F. Aghajafari, K. McBrien, C. Claussen, Rida Abboud, A. Ness, Myles Leslie
{"title":"Getting test results and clinical guidance to the front lines of primary care in alberta: A qualitative study","authors":"F. Aghajafari, K. McBrien, C. Claussen, Rida Abboud, A. Ness, Myles Leslie","doi":"10.1370/afm.20.s1.2829","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2829","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85806583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina Wong, K. Haase, M. Schwandt, Elsie Tan, Ranjit Dhari, Manon Ranger, M. Romney, Elizabeth Saewyc, Erica Tobias, F. Affleck, I. Ndateba, N. Matic
{"title":"Understanding feasibility of rapid antigen testing in congregate living settings","authors":"Sabrina Wong, K. Haase, M. Schwandt, Elsie Tan, Ranjit Dhari, Manon Ranger, M. Romney, Elizabeth Saewyc, Erica Tobias, F. Affleck, I. Ndateba, N. Matic","doi":"10.1370/afm.20.s1.2913","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2913","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90120210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: Reports of post-acute sequelae of COVID-19 continue to emerge, but it remains unclear how the severity of a patient’s COVID -19 infection affects risk for future hospitalizations for non-COVID-19 problems. Objective: To examine in a 6-month cohort the risk of a hospitalization among patients infected with COVID-19. Study Design, Setting, and Participants: This retrospective cohort study assessed University of Florida Health adult patients (n=10,646 patients) who were PCR validated to be COVID-19 positive or negative and followed them for 6 months using electronic health records. The data were left censored for 30 days to exclude readmissions. Outcome Measures: Hospitalization for any cause and for conditions that could be seen as complications of COVID-19 (cardiovascular, respiratory, and clotting diagnoses). The 6-month risk of a new hospitalization was assessed in both unadjusted and adjusted Cox regressions. Results: Of the 10,646 patients,114 had severe COVID-19, 211 had mild/moderate COVID-19, and 10,321 were COVID-19 negative. After adjustment for potential confounding variables, there was no significantly increased risk in future hospitalization for any condition for patients who were COVID-19 positive versus those who were COVID-19 negative (HR 1.31; 95% CI 0.98, 1.74). In adjusted analyses, individuals with severe COVID-19 had an increased risk of hospitalization for potential complications compared to both mild/moderate COVID-19 (HR 2.20; 95% CI 1.13, 4.28) and COVID-19 negative patients (HR 2.24; 95% CI: 1.52, 3.30). Conclusions: Patients with a severe COVID-19 episode were at greater risk for future hospitalizations. This study reinforces the importance of preventing infection in patients at higher risk for severe COVID-19 cases.
背景:关于COVID-19急性后后遗症的报道不断出现，但尚不清楚患者感染COVID-19的严重程度如何影响未来因非COVID-19问题住院的风险。目的:通过为期6个月的队列研究COVID-19感染患者的住院风险。研究设计、环境和参与者:这项回顾性队列研究评估了佛罗里达大学健康中心的成年患者(n=10,646例患者)，这些患者经PCR验证为COVID-19阳性或阴性，并使用电子健康记录对他们进行了6个月的随访。这些数据被审查了30天，以排除再入境。结果指标:因任何原因和可能被视为COVID-19并发症的情况(心血管、呼吸和凝血诊断)住院。在未调整和调整的Cox回归中评估6个月新住院的风险。结果:10646例患者中，重症114例，轻/中度211例，阴性10321例。在对潜在的混杂变量进行调整后，与COVID-19阴性患者相比，COVID-19阳性患者未来因任何疾病住院的风险均未显着增加(HR 1.31;95% ci 0.98, 1.74)。在调整分析中，与轻度/中度COVID-19相比，重度COVID-19患者因潜在并发症住院的风险增加(HR 2.20;95% CI 1.13, 4.28)和COVID-19阴性患者(HR 2.24;95% ci: 1.52, 3.30)。结论:严重的COVID-19发作患者未来住院的风险更大。这项研究强调了预防COVID-19严重病例高风险患者感染的重要性。
{"title":"Post-Acute sequelae of COVID-19 infection: Risk of new hospitalization for Non-COVID-19 conditions","authors":"Arch G Mainous, Benjamin Rooks, Frank A. Orlando","doi":"10.1370/afm.20.s1.2795","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2795","url":null,"abstract":"Context: Reports of post-acute sequelae of COVID-19 continue to emerge, but it remains unclear how the severity of a patient’s COVID -19 infection affects risk for future hospitalizations for non-COVID-19 problems. Objective: To examine in a 6-month cohort the risk of a hospitalization among patients infected with COVID-19. Study Design, Setting, and Participants: This retrospective cohort study assessed University of Florida Health adult patients (n=10,646 patients) who were PCR validated to be COVID-19 positive or negative and followed them for 6 months using electronic health records. The data were left censored for 30 days to exclude readmissions. Outcome Measures: Hospitalization for any cause and for conditions that could be seen as complications of COVID-19 (cardiovascular, respiratory, and clotting diagnoses). The 6-month risk of a new hospitalization was assessed in both unadjusted and adjusted Cox regressions. Results: Of the 10,646 patients,114 had severe COVID-19, 211 had mild/moderate COVID-19, and 10,321 were COVID-19 negative. After adjustment for potential confounding variables, there was no significantly increased risk in future hospitalization for any condition for