The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study

Abstract

Objective

Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period.

Design

Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service’s telephone records.

Setting

Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected.

Subjects

Patients in contact with GPs and the OOH service during the outbreak and a control period.

Main outcome measures

Patient contacts with GPs and the OOH service during the outbreak and a control period.

Results

There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases.

Conclusion

The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.

Keywords:

• Campylobacter infection
• gastroenteritis
• primary health care
• out-of-hours services
• general practice
• disease outbreaks
• Campylobacter jejuni

Acknowledgements

We thank Ingvild Roaldsnes and Andrea Habbestad for assistance in data collection. We thank the GP offices Fenring, Fromreide, Kleppestø, Strand and Strusshamn, and Askøy OOH service, for the facilitation of data collection.

Authors contributions

Study planning and writing of the paper: AI, GR, KAW, CPG. Data collection, analysis, and programming: AI.

Ethics statement

The study received approval from the regional medical research and ethics committee, with a waiver for patient consent for de-identified EMR data use (statement no. 114,230). Public notification was done through a local newspaper ad and posters at local OOH services and GP offices, allowing for withdrawal requests, of which there were none.

Disclosure statement

No potential conflict of interest was reported by the author(s).