Primary Care Network Research Articles

Antibiotic prescribing for acute, non-complicated infections in primary care in Germany: baseline assessment in the cluster randomized trial ARena

BackgroundAntimicrobial resistance is fueled by inappropriate use of antibiotics. Global and national strategies support rational use of antibiotics to retain treatment options and reduce resistance. In Germany, the ARena project (Sustainable reduction of antibiotic-induced antimicrobial resistance) intended to promote rational use of antibiotics for acute non-complicated infections by addressing network-affiliated physicians, primary care teams and patients through multiple interacting interventions. The present study documented patterns of antibiotic prescribing for patients with acute non-complicated infections who consulted a physician in these networks at the start of the ARena project. It explored variation across subgroups of patients and draws comparisons to prescribing patterns of non-targeted physicians.MethodsThis retrospective cross-sectional analysis used mixed logistic regression models to explore factors associated with the primary outcome, which was the percentage of patient cases with acute non-complicated respiratory tract infections consulting primary care practices who were treated with antibiotics. Secondary outcomes concerned the prescribing of different types of antibiotics. Descriptive methods were used to summarize the data referring to targeted physicians in primary care networks, non-targeted physicians (reference group), and patient subgroups.ResultsOverall, antibiotic prescribing rates were 32.0% in primary care networks and 31.7% in the reference group. General practitioners prescribed antibiotics more frequently than other medical specialist groups (otolaryngologists vs. General practitioners OR = 0.465 CI = [0.302; 0.719], p < 0.001, pediatricians vs. General practitioners: OR = 0.369 CI = [0.135; 1.011], p = 0.053). Quinolone prescribing rates were 9.9% in primary care networks and 8.1% in reference group. Patients with comorbidities had a higher likelihood of receiving an antibiotic and quinolone prescription and were less likely to receive a guideline-recommended substance. Younger patients were less likely to receive antibiotics (OR = 0.771 CI = [0.636; 0.933], p = 0.008). Female gender was more likely to receive an antibiotic prescription (OR = 1.293 CI = [1.201, 1.392], p < 0.001).ConclusionThis study provided an overview of observed antibiotic prescribing for acute non-complicated respiratory tract infections in German primary care at the start of the ARena project. Findings indicate potential for improvement and will serve as comparator for the post-interventional outcome evaluation to facilitate describing of potential changes.

Equity and the funding of Primary Care Networks.

There is a 19-year difference in healthy life expectancy between deprived and more affluent populations in England.1 These health inequities have multiple direct impacts, such as increased disease burden and reduced economic activity.2 Their reduction is an important goal of the NHS Long Term Plan (LTP).3 High-quality and accessible primary care is recognised internationally as an important component of an equitable health system,4 yet there are 15% fewer GPs per capita in deprived areas of England.5 The proportion of the NHS budget spent on primary care has decreased in recent years.6 The LTP promised increased funding to address this.2 Currently, general practice funding in England goes directly to individual practices, according to formulae that include some adjustments to account for workload variation. Rather than directing additional resources into primary care via these existing funding streams, the LTP proposed the creation of new Primary Care Networks (PCNs). These are voluntary groups of practices contracted to work together to deliver additional services for additional funding (technically called a Directed Enhanced Service). The PCN contract offers £1.8 billion extra funding as part of the £2.4 billion increase in overall primary care funding; this is a 14% real-terms increase compared with the £9.6 billion budget in 2014/2015.7 To understand whether this will address or exacerbate existing health inequities and address the so-called ‘inverse care law’,8 it is important to explore how these resources will be allocated and what conditions will be applied to how they can be used. The majority of funding for primary care is distributed through General or Personal Medical Services contracts, with additional payments paid for some specific extra activities.9 The core of practice income is derived from the ‘global sum’, a weighted capitation payment. The average payment of £93.46 per …

Change starts with me: an impact evaluation of a multiprofessional leadership programme to support primary care networks in the South East of England

