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Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK.

Joy, M; McGagh, D; Jones, N; Liyanage, H; Sherlock, J; Parimalanathan, V; Akinyemi, O; ... de Lusignan, S; + view all (2020) Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK. British Journal of General Practice , 70 (697) e540-e547. 10.3399/bjgp20X710933. Green open access

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Abstract

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a rapid change in workload across healthcare systems. Factors related to this adaptation in UK primary care have not yet been examined. AIM: To assess the responsiveness and prioritisation of primary care consultation type for older adults during the COVID-19 pandemic. DESIGN AND SETTING: A cross-sectional database study examining consultations between 17 February and 10 May 2020 for patients aged ≥65 years, drawn from primary care practices within the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network, UK. METHOD: The authors reported the proportion of consultation type across five categories: clinical administration, electronic/video, face-to-face, telephone, and home visits. Temporal trends in telephone and face-to-face consultations were analysed by polypharmacy, frailty status, and socioeconomic group using incidence rate ratios (IRR). RESULTS: Across 3 851 304 consultations, the population median age was 75 years (interquartile range [IQR] 70-82); and 46% (n = 82 926) of the cohort (N = 180 420) were male. The rate of telephone and electronic/video consultations more than doubled across the study period (106.0% and 102.8%, respectively). Face-to-face consultations fell by 64.6% and home visits by 62.6%. This predominantly occurred across week 11 (week commencing 9 March 2020), coinciding with national policy change. Polypharmacy and frailty were associated with a relative increase in consultations. The greatest relative increase was among people taking ≥10 medications compared with those taking none (face-to-face IRR 9.90, 95% CI = 9.55 to 10.26; telephone IRR 17.64, 95% CI = 16.89 to 18.41). CONCLUSION: Primary care has undergone an unprecedented in-pandemic reorganisation while retaining focus on patients with increased complexity.

Type: Article
Title: Reorganisation of primary care for older adults during COVID-19: a cross-sectional database study in the UK.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.3399/bjgp20X710933
Publisher version: https://doi.org/10.3399/bjgp20X710933
Language: English
Additional information: © The Authors. This article is Open Access: CC BY 4.0 licence (http://creativecommons.org/licences/by/4.0/).
Keywords: COVID-19, frailty, polypharmacy, remote consultation, workload
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health
URI: https://discovery.ucl.ac.uk/id/eprint/10108054
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