Evaluating the Appropriateness of Antibiotic Treatment of Tonsillitis during COVID-19 in the North Wale Primary Healthcare Setting

Li, Chunhei; Ong, Caitlin; Morris, Anna; Woollons, Isobel; Ashfaq, Ahsan; Jagatia, Rikesh

doi:10.1177/21501327211003687

Cited by 7 publications

(13 citation statements)

References 13 publications

(21 reference statements)

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“…Of these, 3 were systematic reviews (SRs) [11][12][13] and 8 were non-randomized comparative studies. 8,10,[14][15][16][17][18][19] For additional information, 7 publications from the grey literature search [20][21][22][23][24][25][26] were also included. Altogether, 18 publications were included to address the research questions; of these, 7 were evaluation guidance documents being used in various countries to evaluate virtual care in primary care settings and 11 were evaluations of virtual care in primary care settings.…”

Section: Resultsmentioning

confidence: 99%

“…12 Li et al ( 2021) evaluated the appropriateness of prescribing with compliance to the recommendation of the clinical scale scores Centor or FeverPAIN in tonsillitis, for which the scoring system usage rate was significantly higher in the remote consultation group compared to the face-to-face group (P = 0.0415). 10 During remote consultation, 51 out of 67 (76.1%) prescriptions complied with the Centor and FeverPAIN recommendation and were deemed appropriate, but 16 out of 24 (66.7%) did not comply and were inappropriate.…”

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

“…10,11 These evaluations referred to the comparator as face-to-face visits; although the authors did not specify that these were in-person visits, other information provided in the articles suggested that the face-to-face visits were predominantly or entirely conducted in person, which supported their inclusion in this ES. Namely, Li et al (2021) noted that face-to-face consultations largely facilitated visits before the COVID-19 pandemic, with the comparator group referred to as remote consultations, and Han et al (2020) noted that video modalities were included in the remote consultation group (comparator of the faceto-face group). 10,11 The virtual care (intervention) and comparator terms used in the source publications of the included evaluation guidance documents and evaluations are detailed in Table 4 and Table 5, respectively.…”

Section: Synthesis Approachmentioning

confidence: 99%

“…Namely, Li et al (2021) noted that face-to-face consultations largely facilitated visits before the COVID-19 pandemic, with the comparator group referred to as remote consultations, and Han et al (2020) noted that video modalities were included in the remote consultation group (comparator of the faceto-face group). 10,11 The virtual care (intervention) and comparator terms used in the source publications of the included evaluation guidance documents and evaluations are detailed in Table 4 and Table 5, respectively. Extracted information from the evaluation guidance documents were paraphrased and summarized with the document-specific terminology and distinct statements reported in italics or with quotations and references to the page number from the source document.…”

Section: Synthesis Approachmentioning

confidence: 99%

“…Differences in appropriate and inappropriate prescriptions between remote consultation and face-to-face groups were not statistically significant. 10 Of note, what constituted remote and face-to-face appointments were not reported; thus, it is presumed that remote refers to virtual care and face-to-face care were in-person appointments.…”

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

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Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

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A literature search informed this Environmental Scan and identified 11 evaluations of virtual care in primary care health settings and 7 publications alluding to methods, standards, and guidelines (referred to as evaluation guidance documents in this report) being used in various countries to evaluate virtual care in primary care health settings. The majority of included literature was from Australia, the US, and the UK, with 2 evaluation guidance documents published by the Heart and Stroke Foundation of Canada. Evaluation guidance documents recommended using measurements that assess the effectiveness and quality of clinical care including safety outcomes, time and travel, financial and operational impact, participation, health care utilization, technology experience including feasibility, user satisfaction, and barriers and facilitators or measures of health equity. Evaluation guidance documents specified that the following key decisions and considerations should be integrated into the planning of a virtual care evaluation: refining the scope of virtual care services; selecting an appropriate meaningful comparator; and identifying opportune timing and duration for the evaluation to ensure the evaluation is reflective of real-world practice, allows for adequate measurement of outcomes, and is comprehensive, timely, feasible, non-complex, and non–resource-intensive. Evaluation guidance documents highlighted that evaluations should be systematic, performed regularly, and reflect the stage of virtual care implementation to encompass the specific considerations associated with each stage. Additionally, evaluations should assess individual virtual care sessions and the virtual care program as a whole. Regarding economic components of virtual care evaluations, the evaluation guidance documents noted that costs or savings are not limited to monetary or financial measures but can also be represented with time. Cost analyses such as cost-benefit and cost-utility estimates should be performed with a specific emphasis on selecting an appropriate perspective (e.g., patient or provider), as that influences the benefits, effects, and how the outcome is interpreted. Two identified evaluations assessed economic outcomes through cost analyses in the perspective of the patient and provider. Evidence suggests that, in some circumstances, virtual care may be more cost-effective and reduces the cost per episode and patient expenses (e.g., travel and parking costs) compared to in-person care. However, virtual care may increase the number of individuals treated, which would increase overall health care spending. Four identified evaluations assessed health care utilization. The evidence suggests that virtual care reduces the duration of appointments and may be more time-efficient compared to in-person care. However, it is unclear if virtual care reduces the use of medical resources and the need for follow-up appointments, hospital admissions, and emergency department visits compared to in-person care. Five identified evaluations assessed participation outcomes. Evidence was variable, with some evidence reporting that virtual care reduced attendance (e.g., reduced attendance rates) and other evidence noting improved attendance (e.g., increased completion rate and decreased cancellations and no-show rates) compared to in-person care. Three identified evaluations assessed clinical outcomes in various health contexts. Some evidence suggested that virtual care improves clinical outcomes (e.g., in primary care with integrated mental health services, symptom severity decreased) or has a similar effect on clinical outcomes compared to in-person care (e.g., use of virtual care in depression elicited similar results with in-person care). Three identified evaluations assessed the appropriateness of prescribing. Some studies suggested that virtual care improves appropriateness by increasing guideline-based or guideline-concordant antibiotic management, or elicits no difference with in-person care.

