scholarly journals Associations between multiple long-term conditions and mortality in diverse ethnic groups

2022 ◽  
Author(s):  
Mai Stafford ◽  
Hannah Knight ◽  
Jay Hughes ◽  
Anne Alarilla ◽  
Luke Mondor ◽  
...  
Keyword(s):  
Primary Care ◽  
Mortality Rate ◽  
Ethnic Groups ◽  
Differential Mortality ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
Black Caribbean ◽  
Multiple Conditions

Background Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. Methods and Findings A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Cox regression models were used to estimate mortality by number of long-term conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional long-term condition at baseline was associated with increased mortality. This association differed across ethnic groups. Compared with 50-year-olds of white ethnicity with no conditions, the mortality rate was higher for white 50-year-olds with two conditions (HR 1.77) or four conditions (HR 3.13). Corresponding figures were higher for 50-year-olds of Black Caribbean ethnicity with two conditions (HR=2.22) or four conditions (HR 4.54). The direction of the interaction of number of conditions with ethnicity showed higher mortality associated with long-term conditions in nine out of ten minoritised ethnic groups, attaining statistical significance in four (Pakistani, Black African, Black Caribbean and Black other ethnic groups). Conclusions The raised mortality rate associated with having multiple conditions is greater in minoritised ethnic groups compared with white people. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.

scholarly journals Long-term oral prednisolone exposure in primary care for bullous pemphigoid: population-based study

2021 ◽  
pp. BJGP.2020.0870
Author(s):  
Monica SM Persson ◽  
Karen E Harman ◽  
Kim S Thomas ◽  
Joanne Chalmers ◽  
Yana Vinogradova ◽  
...  
Keyword(s):  
Primary Care ◽  
Bullous Pemphigoid ◽  
Secondary Care ◽  
Oral Prednisolone ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
High Dose ◽  
The Uk

Background: Oral prednisolone is the mainstay treatment for bullous pemphigoid, an auto-immune blistering skin disorder affecting older people. Moderate to high dose treatment is often initiated in secondary care, but then continued in primary care. Aim: To describe long-term oral prednisolone prescribing in UK primary care for adults with bullous pemphigoid 1998-2017. Design and setting: A prospective cohort study using routinely collected data from the Clinical Practice Research Datalink, a primary care database containing the healthcare records for over 17 million people in the UK. Method: Oral prednisolone exposure was characterised in terms of the proportion of individuals with incident bullous pemphigoid prescribed oral prednisolone following their diagnosis and the duration and dose of prednisolone. Results: 2,312 (69.6%) of 3,322 people with bullous pemphigoid were prescribed oral prednisolone in primary care. The median duration of exposure was 10.6 months (IQR 3.4 to 24.0). Of prednisolone users, 71.5% were continuously exposed for >3 months, 39.8% for >1 year, 14.7% for >3 years, 5.0% for >5 years, and 1.7% for >10 years. The median cumulative dose was 2,974mg (IQR 1,059 to 6,456). Maximum daily doses were ≥10mg/day in 74.4% of users, ≥20mg/day in 40.7%, ≥30mg/day in 18.2%, ≥40mg/day in 6.6%, ≥50mg/day in 3.8%, and ≥60mg/day in 1.9%. Conclusions: A high proportion of people with incident bullous pemphigoid are treated with oral prednisolone in UK primary care. Primary and secondary care should address steroid-sparing alternatives and, where switching is not possible, ensure prophylactic treatments and proactive monitoring of potential side-effects are in place.

scholarly journals Multimorbidity within households and health and social care utilisation and cost: retrospective cohort study using administrative data

2020 ◽  
Author(s):  
Mai Stafford ◽  
Sarah R. Deeny ◽  
Kathryn Dreyer ◽  
Jenny Shand
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Retrospective Cohort ◽  
Social Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
Care Utilisation ◽  
Health And Social Care ◽  
Care Activity

AbstractBackgroundThe daily management of long-term conditions falls primarily on individuals and their informal carers, but the household context and its impact on health and social care activity among people with multimorbidity is understudied.MethodsLinked data from health providers and local government in Barking and Dagenham provided a retrospective cohort of people aged 50+ in two-person households between April 2016 and March 2018. Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink.ResultsOver 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have any community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have any mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ between these groups. Findings in the national data were similar.ConclusionsCare utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and other community service input across household members.