PurposeThis paper aims to present the impact evaluation findings from a multiprofessional leadership programme commissioned in the South East of England to support primary care networks (PCNs) to lead system improvement together. It identifies programme impact at micro and meso system levels; a leadership impact continuum that can be used by individuals and teams to evidence impact of improvements in PCN practices; the learning and development strategies that were effective and proposes implications for other networks.Design/methodology/approachMixed methods underpinned by practice development methodology were used to explore the impact of the programme on two practitioner cohorts across 16 PCNs. Data were collected at the start, mid-point and end of the eight-month programme.FindingsResults illustrate an innovative approach to collective leadership development. A continuum of impact created with participants offers insight into the journey of transformation, recognising that “change starts with me”. The impact framework identifies enablers, attributes and consequences for measuring and leading change at micro, meso and macro levels of the health-care system. Participants learned how to facilitate change and collaboratively solve problems through peer consulting which created a safe space for individuals to discuss workplace issues and receive multiprofessional views through action learning. These activities enabled teams to present innovative projects to commissioners for service redesign, enabling their PCN to be more effective in meeting population health needs. The authors believe that this programme may provide a model for other PCNs England and other place-based care systems internationally.Originality/valueThis study offers insight into how to enable a journey of transformation for individuals and PCN teams to enhance team effectiveness and collective leadership for system-wide transformation required by the National Health Service Long Term Plan (2019).Contribution to Impact

Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis.

BackgroundIn England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.AimTo examine recent trends in general practice workforce inequalities.Design & settingA longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England.MethodThe slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.ResultsFewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.ConclusionSignificant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

Immunogenicity of single vaccination with BNT162b2 or ChAdOx1 nCoV-19 at 5–6 weeks post vaccine in participants aged 80 years or older: an exploratory analysis

SummaryBackgroundIn several countries, extended interval COVID-19 vaccination regimens are now used to accelerate population coverage, but the relative immunogenicity of different vaccines in older people remains uncertain. In this study we aimed to assess the antibody and cellular responses of older people after a single dose of either the BNT162b2 vaccine (tozinameran; Pfizer–BioNTech) or ChAdOx1 nCoV-19 vaccine (Oxford University–AstraZeneca).MethodsParticipants aged 80 years or older, who did not live in a residential or care home or require assisted living, and had received a single dose of either the BNT162b2 vaccine or ChAdOx1 nCoV-19 vaccine were eligible to participate. Participants were recruited through local primary care networks in the West Midlands, UK. Blood samples and dried blood spots were taken 5–6 weeks after vaccination to assess adaptive immune responses using Elecsys electrochemiluminescence immunoassay and cellular responses by ELISpot. Primary endpoints were percentage response and quantification of adaptive immunity.FindingsBetween Dec 29, 2020, and Feb 28, 2021, 165 participants were recruited and included in the analysis. 76 participants had received BNT162b2 (median age 84 years, IQR 82–89; range 80–98) and 89 had received ChAdOx1 nCoV-19 (median age 84 years, 81–87; 80–99). Antibody responses against the spike protein were detectable in 69 (93%) of 74 BNT162b2 vaccine recipients and 77 (87%) of 89 ChAdOx1 nCoV-19 vaccine recipients. Median antibody titres were of 19·3 U/mL (7·4–79·4) in the BNT162b2 vaccine recipients and 19·6 U/mL (6·1–60·0) in the ChAdOx1 nCoV-19 vaccine recipients (p=0·41). Spike protein-specific T-cell responses were observed in nine (12%) of 73 BNT162b2 vaccine recipients and 27 (31%) of 88 ChAdOx1 nCoV-19 vaccine recipients, and median responses were three-times higher in ChAdOx1 nCoV-19 vaccine recipients (24 spots per 1 × 106 peripheral blood mononuclear cells) than BNT162b2 vaccine recipients (eight spots per 1 × 106 peripheral blood mononuclear cells; p<0·0001). Humoral and cellular immune responses against spike protein were correlated in both cohorts. Evidence of previous SARS-CoV-2 infection was seen in eight participants (n=5 BNT162b2 recipients and n=3 ChAdOx1 nCoV-19 recipients), and was associated with 691-times and four-times increase in humoral and cellular immune responses across the whole cohort.InterpretationSingle doses of either BNT162b2 or ChAdOx1 nCoV-19 in older people induces humoral immunity in most participants, and is markedly enhanced by previous infection. Cellular responses were weaker, but showed enhancement after the ChAdOx1 nCoV-19 vaccine at the 5–6 week timepoint.FundingMedical Research Council, National Institute for Health Research, and National Core Studies.

