case patients by age (standard deviation 2 years), sex, practice, and year of registration. The associations between OA and healthcare utilisation and all-cause mortality were estimated using multinomial logistic regression and Cox regression, respectively, adjusting for covariates. The mean age of the study population was 61 years and 58% were female. In the OA group, the median number of primary care consultations per year after the index date was 10.91 compared with 9.43 in the non-OA control group (P = 0.001) OA was associated with an increased risk of GP consultation and admission to hospital. The adjusted hazard ratio for all-cause mortality was 1.89 (95% confidence interval [CI] = 1.85 to 1.93) for any OA, 2.09 (95% CI = 2.01 to 2.19) for knee OA, 2.08 (95% CI = 1.95 to 2.21) for hip OA, and 1.80 (95% CI = 1.58 to 2.06) for wrist/hand OA, compared with the respective non-OA control group. People with OA had increased rates of GP consultations, admissions to hospital, and all-cause mortality that varied across joint sites.

Impact of the Presenting Symptom on Time Intervals and Diagnostic Routes of Patients with Symptomatic Oral Cancer.

Simple SummaryInformation about the relative length of patient stays, primary care, and prereferral intervals (from symptom onset to specialist referral) is very scarce, and how the presenting symptoms influence these intervals and referral routes remains unknown. This study assesses the impact of presenting symptoms on time intervals, number of visits at the primary care level, and referral pattern of patients with symptomatic oral cancer. This approach will allow targets to be identified for future interventions and the optimization of the treatment pathway for symptomatic oral cancer patients.This investigation was aimed at determining the time intervals from the presenting symptoms until the beginning of oral cancer treatment and their relative contribution to the total time, and to assess the impact of the presenting symptom on diagnostic timelines and patient referral routes. A cross-sectional, ambispective study was designed to investigate symptomatic incident cases. The Aarhus statement was used as a conceptual framework. Strategies for minimizing potential recall biases were implemented. A sample of 181 patients was recruited (power: 99.5%; α = 0.05). The patient interval reached 58.2 days (95% CI, 40.3–76.2), which accounted for 74% of the whole prereferral interval and for more than one third of the total time interval. The presenting symptom (trigger for consultation) influenced both the number of primary care consultations and the length of time to diagnosis. General dental practitioners generated longer intervals to diagnosis (p < 0.005) and needed more consultations before referring a patient (RR = 0.76; 95% CI, 0.61–0.93), than general medical practitioners. The current study identifies the patient as the main target for interventions to improve awareness and reinforces the need for increased alertness amongst healthcare professionals about presenting symptoms of oral cancer and to diminish the number of prereferral consultations in order to optimize the primary care interval.

Primary care consultations after hospitalisation for pneumonia: a large population-based cohort study.

Up to 70% of patients report ongoing symptoms 4 weeks after hospitalisation for pneumonia; the impact on primary care is poorly understood. To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. A population-based cohort study in England using a UK primary care database of anonymised medical records (Clinical Practice Research Datalink [CPRD]) linked to Hospital Episode Statistics (HES). Adults with the first International Classification of Diseases, 10th Revision (ICD-10) code for pneumonia (J12-J18) recorded in HES between July 2002 and June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Of 56 396 adults, 55.9% (n = 31 542) consulted primary care within 30 days of hospital discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year before index admission (adjusted subhazard ratio [sHR] 8.98, 95% confidence interval [CI] = 6.42 to 12.55). The most common reason for consultation was for a respiratory disorder (40.7%, n = 12 840), 11.8% for pneumonia specifically. At consultation, 31.1% (n = 9823) received further antibiotics. Penicillins (41.6%, n = 5753/13 829) and macrolides (21.9%, n = 3029/13 829) were the most common antibiotics prescribed. Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

Point-of-care tests for urinary tract infections: protocol for a systematic review and meta-analysis of diagnostic test accuracy.

IntroductionUrinary tract infections (UTIs) are the second most common type of infection worldwide, accounting for a large number of primary care consultations and antibiotic prescribing. Current diagnosis is based on an empirical approach, relying on symptoms and occasional use of urine dipsticks. The diagnostic reference standard is still urine culture, although it is not routinely recommended for uncomplicated UTIs in the community, due to time to diagnosis (48 hours). Faster point-of-care tests have been developed, but their diagnostic accuracy has not been compared. Our objective is to systematically review and meta-analyse the diagnostic accuracy of currently available point-of-care tests for UTIs.Methods and analysisStudies evaluating the diagnostic accuracy of point-of-care tests for UTIs will be included. PubMed, Web of Science, Embase and Cochrane Database of Systematic Reviews were searched from inception to 1 June 2019. Data extraction and risk-of-bias assessment will be assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. Meta-analysis will be performed depending on data availability and heterogeneity.Ethics and disseminationThis is a systematic review protocol and therefore formal ethical approval is not required, as no primary, identifiable, personal data will be collected. Patients or the public were not involved in the design of our research. However, the findings from this review will be shared with key stakeholders, including patient groups, clinicians and guideline developers, and will also be presented and national and international conferences.PROSPERO registration numberCRD42018112019.

