Pub Date : 2024-09-30DOI: 10.1038/s41533-024-00384-9
Joseph David Clark, Kate Binnie, Maddie Bond, Michael Crooks, David C Currow, Jordan Curry, Helen Elsey, Monsur Habib, Ann Hutchinson, Ireneous Soyiri, Miriam J Johnson, Shreya Nair, Seema Rao, Noemia Siqueira-Filha, Anna Spathis, Siân Williams
{"title":"Breathlessness without borders: a call to action for global breathlessness research.","authors":"Joseph David Clark, Kate Binnie, Maddie Bond, Michael Crooks, David C Currow, Jordan Curry, Helen Elsey, Monsur Habib, Ann Hutchinson, Ireneous Soyiri, Miriam J Johnson, Shreya Nair, Seema Rao, Noemia Siqueira-Filha, Anna Spathis, Siân Williams","doi":"10.1038/s41533-024-00384-9","DOIUrl":"10.1038/s41533-024-00384-9","url":null,"abstract":"","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1038/s41533-024-00385-8
Martin Chapman, Stevo Durbaba, Florence Tydeman, Matt Friend, Laura Duly, Julie Moore, Vasa Curcin, Yanzhong Wang, Caroline J Jolley, Georgios Kaltsakas, Trudie Chalder, Nicholas Hart, Mark Ashworth
Once the nature and number of patients with Long COVID was more fully understood, UK secondary care developed services to investigate, treat and support these patients. We aimed to identify evidence for demographic health inequalities based on general practitioner (GP) Long COVID referrals to available secondary care services. Despite Long COVID demographics broadly reflecting the multiethnic and socially disadvantaged profile of the study population, we found that secondary care referral was mainly focussed on older age patients and those born in the UK with co-morbid anxiety; although co-morbid diabetes was associated with reduced referrals.
一旦对长COVID患者的性质和数量有了更全面的了解,英国的二级医疗机构就会开发相关服务来调查、治疗和支持这些患者。我们的目标是根据全科医生(GP)将长COVID患者转介到现有二级医疗服务机构的情况,找出人口健康不平等的证据。尽管 Long COVID 的人口统计学特征大致反映了研究人群的多种族和社会弱势群体特征,但我们发现二级医疗转诊主要集中在老年患者和在英国出生并合并焦虑症的患者;尽管合并糖尿病与转诊减少有关。
{"title":"Long COVID demographic and secondary care referral characteristics in primary care: analysis of anonymised primary care data from a multiethnic, deprived urban area in the UK.","authors":"Martin Chapman, Stevo Durbaba, Florence Tydeman, Matt Friend, Laura Duly, Julie Moore, Vasa Curcin, Yanzhong Wang, Caroline J Jolley, Georgios Kaltsakas, Trudie Chalder, Nicholas Hart, Mark Ashworth","doi":"10.1038/s41533-024-00385-8","DOIUrl":"10.1038/s41533-024-00385-8","url":null,"abstract":"<p><p>Once the nature and number of patients with Long COVID was more fully understood, UK secondary care developed services to investigate, treat and support these patients. We aimed to identify evidence for demographic health inequalities based on general practitioner (GP) Long COVID referrals to available secondary care services. Despite Long COVID demographics broadly reflecting the multiethnic and socially disadvantaged profile of the study population, we found that secondary care referral was mainly focussed on older age patients and those born in the UK with co-morbid anxiety; although co-morbid diabetes was associated with reduced referrals.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142351132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-06DOI: 10.1038/s41533-024-00383-w
Craig Mortimer, Dimitra Nikoletou, Ann Ooms, Julia Williams
The heterogeneous nature of asthma results in a wide range of presentations during exacerbation. Despite UK pre-hospital management guidelines focusing on β₂ agonists, variables such as cause, severity, underlying health, comorbidities, and drug side effects can often make emergency treatment optimisation difficult. This article examines paramedics' methods of observing, perceiving, interpreting, and treating asthma with β₂ agonists, often acting on limited information in rapidly evolving situations. We recruited paramedics from a single UK National Health Service ambulance Trust for qualitative semi-structured interviews. Responses underwent framework analysis to identify data similarities and differences. Fifteen qualitative interviews with paramedics revealed three main themes affecting patient management: clinician experience of presentation, adaptation of patient management approaches, and severity of side effects. Paramedics felt their ability to manage various asthma presentations was enhanced through guideline adaptation based on their own clinical experience and understanding of β₂ agonist side effects, allowing tailored responses based on a set of reinforcing factors. Inductive analysis revealed additional complexities within these themes, such as anxiety and diabetes, which may influence β₂ agonist administration and result in multiple care pathways being initiated during exacerbation. Paramedic care mirrors asthma's complexity, accounting for a range of characteristics. A dynamic, critically thought approach enables patient management to be based on the presenting conditions rather than strict adherence to a single algorithm. Comprehending the complexities and variables in treatment can be crucial to how paramedics rationalise their treatment and optimise the care provided.
