In 2020, the COVID-19 pandemic brought dramatic changes in the delivery of primary health care across the world, presumably changing the number of consultations for infectious diseases and antibiotic use. We aimed to assess the impact of the pandemic on infections and antibiotic prescribing in Dutch primary care. All patients included in the routine health care database of the Julius General Practitioners’ Network were followed from March through May 2019 (n = 389,708) and March through May 2020 (n = 405,688). We extracted data on consultations for respiratory/ear, urinary tract, gastrointestinal and skin infections using the International Classification of Primary Care (ICPC) codes. These consultations were combined in disease episodes and linked to antibiotic prescriptions. The numbers of infectious disease episodes (total and those treated with antibiotics), complications, and antibiotic prescription rates (i.e., proportion of episodes treated with antibiotics) were calculated and compared between the study periods in 2019 and 2020. Fewer episodes were observed during the pandemic months than in the same months in 2019 for both the four infectious disease entities and complications such as pneumonia, mastoiditis and pyelonephritis. The largest decline was seen for gastrointestinal infections (relative risk (RR), 0.54; confidence interval (CI), 0.51 to 0.58) and skin infections (RR, 0.71; CI, 0.67 to 0.75). The number of episodes treated with antibiotics declined as well, with the largest decrease seen for respiratory/ear infections (RR, 0.54; CI, 0.52 to 0.58). The antibiotic prescription rate for respiratory/ear infections declined from 21% to 13% (difference −8.0% (CI, −8.8 to −7.2)), yet the prescription rates for other infectious disease entities remained similar or increased slightly. The decreases in primary care infectious disease episodes and antibiotic use were most pronounced in weeks 15–19, mid-COVID-19 wave, after an initial peak in respiratory/ear infection presentation in week 11, the first week of lock-down. In conclusion, our findings indicate that the COVID-19 pandemic has had profound effects on the presentation of infectious disease episodes and antibiotic use in primary care in the Netherlands. Consequently, the number of infectious disease episodes treated with antibiotics decreased. We found no evidence of an increase in complications.

Urinary tract infections in the elderly are common. Treatment with nitrofurantoin in men may not be sufficient if concomitant tissue involvement is present, resulting in treatment failure. The aim of this study is to determine the prevalence of nitrofurantoin failure in the elderly, and to assess the effect of gender and age. A retrospective observational study was conducted using a Dutch general practice medical record database of 21,789 men and 26,622 women aged 65 years or older in 2015. First, nitrofurantoin prescriptions in 2015 were analyzed. Nitrofurantoin failure (subsequent prescription of antibiotic within 30 days) for men, women, and different age categories were compared. The effect of age and gender was assessed using multivariate logistic regression. A total of 3537 patients had a first nitrofurantoin prescription in 2015; 506 men and 3031 women. Overall, 584 patients (17%) experienced nitrofurantoin failure; 135 (27%) men and 449 (15%) women. Male gender (odds ratio (OR) = 2.09, 95% confidence interval (CI) 1.68–2.61) and age (OR = 1.02, 95% CI 1.01–1.03) was associated with higher treatment failure. Our findings indicate that in a substantial number of elderly men, nitrofurantoin might not be the appropriate treatment. Nitrofurantoin, as a first choice in elderly men with urinary tract infections, should be reconsidered.