Characteristics, service use, and mortality of clusters of multimorbid patients in England: a population-based study

BackgroundMultimorbidity is a major challenge facing health systems. To help understand the changes to services and policies that are required, we investigated which diseases co-occur and which combinations lead to the highest mortality and service use. MethodsFor this population-based study, we used linked primary and secondary care electronic health records contributed by general practices in England to the Clinical Practice Research Datalink (CPRD). The study includes all multimorbid adults (aged ≥18 years) with two or more predefined long-term health conditions. For the primary objective, latent class analysis, stratified by age groups, was used to identify multimorbidity clusters using a random set of 80% of the multimorbid patients, with consistency of results checked in the remaining 20%. Associations between multimorbidity clusters, demographics and primary outcomes (hospitalisation, polypharmacy and mortality) were quantified using generalised linear models as the secondary objective. This study was approved by the CPRD Independent Scientific Advisory Committee and is covered by their ethical approval. FindingsWe included all adult patients with multimorbidity (n=113 211) from a random sample of the CPRD data (n=391 669). Physical–mental health co-morbidity and respiratory disease and multimorbidity clusters were common across all age strata. In people younger than 65 years, the substance misuse and mental illness co-morbidity cluster (<7% prevalence; consisted mostly of male, current smokers and patients from deprived areas) had the highest demographic-adjusted 5-year mortality rate (in the age 45–64 years strata, the adjusted odds ratio was 1·08 [95% CI 1·07–1·10]) despite low health service use. Cardiovascular-related clusters were prevalent in people aged 65 years or older, in whom the cluster chronic pain, cardiovascular disease, and mental illness (age 65–84 years strata) had the highest number of primary care consultations in 1 year (median 23 [IQR 14–35]) and 5-year mortality (39%). In the 85 years and older age strata, patients in the low service use multimorbidity cluster had the lowest number of morbidities (median 3 [2–4]), service use, and mortality. Across identification and validation data, results showed consistency between obtained disease profiles, similar classification quality, and similar relationships between patient clusters, demographic characteristics, and primary outcomes. InterpretationInterventions and policies to improve the care of patients with multimorbidity might be more effective when targeted at the distinct clusters of multimorbidity that we have highlighted. Results may be further strengthened by validation in external databases. FundingMRC Career Development Award (MR/P021573/1).

Laypersons’ perception of common cold and influenza prevention—a qualitative study in Austria, Belgium and Croatia

Background: Common cold and influenza result in an increased number of primary care consultations, significant work/school absences and cause a socio-economic burden. Laypeople’s perceptions and knowledge regarding common cold and influenza prevention is poorly understood and under-researched.Objectives: Our study explores laypeople’s knowledge of prevention of common cold and influenza across three European countries. Furthermore, it investigates if there is any distinction between prevention activities focussing on reasons impacting the attitude towards influenza vaccination as well as investigating cross-country variation.Methods: In total, 85 semi-structured individual interviews were performed across three European countries (Austria n = 31, Belgium n = 30, Croatia n = 24). Qualitative thematic content analysis was performed.Results: Most participants across all three countries made no distinction between the prevention of the common cold and influenza and referenced the same preventative measures for both conditions. They mainly expressed negative attitudes towards influenza vaccination possibly effective but only intended for high-risk groups (bedridden/older people, chronic patients or health workers). There were very few cross-country differences in results.Conclusion: The perception of health risk of contracting influenza and a primary healthcare physicians’ recommendation played an important role in shaping participants’ decisions towards vaccination. Primary healthcare physicians are invited to assess and if necessary adjust inappropriate prevention behaviour through their everyday patient consultations as well as add to the knowledge about influenza severity and influenza vaccination benefits to their patients.

Asthma COPD overlap: a case study

Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory diseases that account for a significant number of primary care consultations. The classical clinical features of asthma and COPD can be clearly differentiated. However, many patients have contemporaneous features of asthma and COPD, and it is estimated that a significant proportion of these patients have asthma-COPD overlap (ACO). This article provides an overview of the diagnostic process and clinical management, both pharmacological and non-pharmacological, of a 58-year-old male presenting at his GP practice with ACO.