{"title":"Clinical reasoning amongst paramedics using nebulised β₂ agonists to treat acute asthma exacerbations: a qualitative study.","authors":"Craig Mortimer, Dimitra Nikoletou, Ann Ooms, Julia Williams","doi":"10.1038/s41533-024-00383-w","DOIUrl":"10.1038/s41533-024-00383-w","url":null,"abstract":"<p><p>The heterogeneous nature of asthma results in a wide range of presentations during exacerbation. Despite UK pre-hospital management guidelines focusing on β₂ agonists, variables such as cause, severity, underlying health, comorbidities, and drug side effects can often make emergency treatment optimisation difficult. This article examines paramedics' methods of observing, perceiving, interpreting, and treating asthma with β₂ agonists, often acting on limited information in rapidly evolving situations. We recruited paramedics from a single UK National Health Service ambulance Trust for qualitative semi-structured interviews. Responses underwent framework analysis to identify data similarities and differences. Fifteen qualitative interviews with paramedics revealed three main themes affecting patient management: clinician experience of presentation, adaptation of patient management approaches, and severity of side effects. Paramedics felt their ability to manage various asthma presentations was enhanced through guideline adaptation based on their own clinical experience and understanding of β₂ agonist side effects, allowing tailored responses based on a set of reinforcing factors. Inductive analysis revealed additional complexities within these themes, such as anxiety and diabetes, which may influence β₂ agonist administration and result in multiple care pathways being initiated during exacerbation. Paramedic care mirrors asthma's complexity, accounting for a range of characteristics. A dynamic, critically thought approach enables patient management to be based on the presenting conditions rather than strict adherence to a single algorithm. Comprehending the complexities and variables in treatment can be crucial to how paramedics rationalise their treatment and optimise the care provided.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-20DOI: 10.1038/s41533-024-00382-x
Mark L Levy, Janwillem W H Kocks, Sinthia Bosnic-Anticevich, Guilherme Safioti, Michael Reich, Michael Depietro, Mario Castro, Nabeel Farooqui, Njira L Lugogo, Randall Brown, Tanisha Hill, Thomas Li, Henry Chrystyn
Electronic inhalers provide information about patterns of routine inhaler use. During a 12-week study, 360 asthma patients using albuterol Digihaler generated 53,083 inhaler events that were retrospectively analyzed. A total of 41,528 (78%) of the recorded inhalation events were suitable for flow analysis (having a PIF ≥ 18 L/min and <120 L/min). Median PIF, inhalation volume, inhalation duration, and time to PIF for these events steadily decreased between the first and last 10 days of the study, by 5.1%, 12.6%, 15.9%, and 6.4%, respectively. Continuous short-acting beta2-agonist (SABA) overuse, defined as ≥2 SABA inhalations/week throughout the study period, was seen in 29% (n = 104) of patients. Of 260 patients with ≥1 instance of acute short-term SABA overuse, 55 (21%) had a confirmed exacerbation. Electronic recording of real-life inhaler use can capture valuable, objective information that could inform disease management and clinical decision-making.