patients who were COVID-19 positive versus those who were COVID-19 negative (HR 1.31; 95% CI 0.98, 1.74). In adjusted analyses, individuals with severe COVID-19 had an increased risk of hospitalization for potential complications compared to both mild/moderate COVID-19 (HR 2.20; 95% CI 1.13, 4.28) and COVID-19 negative patients (HR 2.24; 95% CI: 1.52, 3.30). Conclusions: Patients with a severe COVID-19 episode were at greater risk for future hospitalizations. This study reinforces the importance of preventing infection in patients at higher risk for severe COVID-19 cases.","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82023380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cathy F Thorpe, Judith Brown, Saadia Hameed, B. Ryan, Amanda Terry, R. Clark
{"title":"Health system change in the midst of a pandemic","authors":"Cathy F Thorpe, Judith Brown, Saadia Hameed, B. Ryan, Amanda Terry, R. Clark","doi":"10.1370/afm.20.s1.2866","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2866","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72562800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Erickson, E. Westfall, Augustine Chavez, Susan B. Laabs, Thomas Thacher
{"title":"Primary care clinical experience during a pandemic: A model for medical crisis planning","authors":"R. Erickson, E. Westfall, Augustine Chavez, Susan B. Laabs, Thomas Thacher","doi":"10.1370/afm.20.s1.2782","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2782","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73005829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathryn Hodwitz, P. Das, Janet Parsons, E. Rosenthal, Stephen Hwang, Clara Juando-Prats, Tara Kiran, J. Lockwood, Carolyn Snider
Context: COVID-19 has posed unique challenges for people experiencing homelessness, who often live in congregate settings and cannot easily follow public health directives like social distancing. Responding to COVID-19 has also taken a psychological toll on frontline healthcare workers. Objective: This study aimed to explore the experiences of people experiencing homelessness and the healthcare workers who cared for them during the early COVID-19 pandemic. Study Design: Qualitative inquiry using a constructivist, interview-based approach and reflexive thematic analysis. Setting: An inner-city hospital in Toronto, Ontario. Population studied: 1) Shelter residents tested for COVID-19 during mobile outreach and 2) Healthcare workers in the COVID-19 testing centre and emergency department who interacted with people experiencing homelessness. Results: Three cross-cutting themes were generated: 1) A collective feeling of ‘Navigating the Unknown’ wherein healthcare workers were challenged with providing a frontline response to a novel virus amidst continuously evolving public health guidelines and patients faced uncertainty about te sting and isolation protocols; 2) A sense of ‘Placelessness’ among patients who were often left with nowhere to go early in the pandemic, unable to return to their shelters because they were awaiting test results or had tested positive and thus needed to stay in impromptu encampment spaces in the ED; and 3) A feeling of ‘Powerlessness’ among patients who lacked agency in their placelessness and among healthcare workers who lacked control in the care they were able to provide. Overall, participants conveyed that COVID-19 exacerbated the vulnerability and displacement of patients experiencing homelessness due to reduced access to public spaces and lack of isolation options early in the pandemic. Witnessing this displacement, and attempting to care for this population amidst resource constraints, led to
{"title":"Placeless and powerless: Experiences of patients who are homeless and healthcare workers caring for them during COVID-19","authors":"Kathryn Hodwitz, P. Das, Janet Parsons, E. Rosenthal, Stephen Hwang, Clara Juando-Prats, Tara Kiran, J. Lockwood, Carolyn Snider","doi":"10.1370/afm.20.s1.2927","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2927","url":null,"abstract":"Context: COVID-19 has posed unique challenges for people experiencing homelessness, who often live in congregate settings and cannot easily follow public health directives like social distancing. Responding to COVID-19 has also taken a psychological toll on frontline healthcare workers. Objective: This study aimed to explore the experiences of people experiencing homelessness and the healthcare workers who cared for them during the early COVID-19 pandemic. Study Design: Qualitative inquiry using a constructivist, interview-based approach and reflexive thematic analysis. Setting: An inner-city hospital in Toronto, Ontario. Population studied: 1) Shelter residents tested for COVID-19 during mobile outreach and 2) Healthcare workers in the COVID-19 testing centre and emergency department who interacted with people experiencing homelessness. Results: Three cross-cutting themes were generated: 1) A