Health services savings in patients with cardiac valve replacement after a cardiac rehabilitation program

In spite of the high prevalence of cardiac valvulopathies, the evidence of the effect of cardiac rehabilitation (CR) after surgical valve replacement (SVR) is scarce, but nevertheless CR is recommended for this group of patients. We aimed to compare the healthcare services utilization when comparing patients after a valve surgery who completed a eight weeks phase II cardiac rehabilitation program to those who did not. A descriptive retrospective study was conducted of CR eligible patients after SVR aged 18 or older between January 2014 and December 2017 with a follow-up of at least 12 months after surgery. We assessed the number of primary care consultations, emergency service utilization, number of hospital admissions and length of hospital stay because of cardiovascular reasons. A total of 124 patients had valve surgery. Fifty-eight (47%) completed CR phases I and II while 66 (53%) patients completed only phase 1 (hospitalization). The mean age was 60.19 years (SD 7.76). The most common type of surgery was aortic replacement (54 = 67.7%). Bioprothesis (24.2%) and mechanical prosthesis (48.4%). Period of follow-up: 33.54 months (SD 10.99). We found participation in phase II CR program is significantly associated with a lower number of visits to the emergency room (25.9% vs. 33.4%, P > 0.05), less hospitalizations (15.5% vs. 31.8%, P = 0.016) and shorter length of hospitalization stay (1.33 vs. 4.24 days P = 0.03). Participation in phase I and phase II CR program after SVR significantly reduces healthcare services utilization when compared to those patients who do not attend to a phase II CR program. CR among all these kind of patients is long-term cost-effective so it should be encouraged.

Seasonal immunisation against respiratory syncytial virus disease

Seasonal immunisation against respiratory syncytial virus disease

Burden of paediatric respiratory syncytial virus disease and potential effect of different immunisation strategies: a modelling and cost-effectiveness analysis for England

SummaryBackgroundVaccines and prophylactic antibodies against respiratory syncytial virus (RSV) are in development and likely to be available in the next 5–10 years. The most efficient way to use these products when they become available is an important consideration for public health decision makers.MethodsWe performed a multivariate regression analysis to estimate the burden of RSV in children younger than 5 years in England (UK), a representative high-income temperate country, and used these results to assess the potential effect of different RSV immunisation strategies (targeting vaccination for infants, or pregnant women, or prophylactic antibodies for neonates). We did a cost-effectiveness analysis for these strategies, implemented either separately or concurrently, and assessed the effect of restricting vaccination to certain months of the year.FindingsWe estimated that RSV is responsible for 12 primary care consultations (95% CI 11·9–12·1) and 0·9 admissions to hospital annually per 100 children younger than 5 years (95% CI 0·89–0·90), with the major burden occurring in infants younger than 6 months. The most cost-effective strategy was to selectively immunise all children born before the start of the RSV season (maximum price of £220 [95% uncertainty interval (UI) 208–232] per vaccine, for an incremental cost-effectiveness ratio of £20 000 per quality-adjusted life-year). The maximum price per fully protected person that should be paid for the infant, newborn, and maternal strategies without seasonal restrictions was £192 (95% UI 168–219), £81 (76–86), and £54 (51–57), respectively.InterpretationNearly double the number of primary care consultations, and nearly five times the number of admissions to hospital occurred with RSV compared with influenza. RSV vaccine and antibody strategies are likely to be cost-effective if they can be priced below around £200 per fully protected person. A seasonal vaccination strategy is likely to provide the most direct benefits. Herd effects might render a year-round infant vaccination strategy more appealing, although it is currently unclear whether such a programme would induce herd effects.FundingUK National Institute for Health Research.

Health characteristics and consultation patterns of people with intellectual disability: a cross-sectional database study in English general practice.

BackgroundPeople with intellectual disability (ID) are a group with high levels of healthcare needs; however, comprehensive information on these needs and service use is very limited.AimTo describe chronic disease, comorbidity, disability, and general practice use among people with ID compared with the general population.Design and settingThis study is a cross-sectional analysis of a primary care database including 408 English general practices in 2012.MethodA total of 14 751 adults with ID, aged 18–84 years, were compared with 86 221 age-, sex- and practice-matched controls. Depending on the outcome, prevalence (PR), risk (RR), or odds (OR) ratios comparing patients with ID with matched controls are shown.ResultsPatients with ID had a markedly higher prevalence of recorded epilepsy (18.5%, PR 25.33, 95% confidence interval [CI] = 23.29 to 27.57), severe mental illness (8.6%, PR 9.10, 95% CI = 8.34 to 9.92), and dementia (1.1%, PR 7.52, 95% CI = 5.95 to 9.49), as well as moderately increased rates of hypothyroidism and heart failure (PR>2.0). However, recorded prevalence of ischaemic heart disease and cancer was approximately 30% lower than the general population. The average annual number of primary care consultations was 6.29 for patients with ID, compared with 3.89 for matched controls. Patients with ID were less likely to have longer doctor consultations (OR 0.73, 95% CI = 0.69 to 0.77), and had lower continuity of care with the same doctor (OR 0.77, 95% CI = 0.73 to 0.82).ConclusionCompared with the general population, people with ID have generally higher overall levels of chronic disease and greater primary care use. Ensuring access to high-quality chronic disease management, especially for epilepsy and mental illness, will help address these greater healthcare needs. Continuity of care and longer appointment times are important potential improvements in primary care.