{"title":"Uncovering patterns of inhaler technique and reliever use: the value of objective, personalized data from a digital inhaler.","authors":"Mark L Levy, Janwillem W H Kocks, Sinthia Bosnic-Anticevich, Guilherme Safioti, Michael Reich, Michael Depietro, Mario Castro, Nabeel Farooqui, Njira L Lugogo, Randall Brown, Tanisha Hill, Thomas Li, Henry Chrystyn","doi":"10.1038/s41533-024-00382-x","DOIUrl":"10.1038/s41533-024-00382-x","url":null,"abstract":"<p><p>Electronic inhalers provide information about patterns of routine inhaler use. During a 12-week study, 360 asthma patients using albuterol Digihaler generated 53,083 inhaler events that were retrospectively analyzed. A total of 41,528 (78%) of the recorded inhalation events were suitable for flow analysis (having a PIF ≥ 18 L/min and <120 L/min). Median PIF, inhalation volume, inhalation duration, and time to PIF for these events steadily decreased between the first and last 10 days of the study, by 5.1%, 12.6%, 15.9%, and 6.4%, respectively. Continuous short-acting beta<sub>2</sub>-agonist (SABA) overuse, defined as ≥2 SABA inhalations/week throughout the study period, was seen in 29% (n = 104) of patients. Of 260 patients with ≥1 instance of acute short-term SABA overuse, 55 (21%) had a confirmed exacerbation. Electronic recording of real-life inhaler use can capture valuable, objective information that could inform disease management and clinical decision-making.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11336086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1038/s41533-024-00380-z
Giseth Bustos, Marcos A Sanchez-Gonzalez, Troy Grogan, Adriana Bonansea-Frances, Camysha Wright, Frank Lichtenberger, Syed A A Rizvi, Alan Kaplan
{"title":"Improving allergy management and treatment: a proposed algorithm and curriculum for prescribing allergen immunotherapy in the primary care setting.","authors":"Giseth Bustos, Marcos A Sanchez-Gonzalez, Troy Grogan, Adriana Bonansea-Frances, Camysha Wright, Frank Lichtenberger, Syed A A Rizvi, Alan Kaplan","doi":"10.1038/s41533-024-00380-z","DOIUrl":"10.1038/s41533-024-00380-z","url":null,"abstract":"","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-18DOI: 10.1038/s41533-024-00381-y
Alvar Agusti, Peter G Gibson, Liam G Heaney, Mike Thomas
Despite great advancements in the treatment of chronic airway diseases, improvements in morbidity and mortality have stalled in recent years. Asthma and chronic obstructive pulmonary disease are complex and heterogeneous diseases that require tailored management based on individual patient characteristics and needs. The Treatable Traits (TTs) approach aims to personalise and improve patient care through the identification and targeting of clinically relevant and modifiable pulmonary, extra-pulmonary and behavioural traits. In this article, we outline the rationale for TTs-based management and provide practical guidance for its application in primary care. To aid implementation, seven potential 'prime' traits are proposed: airflow obstruction, eosinophilic inflammation, adherence, inhaler technique, smoking, low body mass index/obesity and anxiety and depression-selected for their prevalence, recognisability and feasibility of use. Some of the key questions among healthcare professionals, that may be roadblocks to widespread application of a TTs model of care, are also addressed.
{"title":"Change is in the air: key questions on the 'Treatable Traits' model for chronic airway diseases in primary care.","authors":"Alvar Agusti, Peter G Gibson, Liam G Heaney, Mike Thomas","doi":"10.1038/s41533-024-00381-y","DOIUrl":"10.1038/s41533-024-00381-y","url":null,"abstract":"<p><p>Despite great advancements in the treatment of chronic airway diseases, improvements in morbidity and mortality have stalled in recent years. Asthma and chronic obstructive pulmonary disease are complex and heterogeneous diseases that require tailored management based on individual patient characteristics and needs. The Treatable Traits (TTs) approach aims to personalise and improve patient care through the identification and targeting of clinically relevant and modifiable pulmonary, extra-pulmonary and behavioural traits. In this article, we outline the rationale for TTs-based management and provide practical guidance for its application in primary care. To aid implementation, seven potential 'prime' traits are proposed: airflow obstruction, eosinophilic inflammation, adherence, inhaler technique, smoking, low body mass index/obesity and anxiety and depression-selected for their prevalence, recognisability and feasibility of use. Some of the key questions among healthcare professionals, that may be roadblocks to widespread application of a TTs model of care, are also addressed.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11258123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-16DOI: 10.1038/s41533-024-00370-1
Frances Early, James Ward, Alexander Komashie, Timoleon Kipouros, John Clarkson, Jonathan Fuld
Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.