collective feeling of ‘Navigating the Unknown’ wherein healthcare workers were challenged with providing a frontline response to a novel virus amidst continuously evolving public health guidelines and patients faced uncertainty about te sting and isolation protocols; 2) A sense of ‘Placelessness’ among patients who were often left with nowhere to go early in the pandemic, unable to return to their shelters because they were awaiting test results or had tested positive and thus needed to stay in impromptu encampment spaces in the ED; and 3) A feeling of ‘Powerlessness’ among patients who lacked agency in their placelessness and among healthcare workers who lacked control in the care they were able to provide. Overall, participants conveyed that COVID-19 exacerbated the vulnerability and displacement of patients experiencing homelessness due to reduced access to public spaces and lack of isolation options early in the pandemic. Witnessing this displacement, and attempting to care for this population amidst resource constraints, led to","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90634135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Context: The COVID-19 pandemic presented new challenges to primary care, but little is known about the experience of practice leaders. Objective: Describe the experience of leaders in a range of primary care delivery organizations leading their teams during the COVID-19 pandemic. Study Design: Qualitative study using semi-structured interviews. Thematic analysis was performed using a hybrid deductive/inductive approach. Sample: Convenience sample of 15 clinical leaders in organizations in the United States that deliver primary care. Organizations included academic health centers, federally qualified health centers, non-academic health systems, and independent private practices. Results: Early in the pandemic, leaders had to make many critical decisions despite substantial uncertainty. Clinicians and staff experienced fear regarding personal health, potential workplace exposures, and job security, while also having a strong sense of purpose and wanting to help with pandemic response. Strategies leaders used to manage teams included 1) Being present, listening, acknowledging uncertainty and showing vulnerability 2) Near constant communication regarding changing conditions, 3) Strengthening trust among team members by building upon prior relationships, and 4) Changing
{"title":"Perspectives of primary care leaders on the challenges and opportunities of leading through the COVID-19 pandemic","authors":"","doi":"10.1370/afm.20.s1.2891","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2891","url":null,"abstract":"Context: The COVID-19 pandemic presented new challenges to primary care, but little is known about the experience of practice leaders. Objective: Describe the experience of leaders in a range of primary care delivery organizations leading their teams during the COVID-19 pandemic. Study Design: Qualitative study using semi-structured interviews. Thematic analysis was performed using a hybrid deductive/inductive approach. Sample: Convenience sample of 15 clinical leaders in organizations in the United States that deliver primary care. Organizations included academic health centers, federally qualified health centers, non-academic health systems, and independent private practices. Results: Early in the pandemic, leaders had to make many critical decisions despite substantial uncertainty. Clinicians and staff experienced fear regarding personal health, potential workplace exposures, and job security, while also having a strong sense of purpose and wanting to help with pandemic response. Strategies leaders used to manage teams included 1) Being present, listening, acknowledging uncertainty and showing vulnerability 2) Near constant communication regarding changing conditions, 3) Strengthening trust among team members by building upon prior relationships, and 4) Changing","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"251 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76310954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cathy F Thorpe, Judith Brown, Saadia Hameed, B. Ryan, A. Terry, Rebecca E. Clark