Stratifying for Value: An Updated Population Health Risk Stratification Approach.

Most risk stratification approaches attempt to predict clinical outcomes rather than value. For a provider organization or health system to have financial success in value-based contracting, future risk models must analyze costs as well as disease burden. The purpose of this study was to create a customized risk stratification algorithm that considered a patient's medical spend alongside disease burden while delivering a scoring system that improves the efficiency of a care coordination program. The authors focused on University Hospitals (UH) Health System's Accountable Care Organization population of 554,805 because this patient cohort is engaged with UH's primary care network and has the most robust data. The 5-category risk algorithm was found to be meaningful and impactful after integrating the foundation of the Minnesota Tiering system with an expanded comorbidity list and weighting the result by the previous 12 months of medical spend. This new technique can identify patients in need of intensive care coordination. The complex risk tier of the stratification system reduces the number of patients from 551,045 to 27,552, or 5% of the patient population, and accounts for 67.9% ($1,107,822,887) of total annual medical spend. Expanding care coordination efforts to patients in the top 2 tiers would account for 15% of the patients and 83.2% ($1,357,545,872) of annual medical spend. The novelty of the new approach allows clinical teams to focus intense resources on a smaller sample of the patient population and to identify chronic conditions contributing to costs, and feel confident that they have greater explanatory power regarding value.

Childhood Obesity Management at the 9-11 Year Well Child Check-An Opportunity for Expert Committee Recommended Comorbidity Screening

Our study assessed how primary care providers in a large outpatient network follow ECR guidelines with regards to laboratory screening for comorbidities of obese patients in the 9 to 11 year age group. This retrospective cohort study included 706 patients seen in an outpatient network with a 10 year well child check from 7/1/17 to 7/1/18 and a BMI greater than or equal to the 95th percentile. Our study found 42% of patients, who met ECR guidelines, had no lipid screening or obesity co-morbidity screening obtained. The most frequently abnormal test was the lipid panel, at 23%, and notably 16 % of Hemoglobin A1C screening resulted pre-diabetic range. Our study serves as an updated review of ECR compliance in a large primary care network and suggests an opportunity to enhance education on screening recommendations.

Structured medication reviews: origins, implementation, evidence, and prospects

Pharmacists have been employed in UK general practice for many years. Their numbers are now expanding and their roles developing. Clinical pharmacists are expected to alleviate workload pressures on GPs. Notwithstanding the COVID-19 vaccination programme, a new Structured Medication Review (SMR) service has been introduced in Primary Care Networks (PCNs). The long term drivers are clear: addressing problematic polypharmacy in the NHS, reducing avoidable hospitalisations, and delivering better value from medicines spending. SMRs are intended to improve the quality of prescribing, delivering improvements to patient care and outcomes.

The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis.

BackgroundDigital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective.ObjectiveThe aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending.MethodsA retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or “weight” the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20.ResultsThe NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was £1.6 billion and £1.65 billion (a currency exchange rate of £1=US $1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12%, 31%, and 54% (£93, P=.047; £223, P<.001; and £389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15%, 35%, and 51% (£114, P=.006; £246, P<.001; and £362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of £1.37, £4.40 million, and £11.6 million, respectively, in FY18/19; and £3.26 million, £9.54 million, and £18.8 million, respectively, in FY19/20.ConclusionsPatients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs.