{"title":"A systems approach to developing user requirements for increased pulmonary rehabilitation uptake by COPD patients.","authors":"Frances Early, James Ward, Alexander Komashie, Timoleon Kipouros, John Clarkson, Jonathan Fuld","doi":"10.1038/s41533-024-00370-1","DOIUrl":"10.1038/s41533-024-00370-1","url":null,"abstract":"<p><p>Chronic Obstructive Pulmonary Disease is a progressive lung disease associated with anxiety, depression, and reduced health-related quality of life. Pulmonary rehabilitation (PR) is a cost-effective and transformative treatment, but 31% of referred patients do not take up their PR appointment. The study aimed to develop user requirements for an intervention to increase PR uptake. A systems approach, the Engineering Better Care framework, was used to develop a system map of the PR pathway, translate evidence-based user needs into user requirements, and validate the user requirements in a stakeholder workshop. Eight user requirements addressed patient and health care practitioner needs to understand what PR entails, understand the benefits of PR and have positive conversations about PR to address patient concerns. The solution-independent user requirements can be applied to the development of any intervention sharing similar goals. The study demonstrates potential in taking a systems approach to more challenges within respiratory medicine.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11252258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.1038/s41533-024-00376-9
M G Crooks, H Cummings, A H Morice, D Sykes, S Brooks, A Jackson, Y Xu
{"title":"Author Correction: Reducing short-acting beta-agonist use in asthma: Impact of national incentives on prescribing practices in England and the findings from SENTINEL Plus early adopter sites.","authors":"M G Crooks, H Cummings, A H Morice, D Sykes, S Brooks, A Jackson, Y Xu","doi":"10.1038/s41533-024-00376-9","DOIUrl":"10.1038/s41533-024-00376-9","url":null,"abstract":"","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1038/s41533-024-00377-8
Mome Mukherjee, Cecilia Okusi, Gavin Jamie, Rachel Byford, Filipa Ferreira, Monica Fletcher, Simon de Lusignan, Aziz Sheikh
Every year, there are ~100,000 hospital admissions for asthma in the UK, many of which are potentially preventable. Evidence suggests that carefully conceptualised and implemented audit and feedback (A&F) cycles have the potential to improve clinical outcomes for those with chronic conditions. We wanted to investigate the technical feasibility of developing a near-real time asthma dashboard to support A&F interventions for asthma management in primary care. We extracted cross-sectional data on asthma from 756 participating GP practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database in England comprising 7.6 million registered people. Summary indicators for a GP practice were compared to all participating RCGP RSC practices using practice-level data, for the week 6-12th-Mar-2023. A weekly, automated asthma dashboard with features that can support electronic-A&F cycles that compared key asthma indicators for a GP practice to RCGP RSC could be created ( https://tinyurl.com/3ydtrt85 ): 12-weeks-incidence 0.4% vs 0.4%, annual prevalence 6.1% vs 6.7%, inhaled relievers to preventer 1.2 vs 1.1, self-management plan given 83.4% vs 60.8%, annual reviews 36.8% vs 57.3%, prednisolone prescriptions 2.0% vs 3.2%, influenza vaccination 56.6% vs 55.5%, pneumococcal vaccination ever (aged ≥65 years) 90.2% vs 84.1% and current smokers 14.9% vs 14.8%. Across the RCGP RSC, the rate of hospitalisations was 0.024%; comparative data had to be suppressed for the study practice because of small numbers. We have successfully created an automated near real-time asthma dashboard that can be used to support A&F initiatives to improve asthma care and outcomes in primary care.