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Section: Resultsmentioning

confidence: 99%

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

Section: Synthesis Approachmentioning

confidence: 99%

Section: Synthesis Approachmentioning

confidence: 99%

Section: Evaluations Reporting Prescription Outcomesmentioning

confidence: 99%

See 3 more Smart Citations

Approaches to Evaluations of Virtual Care in Primary Care

Hui¹,

Dolcine²,

Loshak³

2022

cjht

View full text Add to dashboard Cite

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Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany

Windfuhr

Günster

2022

Eur Arch Otorhinolaryngol

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Purpose To longitudinally evaluate the impact of the COVID-19-pandemic on the incidence of inpatient tonsil surgery and outpatient primary care of sore throat in Germany. Methods A retrospective interrupted time-series analysis was conducted. The national database of the Hospital Remuneration System was used to retrieve the number of operations performed between January 2019 and September 2021 including elective and non-elective cases with the exception of malign diseases. Three episodes were compared on a weekly basis: before, during, and after the first national lockdown (March 16–May 3, 2020). We also analysed the number of outpatient doctor contacts of sore throat patients in 2019 and 2020. Results Overall, 144,069 surgical cases were included in the analysis. The first lockdown resulted in an abrupt and significant decrease of all types of tonsil surgery ( p < 0.01). The incidence of tonsillectomy decreased from 556 (before) to 111 (during) and 326 (after) cases per week (relative risk 0.24; 95% CI 0.19–0.30, and 0.82; 95% CI 0.73–0.92). After the lockdown, the incidence persisted on a lower level compared to 2019. The number of doctor contacts decreased from 2,967,322 in 2019 to 1,976,617 in 2020 (− 33.4%). Conclusions The first lockdown was associated with a significant decrease of all types of tonsil surgery. A return to pre-pandemic surgical activity was not identified. The findings were accompanied by a significant decrease of outpatient doctor contacts of sore throat patients in primary care, particularly in the subgroup of children and adolescents. The impact of the second lockdown, starting in December 2020, was by far not comparable. Supplementary Information The online version contains supplementary material available at 10.1007/s00405-022-07308-8.

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Assessing the Appropriateness of Antimicrobial Prescribing in the Community Setting: A Scoping Review

Okonkwo,

Grant,

Ndukwe

et al. 2024

Open Forum Infectious Diseases

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Background This scoping review examined the concept and scope of appropriateness of antimicrobial prescribing in the community setting and how it has been measured. Methods Utilizing the Joanna Briggs Institute’s methodology, we appraised peer-reviewed articles and unpublished studies, focusing on the US, UK, Canada, and Australia, with no limit to date. Results Four basic components of antimicrobial prescribing to be evaluated during assessment of antimicrobial appropriateness in the community setting were identified: diagnosis for infection or indication for antimicrobial therapy, choice of antimicrobial therapy, dosing, and duration of therapy. The benchmark for definition of appropriateness is crucial in assessing antimicrobial prescribing appropriateness. The use of recommended guidelines as a benchmark is the standard for appropriate antimicrobial therapy, and when necessary, susceptibility testing should be explored. Conclusions Studies evaluating the appropriateness of antimicrobial prescribing should assess these components of antimicrobial prescribing, and this should be clearly stated in the aim and objectives of the study.

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Evaluating the Appropriateness of Antibiotic Treatment of Tonsillitis during COVID-19 in the North Wale Primary Healthcare Setting

Cited by 7 publications

References 13 publications

Approaches to Evaluations of Virtual Care in Primary Care

Approaches to Evaluations of Virtual Care in Primary Care

Impact of the COVID-pandemic on the incidence of tonsil surgery and sore throat in Germany

Assessing the Appropriateness of Antimicrobial Prescribing in the Community Setting: A Scoping Review

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