Developmental Delay in Infants With Positional Skull Deformity

Research Article| July 01 2021 Developmental Delay in Infants With Positional Skull Deformity AAP Grand Rounds (2021) 46 (1): 4. https://doi.org/10.1542/gr.46-1-4 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share MailTo Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Developmental Delay in Infants With Positional Skull Deformity. AAP Grand Rounds July 2021; 46 (1): 4. https://doi.org/10.1542/gr.46-1-4 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: developmental delay, plagiocephaly, skull malformation Source: Rohde JF, Goyal NK, Slovin SR, et al. Association of positional plagiocephaly and developmental delay within a primary care network. J Dev Behav Pediatr. 2021;42(2):128-134; doi: https://doi.org/10.1097/DBP.0000000000000860Google Scholar Investigators from Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, conducted a retrospective study to assess the association between plagiocephaly and developmental delay among a cohort of children seen in primary care offices and the relative timing of plagiocephaly and developmental delay. For the study, they reviewed data obtained from 45 primary care sites within a single health care system and abstracted data on patients <5 years old who had a first primary care office visit by the age of 12 months between 2000 and 2017. Children with a plagiocephaly diagnosis by 12 months were identified by ICD-9 and ICD-10 codes. Controls were patients seen by 12 months without a diagnosis of plagiocephaly. Data on demographics, history of prematurity, and diagnoses of abnormal tone and torticollis also were abstracted. The primary study outcome was a diagnosis of developmental delay, identified with ICD-9 and ICD-10 codes, assigned by a primary care provider. Secondary outcomes included diagnoses of specific types of developmental delay. The dates of first diagnosis of plagiocephaly and developmental delay were obtained. The association between demographic and clinical characteristics and plagiocephaly was assessed with chi-square or Fisher exact tests. Logistic regression was used to determine if plagiocephaly was independently associated with developmental delay and specific types of delay. Data were analyzed on 77,108 children, including 2,315 (3.0%) diagnosed with plagiocephaly by the age of 12 months. The median age of diagnosis was 3 months. Children diagnosed with plagiocephaly were significantly more likely to be male, white, have private insurance, and to have been born prematurely than controls (all P values <0.001). Diagnoses of abnormal tone (P <0.001) and torticollis (P <0.001) also were significantly associated with plagiocephaly. Developmental delay was diagnosed in 404 (17.5%) of those with plagiocephaly and 6,492 (8.7%) of controls. After controlling for confounding variables, plagiocephaly was independently associated with developmental delay (odds ratio [OR], 1.50; 95% confidence interval [CI], 1.32, 1.70). Among specific types of developmental delay, plagiocephaly was associated with an increased odds for motor delay (OR, 1.67; 95% CI, 1.29, 2.16), language delay (OR, 1.35; 95% CI, 1.17, 1.56), and general delay (OR, 1.77; 95% CI, 1.39, 2.24), but not social delay (OR, 2.72; 95% CI, 0.87, 8.50) or cognitive delay (OR, 0.36; 95% CI, 0.11, 1.23). The diagnosis of plagiocephaly preceded that of developmental delay in 374 of 406 children (92.6%) with both conditions. The authors conclude that among a cohort of children seen in primary care offices there was an association between plagiocephaly and developmental delay. Dr Badawi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Deformational plagiocephaly and brachycephaly result from prolonged forces applied to the back... You do not currently have access to this content.

Patient navigation programs in Alberta, Canada: an environmental scan.

Background:Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada.Methods:We included patient navigation programs within Alberta Health Services (AHS) and Alberta’s Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics.Results:Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration.Interpretation:Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.

Patient, provider, and clinic factors associated with the use of cervical cancer screening.