在英国,每年约有 10 万人因哮喘入院治疗,其中很多都是可以预防的。有证据表明,精心构思和实施的审核与反馈(A&F)周期有可能改善慢性病患者的临床疗效。我们希望研究开发近实时哮喘仪表板的技术可行性,以支持初级保健中哮喘管理的 A&F 干预措施。我们从英国牛津大学-皇家全科医师学院研究与监测中心(RCGP RSC)数据库中的 756 个参与全科医生诊所(包括 760 万注册患者)中提取了有关哮喘的横断面数据。利用实践层面的数据,将一家全科医生诊所在2023年3月6日至12日这一周的汇总指标与所有参与RCGP RSC的诊所进行比较。可创建每周自动哮喘仪表板,其功能可支持电子-A&F 循环,将全科医生诊所与 RCGP RSC 的主要哮喘指标进行比较 ( https://tinyurl.com/3ydtrt85 ):12 周发病率为 0.4% vs 0.4%,年发病率为 6.1% vs 6.7%,吸入缓解剂与预防剂的比例为 1.2 vs 1.1,自我管理计划的提供率为 83.4% vs 60.8%,年度复查率为 36.8% vs 57.3%,泼尼松龙处方率为 2.0% vs 3.2%,流感疫苗接种率为 56.6% vs 55.5%,曾经接种过肺炎球菌疫苗(年龄≥65 岁)的比例为 90.2% vs 84.1%,当前吸烟者比例为 14.9% vs 14.8%。在整个 RCGP RSC 中,住院率为 0.024%;由于人数较少,研究实践中的比较数据不得不被抑制。我们成功创建了一个近乎实时的自动化哮喘仪表板,可用于支持 A&F 计划,以改善初级医疗中的哮喘护理和治疗效果。
{"title":"Deploying an asthma dashboard to support quality improvement across a nationally representative sentinel network of 7.6 million people in England.","authors":"Mome Mukherjee, Cecilia Okusi, Gavin Jamie, Rachel Byford, Filipa Ferreira, Monica Fletcher, Simon de Lusignan, Aziz Sheikh","doi":"10.1038/s41533-024-00377-8","DOIUrl":"10.1038/s41533-024-00377-8","url":null,"abstract":"<p><p>Every year, there are ~100,000 hospital admissions for asthma in the UK, many of which are potentially preventable. Evidence suggests that carefully conceptualised and implemented audit and feedback (A&F) cycles have the potential to improve clinical outcomes for those with chronic conditions. We wanted to investigate the technical feasibility of developing a near-real time asthma dashboard to support A&F interventions for asthma management in primary care. We extracted cross-sectional data on asthma from 756 participating GP practices in the Oxford-Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) database in England comprising 7.6 million registered people. Summary indicators for a GP practice were compared to all participating RCGP RSC practices using practice-level data, for the week 6-12th-Mar-2023. A weekly, automated asthma dashboard with features that can support electronic-A&F cycles that compared key asthma indicators for a GP practice to RCGP RSC could be created ( https://tinyurl.com/3ydtrt85 ): 12-weeks-incidence 0.4% vs 0.4%, annual prevalence 6.1% vs 6.7%, inhaled relievers to preventer 1.2 vs 1.1, self-management plan given 83.4% vs 60.8%, annual reviews 36.8% vs 57.3%, prednisolone prescriptions 2.0% vs 3.2%, influenza vaccination 56.6% vs 55.5%, pneumococcal vaccination ever (aged ≥65 years) 90.2% vs 84.1% and current smokers 14.9% vs 14.8%. Across the RCGP RSC, the rate of hospitalisations was 0.024%; comparative data had to be suppressed for the study practice because of small numbers. We have successfully created an automated near real-time asthma dashboard that can be used to support A&F initiatives to improve asthma care and outcomes in primary care.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11217285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141477093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1038/s41533-024-00374-x
Holly Tibble, Tanja Mueller, Euan Proud, Elliott Hall, Amanj Kurdi, Chris Robertson, Marion Bennie, Lana Woolford, Lynn Laidlaw, Kamil Sterniczuk, Aziz Sheikh
We sought to investigate the incidence of severe COVID-19 outcomes after treatment with antivirals and neutralising monoclonal antibodies, and estimate the comparative effectiveness of treatments in community-based individuals. We conducted a retrospective cohort study investigating clinical outcomes of hospitalisation, intensive care unit admission and death, in those treated with antivirals and monoclonal antibodies for COVID-19 in Scotland between December 2021 and September 2022. We compared the effect of various treatments on the risk of severe COVID-19 outcomes, stratified by most prevalent sub-lineage at that time, and controlling for comorbidities and other patient characteristics. We identified 14,365 individuals treated for COVID-19 during our study period, some of whom