Presentation and antibiotic prescribing for common infectious disease episodes decreased substantially during the first COVID-19 pandemic wave in Dutch general practice. We set out to determine the course of these variables during the first pandemic year. We conducted a retrospective observational cohort study using routine health care data from the Julius General Practitioners’ Network. All patients registered in the pre-pandemic year (n = 425,129) and/or during the first pandemic year (n = 432,122) were included. Relative risks for the number of infectious disease episodes (respiratory tract/ear, urinary tract, gastrointestinal, and skin), in total and those treated with antibiotics, and proportions of episodes treated with antibiotics (prescription rates) were calculated. Compared to the pre-pandemic year, primary care presentation for common infections remained lower during the full first pandemic year (RR, 0.77; CI, 0.76–0.78), mainly attributed to a sustained decline in respiratory tract/ear and gastrointestinal infection episodes. Presentation for urinary tract and skin infection episodes declined during the first wave, but returned to pre-pandemic levels during the second and start of the third wave. Antibiotic prescription rates were lower during the full first pandemic year (24%) as compared to the pre-pandemic year (28%), mainly attributed to a 10% lower prescription rate for respiratory tract/ear infections; the latter was not accompanied by an increase in complications. The decline in primary care presentation for common infections during the full first COVID-19 pandemic year, together with lower prescription rates for respiratory tract/ear infections, resulted in a substantial reduction in antibiotic prescribing in Dutch primary care.

Background: Over the past years many innovations are being developed aiming to improve diagnostic processes in primary care. Limited evidence is available on how those actually involved in those processes, in short-hand end-users (patients, general practitioners, and medical specialists such as radiologists), view innovation of the diagnostic process in primary care. Perspectives from end-users are necessary to ensure the effectiveness of initiatives designed to improve the diagnostic process. Therefore, end-users explored directions and opportunities for the primary care diagnostic process, facilitated by change laboratory methodology in which tensions and differences of insight are used as source of inspiration and learning. Methods: Directions and opportunities were explored in two study groups comprising nine and ten participants respectively (consisting of patients, general practitioners, and medical specialists) that both had four change lab sessions in a four-month period. In the analysis, the Cultural-Historical Activity Theory was used as theoretical framework. This theory helps to reveal the operation of different healthcare systems in which participants find themselves and associated tensions and contradictions, creating new directions for thinking, learning, and acting from and with one another. Results: Together with the participants, we identified tensions and contradictions operating within and between different activity systems relevant for diagnostic processes in primary care, like tensions that could arise which arise when more and faster diagnostics are available in primary care or when collaborating parties have other interests and motivations in innovations. By recognizing these tensions and contradictions, participants have formulated innovation directions and opportunities for the diagnostic process in primary care. End-users perceived a need for better exchange of and/or access to test results done in hospital to general practitioners, and they identified certain artificial intelligence imaging techniques as promising to improve the diagnostic process for acute complaints at the point-of-care. Delving into these directions and opportunities for adjusting and advancing the diagnostic process, we formulated criteria to be considered for identifying fruitful innovation projects. Conclusions: By discussing tensions and contradictions between systems new considerations for successful innovation of the diagnostic process were identified and criteria were formulated which increase the likelihood of delivering promising innovation projects.

Background: Amid growing demands, workforce shortages, and rising costs, the evolving role of diagnostics—driven by technological innovation—underscores the urgent need to rethink the diagnostic process with stakeholders at the center. Knowledge on their perspectives on innovation of the diagnostic process is lacking, while it could ensure alignment with their needs and expectations. Aim: To identify perspectives on innovation of the diagnostic process in general practice care. Design and setting: Q-methodological study with stakeholders with different profiles but an informed opinion on the topic. Method: Participants individually sorted 57 statements based on what they thought is most important for innovation of the diagnostic process in general practice care. Statements were collected from literature, media, and group meetings. Factor analyses identified different perspectives, which were subsequently holistically interpreted. Results: We identified five perspectives: 1-innovation through diagnostic transformation, 2-innovation in communication, 3-innovation from a doctor-centered perspective, 4-system reform before innovation: fixing the foundation first, and 5-ambivalence towards innovation. The perspectives differed mostly in their urge for system change and the role for technology in innovation. In some perspectives, changes in the current or future diagnostic system were identified, whereas in others not. Also, the degree to which technology was deemed as the promising way forward differed between the perspectives. Conclusion: This study gives insight into prevailing perspectives of stakeholders on innovation of the diagnostic process in general practice care. Each perspective offers valuable insights, as all are essential for successful innovation of the diagnostic process.