Abstract Background There is concern that the COVID-19 pandemic altered the management of common infections in primary care. This study aimed to evaluate infection-coded consultation rates and antibiotic use during the pandemic and how any change may have affected clinical outcomes. Methods With the approval of NHS England, a retrospective cohort study using the OpenSAFELY platform analysed routinely collected electronic health data from GP practices in England between January 2019 and December 2021. Infection coded consultations and antibiotic prescriptions were used estimate multiple measures over calendar months, including age-sex adjusted prescribing rates, prescribing by infection and antibiotic type, infection consultation rates, coding quality and rate of same-day antibiotic prescribing for COVID-19 infections. Interrupted time series (ITS) estimated the effect of COVID-19 pandemic on infection-coded consultation rates. The impact of the pandemic on non- COVID-19 infection-related hospitalisations was also estimated. Results Records from 24 million patients were included. The rate of infection-related consultations fell for all infections (mean reduction of 39% in 2020 compared to 2019 mean rate), except for UTI which remained stable. Modelling infection-related consultation rates highlighted this with an incidence rate ratio of 0.44 (95% CI 0.36–0.53) for incident consultations and 0.43 (95% CI 0.33–0.54) for prevalent consultations. Lower respiratory tract infections (LRTI) saw the largest reduction of 0.11 (95% CI 0.07–0.17). Antibiotic prescribing rates fell with a mean reduction of 118.4 items per 1000 patients in 2020, returning to pre-pandemic rates by summer 2021. Prescribing for LRTI decreased 20% and URTI increased 15.9%. Over 60% of antibiotics were issued without an associated same-day infection code, which increased during the pandemic. Infection-related hospitalisations reduced (by 62%), with the largest reduction observed for pneumonia infections (72.9%). Same-day antibiotic prescribing for COVID-19 infection increased from 1 to 10.5% between the second and third national lockdowns and rose again during 2022. Conclusions Changes to consultations and hospital admissions may be driven by reduced transmission of non-COVID-19 infections due to reduced social mixing and lockdowns. Inconsistencies in coding practice emphasises the need for improvement to inform new antibiotic stewardship policies and prevent resistance to novel infections. 

The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England

/pdf/paramedicine-literature-search-march-may-2023-28wf2yuf.pdf

Paramedicine Literature Search: March-May 2023

The COVID-19 pandemic has created a worldwide state of emergency, triggering extensive digital innovation within healthcare institutions to recover from the disrupted services caused by the pandemic. The purpose of this research is to explore the phenomena of digital innovation during these extraordinary conditions and to understand the impacts during the pandemic and beyond. To do so, we conducted a systematic literature review by analyzing 130 research articles across research disciplines that were published during the pandemic. We found that the innovation processes were highly iterative and focused on rapid diffusion to address the urgent need for stabilizing and recovering disrupted services. This short-term perspective may result in adverse impacts beyond the pandemic, such as increased inequity. Moreover, we found that some environmental factors were highly adaptive to the pandemic, whereas others were less so. We suggest that organizations should focus on the latter when building resilience to future pandemics. 

Digital Innovation of Healthcare Services in Times of Crisis and Beyond

The COVID-19 pandemic has dramatically impacted the traditional approaches to work. Within the healthcare sector, new and changed ways have created disruptions and challenges; however, opportunities to innovate and disrupt the status quo have also arisen. Our experiences of conducting the independent pan-Wales Welsh Government/NHS Wales COVID-19 Innovation and Transformation Study offer the opportunity to reflect on and evaluate the coronavirus-related challenges within the NHS Wales (NHS-W) and nationally, and how these have been tackled through the multifaceted response and innovation opportunities generated by the health and social care staff of the National Health Service in Wales. Our work has encompassed a multistage design for data collection and analysis, with extensive access to the entirety of the National Health Service in Wales. We also discuss and reflect on the digital transformation of health services and health infrastructure, as well as the many product and process innovation solutions that were devised in the NHS in response to the pandemic. 

Challenges, innovation opportunities, and lessons learned from a prolonged organizational crisis: A case exemplar of the National Health Service Wales

Additional file 1: Table S1. Continued: characteristics of the dynamic study population stratified by year; randomly selecting one observation each year for each unique patient. Figure S1. Monthly rates of coded consultations for six common infections per 1000 registered patients. Showing incident (A) and prevalent (B) consultations. Grey shading represents England national lockdown periods. Data from approximately 2544 TTP practices. – 50th percentile–25th and 75th percentiles. Figure S2. Monthly prevalent consultation rates per 1000 registered patients, stratified by common infections. Grey shading represents England national lockdown periods. Data from approximately 2544 TTP practices. Dotted lines indicate observation counts &lt; 5. Figure S3. The proportion of infection coded consultations that resulted in an antibiotic prescription on the (A) same day, or (B) within +/- 7 days. Figure represents all prevalent consultations. For prevalent consultations see Supplementary Figure 3. Grey shading represents England national lockdown periods. Figure S4. the top five antibiotic types prescribed for six common infections for prevalent consultations. Data represents consultations that resulted in an antibiotic prescription. Grey shading represents England national lockdown periods. Figure S5. The rate of infection-related hospital admissions over calendar time. 

