scholarly journals MORTALITY OF CARE HOME RESIDENTS AND COMMUNITY-DWELLING CONTROLS DURING THE COVID-19 PANDEMIC IN 2020: MATCHED COHORT STUDY

2021 ◽  
Author(s):  
Martin C Gulliford ◽  
Emma C Rezel-Potts
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Care Home ◽  
Community Dwelling ◽  
Matched Cohort ◽  
Long Term Conditions ◽  
Health Records ◽  
Matched Cohort Study ◽  
Electronic Health

Objective: To estimate mortality of care home residents during the Covid-19 pandemic from primary care electronic health records. Design: Matched cohort study Setting: 1,421 general practices contributing to the Clinical Practice Research Datalink Aurum Database in England. Participants: 217,987 patients aged 18 to 104 years with recorded care home residence in England in the period 2015 to 2020. There were 86,371 care home residents contributing data in 2020, with 29,662 deaths; 83,419 (97%) were matched on age, gender and general practice with 312,607 community-dwelling adults. Main outcome measures: All-cause mortality. Analysis was by Poisson regression adjusting for age, gender, long-term conditions, region, year and calendar week. Results: The highest first wave age-specific mortality rate was 6.02 (95% confidence interval 5.97 to 6.07) per 100 patients per week in men aged 95-104 years between 13th-19th April 2020. Compared with community-dwelling controls, the adjusted rate ratio for mortality of care home residents was 4.95 (4.62 to 5.32) in February 2020, increasing to 8.34 (7.95 to 8.74) in April 2020, declining to 3.93 (3.68 to 4.20) in December 2020. During the week of 13th to 19th April 2020, mortality of care home residents was 10.74 (9.72 to 11.85) times higher than for matched community-dwelling controls. Conclusions: Individual-patient data from primary care electronic health records may be used to estimate mortality in care home residents. Mortality is substantially higher than for community-dwelling comparators and showed a disproportionate increase in the first wave of the Covid-19 pandemic but not the second wave. This study provides evidence to support earlier, decisive action to protect these vulnerable populations in the event of further outbreaks. Prospective investigations of care home mortality are warranted.

scholarly journals Do health checks improve risk factor detection in primary care? Matched cohort study using electronic health records

2015 ◽  
Vol 38 (3) ◽  
pp. 552-559 ◽  
Author(s):  
Alice S. Forster ◽  
Caroline Burgess ◽  
Hiten Dodhia ◽  
Frances Fuller ◽  
Jane Miller ◽  
...  
Keyword(s):  
Primary Care ◽  
Risk Factor ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Matched Cohort ◽  
Health Records ◽  
Matched Cohort Study ◽  
Health Checks ◽  
Electronic Health

scholarly journals Childhood obesity trends from primary care electronic health records in England between 1994 and 2013: population-based cohort study

2015 ◽  
Vol 100 (3) ◽  
pp. 214-219 ◽  
Author(s):  
Cornelia H M van Jaarsveld ◽  
Martin C Gulliford
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Age Groups ◽  
Overweight And Obesity ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Obesity Trends ◽  
Electronic Health

ObjectiveThis study aimed to use primary care electronic health records to evaluate the prevalence of overweight and obesity in 2–15-year-old children in England and compare trends over the last two decades.DesignCohort study of primary care electronic health records.Setting375 general practices in England that contribute to the UK Clinical Practice Research Datalink.PatientsIndividual participants were sampled if they were aged between 2 and 15 years during the period 1994–2013 and had one or more records of body mass index (BMI).Main outcome measurePrevalence of overweight (including obesity) was defined as a BMI equal to or greater than the 85th centile of the 1990 UK reference population.ResultsData were analysed for 370 544 children with 507 483 BMI records. From 1994 to 2003, the odds of overweight and obesity increased by 8.1% per year (95% CI 7.2% to 8.9%) compared with 0.4% (−0.2% to 1.1%) from 2004 to 2013. Trends were similar for boys and girls, but differed by age groups, with prevalence stabilising in 2004 to 2013 in the younger (2–10 year) but not older (11–15 year) age group, where rates continued to increase.ConclusionsPrimary care electronic health records in England may provide a valuable resource for monitoring obesity trends. More than a third of UK children are overweight or obese, but the prevalence of overweight and obesity may have stabilised between 2004 and 2013.

scholarly journals Provider Responses to Patients Controlling Access to their Electronic Health Records: A Prospective Cohort Study in Primary Care

2014 ◽  
Vol 30 (S1) ◽  
pp. 31-37 ◽  
Author(s):  
William M. Tierney ◽  
Sheri A. Alpert ◽  
Amy Byrket ◽  
Kelly Caine ◽  
Jeremy C. Leventhal ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Health Records ◽  
Electronic Health

scholarly journals Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records

2016 ◽  
Vol 26 (8) ◽  
pp. 1900-1905 ◽  
Author(s):  
Helen P. Booth ◽  
◽  
Omar Khan ◽  
Alison Fildes ◽  
A. Toby Prevost ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Health Records ◽  
Electronic Health ◽  
The Uk

scholarly journals Depression, depressive symptoms and treatments in women who have recently given birth: UK cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022152 ◽  
Author(s):  
Irene Petersen ◽  
Tomi Peltola ◽  
Samuel Kaski ◽  
Kate R Walters ◽  
Sarah Hardoon
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Depressive Symptoms ◽  
Electronic Health Records ◽  
Postnatal Depression ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Health Records ◽  
Electronic Health ◽  
Ssri Treatment