How reliable are stroke patients' reports of their numbers of general practice consultations over 12 months?

Data on primary health care use are frequently used in economic evaluations. However, it is unclear how patient self-reports of their number of consultations with their general practitioner (GP) relate to actual consultations in the electronic records. These data are crucial if self-reports are used to conduct economic evaluations. To report the accuracy of stroke patients' self-reports of their number of primary care consultations over a 12-month period by comparison with practice-held electronic records. We also recorded the number of contacts required to collect service use data from the practices. We contacted 65 practices requesting electronic consultation records over 12 months for 115 stroke patients who took part in a trial of home blood pressure monitoring. Consultation rates from the electronic records were compared with patients' self-reported number of consultations from a questionnaire covering the same period. Fifty-one practices (78%) responded. Patients' questionnaires (n = 83) reported a mean of 5.7 consultations with their GP per year compared with 7.2 in the electronic records (difference 1.6, 95% confidence interval 0.5-2.7, P < 0.01). The mean time taken to obtain records from practices was 6 weeks. Patients modestly under-reported the number of consultations they had with a GP. Obtaining patient records from practices required more effort than obtaining information from patient questionnaires at the same time as assessing main trial outcomes. If patient self-reports of health care usage are used in economic evaluations in primary care, researchers should consider validating a sample against electronic records.

Intérêt de la détection et de la prise en compte d’une surdispersion dans un modèle de Poisson : illustration à partir d’un exemple

Background Researchers often use the Poisson regression model to analyze count data. Overdispersion can occur when a Poisson regression model is used, resulting in an underestimation of variance of the regression model parameters. Our objective was to take overdispersion into account and assess its impact with an illustration based on the data of a study investigating the relationship between use of the Internet to seek health information and number of primary care consultations. Methods Three methods, overdispersed Poisson, a robust estimator, and negative binomial regression, were performed to take overdispersion into account in explaining variation in the number (Y) of primary care consultations. We tested overdispersion in the Poisson regression model using the ratio of the sum of Pearson residuals over the number of degrees of freedom (χ 2/df). We then fitted the three models and compared parameter estimation to the estimations given by Poisson regression model. Results Variance of the number of primary care consultations (Var[Y] = 21.03) was greater than the mean (E[Y] = 5.93) and the χ 2/df ratio was 3.26, which confirmed overdispersion. Standard errors of the parameters varied greatly between the Poisson regression model and the three other regression models. Interpretation of estimates from two variables (using the Internet to seek health information and single parent family) would have changed according to the model retained, with significant levels of 0.06 and 0.002 (Poisson), 0.29 and 0.09 (overdispersed Poisson), 0.29 and 0.13 (use of a robust estimator) and 0.45 and 0.13 (negative binomial) respectively. Conclusion Different methods exist to solve the problem of underestimating variance in the Poisson regression model when overdispersion is present. The negative binomial regression model seems to be particularly accurate because of its theorical distribution ; in addition this regression is easy to perform with ordinary statistical software packages.

Parental use of the Internet to seek health information and primary care utilisation for their child: a cross-sectional study

BackgroundUsing the Internet to seek health information is becoming more common. Its consequences on health care utilisation are hardly known in the general population, in particular among children whose parents seek health information on the Internet. Our objective was to investigate the relationship between parental use of the Internet to seek health information and primary care utilisation for their child.MethodsThis cross-sectional survey has been carried out in a population of parents of pre-school children in France. The main outcome measure was the self-reported number of primary care consultations for the child, according to parental use of the Internet to seek health information, adjusted for the characteristics of the parents and their child respectively, and parental use of other health information sources.ResultsA total of 1 068 out of 2 197 questionnaires were returned (response rate of 49%). No association was found between parental use of the Internet to seek health information and the number of consultations within the last 12 months for their child. Variables related to the number of primary care consultations were characteristics of the child (age, medical conditions, homeopathic treatment), parental characteristics (occupation, income, stress level) and consultation of other health information sources (advice from pharmacist, relatives).ConclusionWe did not find any relationship between parental use of the Internet to seek health information and primary care utilisation for children. The Internet seems to be used as a supplement to health services rather than as a replacement.

Relationship between airway inflammation and the frequency of exacerbations in patients with smoking related COPD

BACKGROUNDPatients with more frequent exacerbations of chronic obstructive pulmonary disease (COPD) may have increased bronchial inflammation. Airway inflammation was measured in patients who had been thoroughly investigated with full pulmonary...