Context: Several months before the arrival of COVID-19, the province of Ontario began to roll out a new structure of integrated health care delivery. In response, after decades of lacking a cohesive structure, family physicians began to spontaneously form grassroots organizations in order to be engaged in the process of reform. Objective: This study describes the formation and structure of these organizations, and the impact of the COVID-19 pandemic on their development. Study Design: In accordance with Grounded Theory methodology, individual interviews were analyzed, including a constant comparative approach. Setting: Regional health care organizations in Ontario, Canada. Population Studied: A purposive sample of twenty primary care leaders engaged in health system change from across Ontario. Results: While these grassroots organizations assumed different names (e.g., alliance, coalition, collaborative), and varied in their structure (e.g. high/low governance), they shared a common vision of having a strong and unified voice in health system change. Prior to the pandemic, these organizations served as a vehicle to d iscuss shared “pain points” and seek common solutions to local challenges. The declaration of the pandemic mobilized these organizations to respond in several ways. The most important feature was their capacity to rapidly respond at a local level to the pandemic crisis. With lines of communication already established and a foundation of trusting relationships, these organizations acted on requests for PPE, staffing of assessment centres, and created respiratory assessment centres. Participants often noted how the pandemic was a galvanizing agent in the development and engagement of the membership within their organization. Conclusion: Study findings suggest that, while these family medicine organizations came together in response to health care reform in order to create a common voice, the pandemic accelerated not only their value but also the importance of remaining grounded in the needs of their local communities.
{"title":"Primary care collaboratives: Stepping up to the plate during a pandemic","authors":"Cathy F Thorpe, Judith Brown, Saadia Hameed, B. Ryan, A. Terry, Rebecca E. Clark","doi":"10.1370/afm.20.s1.2864","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2864","url":null,"abstract":"Context: Several months before the arrival of COVID-19, the province of Ontario began to roll out a new structure of integrated health care delivery. In response, after decades of lacking a cohesive structure, family physicians began to spontaneously form grassroots organizations in order to be engaged in the process of reform. Objective: This study describes the formation and structure of these organizations, and the impact of the COVID-19 pandemic on their development. Study Design: In accordance with Grounded Theory methodology, individual interviews were analyzed, including a constant comparative approach. Setting: Regional health care organizations in Ontario, Canada. Population Studied: A purposive sample of twenty primary care leaders engaged in health system change from across Ontario. Results: While these grassroots organizations assumed different names (e.g., alliance, coalition, collaborative), and varied in their structure (e.g. high/low governance), they shared a common vision of having a strong and unified voice in health system change. Prior to the pandemic, these organizations served as a vehicle to d iscuss shared “pain points” and seek common solutions to local challenges. The declaration of the pandemic mobilized these organizations to respond in several ways. The most important feature was their capacity to rapidly respond at a local level to the pandemic crisis. With lines of communication already established and a foundation of trusting relationships, these organizations acted on requests for PPE, staffing of assessment centres, and created respiratory assessment centres. Participants often noted how the pandemic was a galvanizing agent in the development and engagement of the membership within their organization. Conclusion: Study findings suggest that, while these family medicine organizations came together in response to health care reform in order to create a common voice, the pandemic accelerated not only their value but also the importance of remaining grounded in the needs of their local communities.","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88592952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathryn Kane, Elisabeth Callen, Melissa K Filippi, Gwendolyn Quintana, Tarin Clay
{"title":"Telehealth in the pandemic: Experiences and perspectives of primary care clinicians","authors":"Kathryn Kane, Elisabeth Callen, Melissa K Filippi, Gwendolyn Quintana, Tarin Clay","doi":"10.1370/afm.20.s1.2744","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2744","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"2052 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86544736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Hirth, Alexandra Ecker, A. Berenson, Sandra Gonzalez, R. Zoorob
{"title":"Understanding mental health among US medical students during the COVID-19 pandemic: Role of primary care providers","authors":"J. Hirth, Alexandra Ecker, A. Berenson, Sandra Gonzalez, R. Zoorob","doi":"10.1370/afm.20.s1.2796","DOIUrl":"https://doi.org/10.1370/afm.20.s1.2796","url":null,"abstract":"","PeriodicalId":10691,"journal":{"name":"Coronavirus Disease 2019 (COVID-19)","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76318645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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