Cervical cancer screening delivery remains suboptimal. Understanding the multiple influences on use of screening is important to designing interventions. We describe the influence of patient, primary care provider (PCP), and clinic characteristics on whether a woman is up-to-date with cervical screening as of December 2016. PCPs (n = 194) and their female screen-eligible patients age 21–65 years (n = 32,115) were included in this cross-sectional analysis of patients from two primary care networks linked to a contemporaneous PCP survey. Principal independent variables for patients included: age, race, insurance, continuity of care; for PCP included: overall satisfaction with the practice of medicine, gender, hours worked per week, financial support for achieving clinical targets; and for clinic included: routine receipt of data on preventive care performance and language translation resources. Overall, 66.6% of women were up-to-date. Women were less likely to be up-to-date with cervical cancer screening if they were younger and were more likely to be screened if they were Black, Hispanic or Asian vs. White. Women with greater continuity of primary care or with a female PCP were more likely to be up-to-date (1.52; 1.33–1.75); those who received care in a clinic that was less prepared to manage language translation were less likely to be up-to-date (0.78; 0.65–0.95). Patient, provider, and clinic factors all influence use of cervical cancer screening. Systems interventions like improving continuity of care, promoting translation services, or enhanced efforts to track screening among patients of male PCPs may improve delivery.

Survey on general practitioners\u2019 and pharmacists\u2019 opinions regarding patient-initiated treatment of recurring urinary tract infections

Background The Dutch general practitioners (GP) guideline for urinary tract infections (UTI) recommends patient-initiated treatment for women with recurring UTI. In countries other than the Netherlands, community pharmacists play a role in dispensing antibiotics for recurring UTI without preceding GP consultation. Objective To study GP and pharmacist opinions regarding the desirability of patient-initiated treatment, including potential pharmacist support for, and consequences of, facilitated access to antibiotics. Setting Dutch community pharmacies that cooperate with at least two GPs in their regional primary care network. Method Pharmacists in a postgraduate education program invited their residency pharmacist and 2–3 GPs to anonymously complete an online questionnaire. Questions related to diagnosis, treatment and potential role of the pharmacist. Answers were formulated as multiple-choice or ratings on a 5-point Likert scale. Data were analysed per professional group using descriptive statistics. Answers of pharmacists and GP to corresponding questions were analysed using a Chi-square test (p < 0.05). Main outcome measure Desirability of patient-initiated treatment and supporting role of the pharmacist. Results A total of 170 GPs and 76 pharmacists completed the questionnaires. Of the GPs, 35.1% supported patient-initiated treatment. Of the pharmacists, 69.7% were willing to dispense an antibiotic to a patient without preceding GP consultation after performing a probability check. In total, 65.7% of GPs and 44.7% of pharmacists thought that facilitated access to antibiotics would increase use of antibiotics (p < 0.05). Conclusion Support of GPs for facilitated access to antibiotic treatment by patient-initiated UTI treatment was limited, even with pharmacist support. The majority of pharmacists were willing to dispense an antibiotic after a probability check of an episode of recurring UTI, but both pharmacists and GPs were concerned about overuse of antibiotics.