were treated for multiple infections. The incidence of severe COVID-19 outcomes (inpatient admission or death) in community-treated patients (81% of all treatment episodes) was 1.2% (n = 137/11894, 95% CI 1.0-1.4), compared to 32.8% in those treated in hospital for acute COVID-19 (re-admissions or death; n = 40/122, 95% CI 25.1-41.5). For community-treated patients, there was a lower risk of severe outcomes (inpatient admission or death) in younger patients, and in those who had received three or more COVID-19 vaccinations. During the period in which BA.2 was the most prevalent sub-lineage in the UK, sotrovimab was associated with a reduced treatment effect compared to nirmaltrelvir + ritonavir. However, since BA.5 has been the most prevalent sub-lineage in the UK, both sotrovimab and nirmaltrelvir + ritonavir were associated with similarly lower incidence of severe outcomes than molnupiravir. Around 1% of those treated for COVID-19 with antivirals or neutralising monoclonal antibodies required hospital admission. During the period in which BA.5 was the prevalent sub-lineages in the UK, molnupiravir was associated with the highest incidence of severe outcomes in community-treated patients.
{"title":"Real-world severe COVID-19 outcomes associated with use of antivirals and neutralising monoclonal antibodies in Scotland.","authors":"Holly Tibble, Tanja Mueller, Euan Proud, Elliott Hall, Amanj Kurdi, Chris Robertson, Marion Bennie, Lana Woolford, Lynn Laidlaw, Kamil Sterniczuk, Aziz Sheikh","doi":"10.1038/s41533-024-00374-x","DOIUrl":"https://doi.org/10.1038/s41533-024-00374-x","url":null,"abstract":"<p><p>We sought to investigate the incidence of severe COVID-19 outcomes after treatment with antivirals and neutralising monoclonal antibodies, and estimate the comparative effectiveness of treatments in community-based individuals. We conducted a retrospective cohort study investigating clinical outcomes of hospitalisation, intensive care unit admission and death, in those treated with antivirals and monoclonal antibodies for COVID-19 in Scotland between December 2021 and September 2022. We compared the effect of various treatments on the risk of severe COVID-19 outcomes, stratified by most prevalent sub-lineage at that time, and controlling for comorbidities and other patient characteristics. We identified 14,365 individuals treated for COVID-19 during our study period, some of whom were treated for multiple infections. The incidence of severe COVID-19 outcomes (inpatient admission or death) in community-treated patients (81% of all treatment episodes) was 1.2% (n = 137/11894, 95% CI 1.0-1.4), compared to 32.8% in those treated in hospital for acute COVID-19 (re-admissions or death; n = 40/122, 95% CI 25.1-41.5). For community-treated patients, there was a lower risk of severe outcomes (inpatient admission or death) in younger patients, and in those who had received three or more COVID-19 vaccinations. During the period in which BA.2 was the most prevalent sub-lineage in the UK, sotrovimab was associated with a reduced treatment effect compared to nirmaltrelvir + ritonavir. However, since BA.5 has been the most prevalent sub-lineage in the UK, both sotrovimab and nirmaltrelvir + ritonavir were associated with similarly lower incidence of severe outcomes than molnupiravir. Around 1% of those treated for COVID-19 with antivirals or neutralising monoclonal antibodies required hospital admission. During the period in which BA.5 was the prevalent sub-lineages in the UK, molnupiravir was associated with the highest incidence of severe outcomes in community-treated patients.</p>","PeriodicalId":19470,"journal":{"name":"NPJ Primary Care Respiratory Medicine","volume":null,"pages":null},"PeriodicalIF":3.1,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11213868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141469743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}