ObjectivesTo investigate how depression is recognised in the year after child birth and treatment given in clinical practice.DesignCohort study based on UK primary care electronic health records.SettingPrimary care.ParticipantsWomen who have given live birth between 2000 and 2013.OutcomesPrevalence of postnatal depression, depression diagnoses, depressive symptoms, antidepressant and non-pharmacological treatment within a year after birth.ResultsOf 206 517 women, 23 623 (11%) had a record of depressive diagnosis or symptoms in the year after delivery and more than one in eight women received antidepressant treatment. Recording and treatment peaked 6–8 weeks after delivery. Initiation of selective serotonin reuptake inhibitors (SSRI) treatment has become earlier in the more recent years. Thus, the initiation rate of SSRI treatment per 100 pregnancies (95% CI) at 8 weeks were 2.6 (2.5 to 2.8) in 2000–2004, increasing to 3.0 (2.9 to 3.1) in 2005–2009 and 3.8 (3.6 to 3.9) in 2010–2013. The overall rate of initiation of SSRI within the year after delivery, however, has not changed noticeably. A third of the women had at least one record suggestive of depression at any time prior to delivery and of these one in four received SSRI treatment in the year after delivery.Younger women were most likely to have records of depression and depressive symptoms. (Relative risk for postnatal depression: age 15–19: 1.92 (1.76 to 2.10), age 20–24: 1.49 (1.39 to 1.59) versus age 30–34). The risk of depression, postnatal depression and depressive symptoms increased with increasing social deprivation.ConclusionsMore than 1 in 10 women had electronic health records indicating depression diagnoses or depressive symptoms within a year after delivery and more than one in eight women received antidepressant treatment in this period. Women aged below 30 and from the most deprived areas were at highest risk of depression and most likely to receive antidepressant treatment.

scholarly journals Impact Of Electronic Health Record Interface Design On Unsafe Prescribing Of Ciclosporin, Tacrolimus and Diltiazem: A Cohort Study In English NHS Primary Care

2019 ◽  
Author(s):  
Brian MacKenna ◽  
Seb Bacon ◽  
Alex J Walker ◽  
Helen J Curtis ◽  
Richard Croker ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Clinical Practice ◽  
Electronic Health Records ◽  
Interface Design ◽  
Quantitative Research ◽  
Health Records ◽  
General Practices ◽  
Electronic Health ◽  
Almost All

AbstractBackgroundIn England, national safety guidance recommends that ciclosporin, tacrolimus and diltiazem are prescribed by brand name due to their narrow therapeutic windows and, in the case of tacrolimus, to reduce the chance of organ transplantation rejection. Various small studies have shown that changes to electronic health records (EHR) interface can affect prescribing choices.ObjectivesOur objectives were to assess variation by EHR system in breaches of safety guidance around prescribing of ciclosporin, tacrolimus and diltiazem; and to conduct user-interface research into the causes of such breaches.MethodsWe carried out a retrospective cohort study using prescribing data in English primary care. Participants were English general practices and their respective electronic health records. The main outcome measures were (1) variation in ratio of breaching / adherent prescribing all practices (2) description of observations of EHR usage.ResultsA total of 2,575,411 prescriptions were issued in 2018 for ciclosporin, tacrolimus and diltiazem (over 60mg); of these, 316,119 prescriptions breached NHS guidance (12.3%). Breaches were most common amongst users of the EMIS EHR (in 23.2% of ciclosporin & tacrolimus prescriptions, and 22.7% of diltiazem prescriptions); but breaches were observed in all EHRs.ConclusionDesign choices in EHR strongly influence safe prescribing of ciclosporin, tacrolimus and diltiazem; and breaches are prevalent in general practices in England. We recommend that all EHR vendors review their systems to increase safe prescribing of these medicines in line with national guidance. Almost all clinical practice is now mediated through an EHR system: further quantitative research into the effect of EHR design on clinical practice is long overdue.

scholarly journals Bi-directional association between depression and HF: An electronic health records-based cohort study

2020 ◽  
Vol 10 ◽  
pp. 2235042X2098405
Author(s):  
William V Bobo ◽  
Euijung Ryu ◽  
Tanya M Petterson ◽  
Kandace Lackore ◽  
Yijing Cheng ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Chronic Conditions ◽  
Newly Diagnosed ◽  
Health Records ◽  
Care Services ◽  
Primary Care Services ◽  
Increased Risk ◽  
Electronic Health

Objective: To determine whether a bi-directional relationship exists between depression and HF within a single population of individuals receiving primary care services, using longitudinal electronic health records (EHRs). Methods: This retrospective cohort study utilized EHRs for adults who received primary care services within a large healthcare system in 2006. Validated EHR-based algorithms identified 10,649 people with depression (depression cohort) and 5,911 people with HF (HF cohort) between January 1, 2006 and December 31, 2018. Each person with depression or HF was matched 1:1 with an unaffected referent on age, sex, and outpatient service use. Each cohort (with their matched referents) was followed up electronically to identify newly diagnosed HF (in the depression cohort) and depression (in the HF cohort) that occurred after the index diagnosis of depression or HF, respectively. The risks of these outcomes were compared (vs. referents) using marginal Cox proportional hazard models adjusted for 16 comorbid chronic conditions. Results: 2,024 occurrences of newly diagnosed HF were observed in the depression cohort and 944 occurrences of newly diagnosed depression were observed in the HF cohort over approximately 4–6 years of follow-up. People with depression had significantly increased risk for developing newly diagnosed HF (HR 2.08, 95% CI 1.89–2.28) and people with HF had a significantly increased risk of newly diagnosed depression (HR 1.34, 95% CI 1.17–1.54) after adjusting for all 16 comorbid chronic conditions. Conclusion: These results provide evidence of a bi-directional relationship between depression and HF independently of age, sex, and multimorbidity from chronic illnesses.

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