Prevalence of Angina Among Primary Care Patients With Coronary Artery Disease

Angina pectoris is associated with morbidity and mortality. Angina prevalence and frequency among contemporary US populations with coronary artery disease (CAD) remain incompletely defined. To ascertain the angina prevalence and frequency among stable outpatients with CAD. This cross-sectional survey study involved telephone-based administration of the Seattle Angina Questionnaire-7 (SAQ-7) between February 1, 2017, and July 31, 2017, to a nonconvenience sample of adults with established CAD who receive primary care through a large US integrated primary care network. Data analysis was performed from August 2017 to August 2019. SAQ-7 administration. Angina prevalence and frequency were assessed using SAQ-7 question 2. Covariates associated with angina were assessed in univariable and multivariable regression. Of 4139 eligible patients, 1612 responded to the survey (response rate, 38.9%). The mean (SD) age of the respondents was 71.8 (11.0) years, 577 (35.8%) were women, 1447 (89.8%) spoke English, 147 (9.1%) spoke Spanish, 1336 (82.8%) were White, 76 (4.7%) were Black, 92 (5.7%) were Hispanic, 974 (60.4%) had Medicare, and 83 (5.2%) had Medicaid. Among respondents, 342 (21.2%) reported experiencing angina at least once monthly; among those, 201 (12.5%) reported daily or weekly angina, and 141 respondents (8.7%) reported monthly angina. The mean (SD) SAQ-7 score was 93.7 (13.7). After multivariable adjustment, speaking a language other than Spanish or English (odds ratio [OR], 5.07; 95% CI, 1.39-18.50), Black race (OR, 2.01; 95% CI, 1.08-3.75), current smoking (OR, 1.88; 95% CI, 1.27-2.78), former smoking (OR, 1.69; 95% CI, 1.13-2.51), atrial fibrillation (OR, 1.52; 95% CI, 1.02-2.26), and chronic obstructive pulmonary disease (OR, 1.61; 95% CI, 1.18-2.18) were associated with more frequent angina. Male sex (OR, 0.63; 95% CI, 0.47-0.86), peripheral artery disease (OR, 0.63; 95% CI, 0.44-0.90), and novel oral anticoagulant use (OR, 0.19; 95% CI, 0.08-0.48) were associated with less frequent angina. Among stable outpatients with CAD receiving primary care through an integrated primary care network, 21.2% of surveyed patients reported experiencing angina at least once monthly. Several objective demographic and clinical characteristics were associated with angina frequency. Proactive assessment of angina symptoms using validated assessment tools and estimation of patients at higher risk of suboptimally controlled angina may be associated with reduced morbidity.

ASSESSMENT OF THE STATE OF THE ORGANIZATION OF CIRCULATION AND THE AVAILABILITY OF MEDICINES FOR DIFFERENT CATEGORIES OF PATIENTS AT THE LEVEL OF OBSTETRIC UNITS

Introduction. In the context of the coronavirus infection pandemic, the relevance of increasing the level of availability of medicines for various categories of patients in primary care is becoming crucial. The aim of the work was to process the state of the organization of circulation and the availability of medicines for various clinical and pharmacological groups of patients at the level of obstetric points. Materials and methods. To assess the organization of circulation and the availability of medicines of various clinical-pharmacological, nomenclature-legal and classification-legal groups, a conditional indicator was used – the conditional availability of medicines, calculated using content analysis. To conduct a content analysis, the organization of the regional primary network of medical care was studied; a list of obstetric points was compiled according to a quantitative indicator by grouping using the Sturges formula, followed by the construction of discrete series of variations and a distribution polygon. Results and discussion. Noted that obstetric centers perform socially oriented tasks to increase the level of organization of circulation and the availability of medicines for all contingents of the population on the principles of medical and pharmaceutical law, as the basis of state policy to minimize risks in the organization of pharmaceutical business. According to our own developed methods using content analysis, the structuring of the primary health care with a network of obstetric points at the regional level was carried out and it was established for the overwhelming majority of districts a low, above low and medium level of conditional availability of drugs for patients. Conclusions. The organization of circulation and the availability of drugs for various contingents of the population in the studied regional primary health care network is at the following level: unsatisfactory (for three districts); low (for five districts); higher than low (twelve districts); medium (for five districts); above average (for one district) satisfactory (for one district). Based on the results obtained, it can be concluded that the insufficient number of obstetric points in the regional primary health care unit is an obstacle to the timely provision of the population with high quality, effective and affordable drugs.

Autism screening: The perfect vs the good

There is no question that we, with our current screening tools are imperfect at identifying many children with the heterogeneous Autism Spectrum Disorder (ASD) (Pediatrics 2020;145:e20193447. doi:10.1542/peds.2019-3447). Until we have more accurate and culturally appropriate methods, pediatricians and other providers of care to children must continue to rely on a variety of broadband developmental screening and autism-specific instruments, and do so at any early age when interventions can have the greatest impact. In this volume of The Journal, McNally Keehn et al provide an evaluation of an innovative state-based network designed to increase early screening and timely access to complete ASD assessments. The authors’ results are important for several reasons: the state-based hub system was highly successful at identifying children with developmental abnormalities and should serve as a replicable model for other states or regions; the lack of concordance between referral concerns of care providers and primary care providers demonstrates the critical importance of shared decision making with families and the adequacy of primary care provider training; and the necessity of further exploring the demographic characteristics of families and how those may interact with differences in referral concerns. The hub system described in this study and other novel approaches such as ECHO-Autism will be the cornerstone of our eventual success in developing accurate universal screening and identification methods to ensure affected toddlers and children have the earliest access to proven or promising therapies. Article page 74 ▸ Associations Among Referral Concerns, Screening Results, and Diagnostic Outcomes of Young Children Assessed in a Statewide Early Autism Evaluation NetworkThe Journal of PediatricsVol. 233PreviewTo examine associations between referral concerns, screening results, and diagnostic outcomes for young children evaluated across a statewide primary care network for early screening and diagnosis of autism spectrum disorder (ASD). Full-Text PDF

