Covid-19: a remote assessment in primary care
From BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1182 (Published 25 March 2020)Cite this as: BMJ 2020;368:m1182
A 37 year-old healthcare assistant develops a cough. Next day, she wakes with a fever (which she measures at 37.4°C) and shortness of breath. She manages her condition at home for several days, experiencing increasing tiredness, loss of appetite, and a persistent dry cough. On the fifth day of her illness, she develops mild diarrhoea, and her chest feels quite tight. She takes her temperature, which has gone up to 38.1°C. Feeling unwell, she contacts her GP surgery for advice. She would like someone to listen to her chest, but the receptionist tells her not to come to the surgery and offers her the choice of a telephone or video consultation. She was previously well apart from mild asthma (on occasional salbutamol). Five years ago, she took citalopram for anxiety. She is a single parent of three children.
Novel coronavirus disease 2019 (covid-19) is an urgent and spreading threat whose clinical and epidemiological characteristics are still being documented.12 With a view to containing covid-19, a shift from in-person to remote consulting is occurring. Clinicians are thus faced with a new disease and a new way of interacting with patients.
This article will present some guiding principles on how to choose between telephone and video appointments, how to conduct a “query covid” consultation remotely, and considerations when arranging follow-up and next steps. It does not cover remote triage or how to set up video consulting in your practice. This article is intended as a broad orientation to a COVID-19 consultation. It does not cover every clinical eventuality, and should not be used as an official guideline for the management of a COVID-19 patient. National and local guidance are being urgently produced, and further research is being undertaken on specific aspects of management such as use of antibiotics.RemoteConsul
Australia’s primary care COVID-19 response
GENERAL PRACTICE is absolutely central to national and local responses to COVID-19 in Australia, and the nation is building a response on the basis of its very strong system of primary healthcare. Australia’s publicly funded universal health insurance scheme, Medicare, is the main source of payment for healthcare services across the country, including for services provided in general practice.1 The majority of primary care services are delivered by doctors, nurses and other health professionals working in general practices in urban, regional, rural and remote locations across the continent
Coronavirus disease 2019 in Iran: the need for more attention to primary health care
While the global effort to prevent coronavirus disease 2019 (COVID-19) spread continues, some experts have suggested that the disease may be in its first stages.1 After initial reports of the disease from China, recent reports of this contagious disease have also been reported elsewhere in the world, including in the World Health Organization (WHO) Eastern Mediterranean region such as Iran.2 The Eastern Mediterranean is an area that has many public health problems.3
On February 20, the Iranian Ministry of Health reported the first cases of the disease. In fact, in Iran, the initial report, in addition to reporting two cases, also reported deaths.4 Given that the incidence of these cases was unrelated to any direct source outside of Iran, and on the other hand, given the geographical location of the provinces where the Iranian Ministry of Health reported cases (central areas of the country), the probability of the epidemic situation of the disease could be considered.
Full Text Corona virus Iran
The coronavirus outbreak: the central role of primary care in emergency preparedness and response
On the last day of 2019, a cluster of cases of a pneumonia with unknown cause were reported by the Chinese authorities to the World Health Organization (WHO), believed to be connected to a seafood market in Wuhan, China. This market was closed the following day. On 7 January 2020, a novel coronavirus was isolated, and known pathogens were ruled out.1
Coronaviruses usually cause respiratory illness ranging from the common cold to severe acute respiratory syndrome (SARS). Clinical symptoms and signs of the Wuhan coronavirus include fever, with some sufferers experiencing difficulty breathing and bilateral pulmonary infiltrates seen on chest X-ray. WHO are referring to it as ‘2019-nCov’.
At the time of writing, there have been over 4,500 confirmed cases and 106 deaths, including among healthcare workers. Over 98% of these cases are within mainland China, but cases have also been confirmed in tens of other countries.