Additional file 1 of The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England

Objectives Allied Health Professionals (AHP) consist of 13 different specialty roles in Wales, sharing the responsibility of promoting and supporting the health and well-being of the population. During the COVID-19 pandemic, there was a shift in care provision, with the increased use of online consultations, such as those using video consultation platforms. However, this shift was associated with uncertainty and hesitancy, and, thus, to understand the usage and reasons for using video consultations, this study aimed to capture the experiences of both AHP and their patients, while investigating each role individually. Participants A survey was distributed to and completed by n=8928 patients and n=4974 clinicians, all AHP were included except for orthoptists and paramedics due to ambiguities in the data. A further 86 clinicians participated in phone interviews. Results All professions had a high prevention of face-to-face with the use of video consultations (68.6% overall and 81.4% of clinicians reported the prevention). However, this was lower for certain professions such as podiatrists, potentially due to the specific patient needs, such as physical assessments. Also, a range of different appointment types were being conducted, and there was a high acceptance of these alternative methods among participants. The interviews with clinicians revealed five important aspects of video consultations: the perceived benefits, the perceived challenges, technology issues and necessary improvements, clinician preference and the future of video consulting. Specifically, the future of video consulting evidenced clinicians’ desire for a blended approach to working, selecting the appropriate modality depending on the situation and patient-specific needs. Conclusions Integrating the traditional methods of service delivery (face-to-face), and novel, innovative ways, such as video consultations, can motivate positive transformations for the efficiency and efficacy of health and social care.

/pdf/online-survey-and-interview-evaluation-to-explore-the-use-of-lf0wjwib.pdf

Online survey and interview evaluation to explore the use of video consulting among Allied Health Professionals during the COVID-19 pandemic

To assess patient and clinician satisfaction and identify any differences between the two with the use of video consulting (VC) in the fields of obstetrics and gynaecology (O&G) and fertility in Wales.A retrospective electronic survey study.All public hospitals in Wales that used virtual methods for delivery of fertility and/or O&G appointments during and after the COVID‐19 pandemic between August 2020 and March 2022.Patients awaiting an appointment on the National Health Service, who have attended virtual fertility or O&G appointments in Wales, and fertility and O&G clinicians who have conducted appointments virtually.Analysis of patient and clinician responses to a VC satisfaction survey delivered after their consultation taking place between August 2020 and March 2022.Patient and clinician satisfaction rates with the use of virtual consultation in fertility and O&G appointments.In satisfaction data collected from 420 patients and 161 clinicians, 83% of patients and 63% of clinicians reported their VC quality to be ‘very good’ or ‘excellent’. Difficulties when using VC were experienced by a minority of patients (1%–9%) and clinicians (1%–8%) and most patients (52v82%) and clinicians (34%–67%) found several aspects of VC to be ‘very beneficial’. Fertility patients rated their VC experience more positively than O&G patients.Most patients and clinicians were satisfied with their VC experience. Patients were more satisfied with the use of VC than clinicians. Fertility patients were more satisfied with the use of VC than O&G patients.

Virtual consultation (VC) in fertility and obstetrics and gynaecology services: An analysis of patient and clinician satisfaction

Background: The use of video consulting (VC) in Wales, United Kingdom (UK) has expanded rapidly during the COVID-19 pandemic. Traditionally, VC has been the subject of small-scale projects and evaluations. In response to the pandemic emergency, there was an opportunity to roll out and evaluate VC on a larger and more representative scale, across a wider range of National Health Service (NHS) specialities. Aims: This paper presents an overview of a dataset captured by the ‘The NHS Wales VC Service’. The purpose of this study was to capture perspectives of healthcare professionals only (including clinicians, administration and management) on the use of VC and explore lessons learnt from the national implementation process. Methodology: Using an online, mixed methods retrospective survey capturing descriptive and narrative data. Results: A total of 1256 NHS healthcare professionals shared their VC experience. Overall, responses were positive, and healthcare professionals expressed optimistic views regarding the use, value and benefit of VC, even when faced with challenges on occasions. Conclusions: A lesson learnt, is that difference occurs in innovation, even in a small country like Wales, yet it is not necessarily a negative outcome, but rather, respecting and incorporating difference, can improve long-term sustainability.

https://journals.sagepub.com/doi/pdf/10.1177/14604582211069030

Early evidence and lessons learnt from an NHS Wales Video Consulting Service

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Online survey and interview evaluation to explore the use of video consulting among Allied Health Professionals during the COVID-19 pandemic

Virtual consultation (VC) in fertility and obstetrics and gynaecology services: An analysis of patient and clinician satisfaction

Early evidence and lessons learnt from an NHS Wales Video Consulting Service