Patient and clinician factors associated with uptake of the human papillomavirus (HPV) vaccine among adolescent patients of a primary care network

BackgroundHuman papillomavirus (HPV) vaccination rates for adolescents remain relatively low. The purpose of this study is to examine patient and clinician factors associated with HPV vaccination among patients, ages 11–17, of a large community-based primary care network. MethodsElectronic health records and administrative data from a large primary care network from January 2017 – June 2018 for patients ages 11–17 (n = 10,682) and the 198 primary care clinicians that saw them were analyzed. Mixed effects logistic regression models examined the association of patient and clinician factors with HPV vaccine uptake. ResultsMost patients (63.0%) had at least one dose of the HPV vaccine, and 37.7% were up to date. In adjusted analyses, patients who received the tetanus, diphtheria, and pertussis (Tdap) vaccine (OR = 2.8, 95% CI: 2.1–3.9) compared to those who did not receive the vaccine and patients with five or more medical visits (OR = 1.9, 95% CI: 1.6–2.2) had the greatest odds of being up to date with the HPV vaccine series. Compared to White patients, African American/Black (OR = 0.8, 95% CI: 0.6 – 1.0) and Alaskan Native/American Indian (OR = 0.5, 95% CI: 0.3–0.9) patients were less likely to be up to date. Boys were also less likely to be up to date with the HPV vaccine series compared to girls (OR = 0.7, 95% CI: 0.7–0.8). Additionally, patients with family/general practice primary care clinicians were less likely to have their patients up to date than those with pediatricians (OR = 0.8, 95% CI: 0.6 – 1.0). ConclusionHPV vaccine uptake varied by patient characteristics, heath care utilization and primary care clinician specialty. These findings may inform future evidence-based interventions aimed at increasing HPV vaccine uptake among adolescents by targeting patient sub-groups and reducing missed opportunities for vaccination.

Intrapartum group B Streptococcal prophylaxis and childhood weight gain

ObjectiveTo determine the difference in rate of weight gain from birth to 5 years based on exposure to maternal group B streptococcal (GBS) intrapartum antibiotic prophylaxis (IAP).DesignRetrospective cohort study of...

Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study

ObjectiveThe increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The...

COVID-19 and Changes in Child Obesity.

* Abbreviation: COVID-19 — : coronavirus disease 2019 The coronavirus disease 2019 (COVID-19) pandemic has caused economic hardship, school closings, shutdowns, limited physical activities, and increased food insecurity for many families. In December 2020, the American Academy of Pediatrics released interim guidance on how pediatricians can help children and families address healthy lifestyles and obesity management during the pandemic.1 To best support pediatric health system obesity prevention and management efforts, a better understanding of emerging disparities is needed to identify at-risk populations and develop focused interventions.2 Through a large pediatric primary care network, we evaluated the shifting rates of obesity for patients attending visits and explored disparities based on age, race and ethnicity, insurance, and income. The Children’s Hospital of Philadelphia Care Network includes 29 urban, suburban, and semirural … Address correspondence to Brian P. Jenssen, MD, MSHP, Children’s Hospital of Philadelphia, 2716 South St, 11-201, Philadelphia, PA 19146. E-mail: jenssenb{at}email.chop.edu