scholarly journals Multimorbidity within households and use of health and social care

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0134
Author(s):  
Mai Stafford ◽  
Sarah Deeny ◽  
Kathryn Dreyer ◽  
Shand Jenny
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Social Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
Health And Social Care ◽  
Care Activity ◽  
The Impact

Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multimorbidity is understudied. Aim: To test whether co-residence with a multimorbid person (compared with a non-multimorbid co-resident) is associated with utilisation and cost of primary, community and secondary health care and formal social care. Design and Setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged 50+ in two-person households in 2016-2018. Methods: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results: Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusions: Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and community service input across household members.

scholarly journals Prognostic value of first-recorded breathlessness for future chronic respiratory and heart disease: a cohort study using a UK national primary care database

2020 ◽  
Vol 70 (693) ◽  
pp. e264-e273 ◽  
Author(s):  
Ying Chen ◽  
Richard Hayward ◽  
Carolyn A Chew-Graham ◽  
Richard Hubbard ◽  
Peter Croft ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Index Date ◽  
Early Mortality ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Obstructive Pulmonary Disease

BackgroundBreathlessness is a common presentation in primary care.AimTo assess the long-term risk of diagnosed chronic obstructive pulmonary disease (COPD), asthma, ischaemic heart disease (IHD), and early mortality in patients with undiagnosed breathlessness.Design and settingMatched cohort study using data from the UK Clinical Practice Research Datalink.MethodAdults with first-recorded breathlessness between 1997 and 2010 and no prior diagnostic or prescription record for IHD or a respiratory disease (‘exposed’ cohort) were matched to individuals with no record of breathlessness (‘unexposed’ cohort). Analyses were adjusted for sociodemographic and comorbidity characteristics.ResultsIn total, 75 698 patients (the exposed cohort) were followed for a median of 6.1 years, and more than one-third subsequently received a diagnosis of COPD, asthma, or IHD. In those who remained undiagnosed after 6 months, there were increased long-term risks of all three diagnoses compared with those in the unexposed cohort. Adjusted hazard ratios for COPD ranged from 8.6 (95% confidence interval [CI] = 6.8 to 11.0) for >6–12 months after the index date to 2.8 (95% CI = 2.6 to 3.0) for >36 months after the index date; asthma, 11.7 (CI = 9.4 to 14.6) to 4.3 (CI = 3.9 to 4.6); and IHD, 3.0 (CI = 2.7 to 3.4) to 1.6 (CI = 1.5 to 1.7). Risk of a longer time to diagnosis remained higher in members of the exposed cohort who had no relevant prescription in the first 6 months; approximately half of all future diagnoses were made for such patients. Risk of early mortality (all cause and disease specific) was higher in members of the exposed cohort.ConclusionBreathlessness can be an indicator of developing COPD, asthma, and IHD, and is associated with early mortality. With careful assessment, appropriate intervention, and proactive follow-up and monitoring, there is the potential to improve identification at first presentation in primary care in those at high risk of future disease who present with this symptom.

scholarly journals The Long-Term Impact of Vaginal Surgical Mesh Devices in UK Primary Care: A Cohort Study in the Clinical Practice Research Datalink

2021 ◽  
Vol Volume 13 ◽  
pp. 1167-1180
Author(s):  
Emily McFadden ◽  
Sarah Lay-Flurrie ◽  
Constantinos Koshiaris ◽  
Georgia C Richards ◽  
Carl Heneghan
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Clinical Practice ◽  
Surgical Mesh ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Impact

Preliminary results from the COPE study using primary-care electronic health records and environmental modelling to examine COPD exacerbations

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696749 ◽  
Author(s):  
Maimoona Hashmi ◽  
Mark Wright ◽  
Kirin Sultana ◽  
Benjamin Barratt ◽  
Lia Chatzidiakou ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Health Management ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Preliminary Results ◽  
Copd Exacerbations ◽  
Electronic Health

BackgroundChronic Obstructive Airway Disease (COPD) is marked by often severely debilitating exacerbations. Efficient patient-centric research approaches are needed to better inform health management primary-care.AimThe ‘COPE study’ aims to develop a method of predicting COPD exacerbations utilising personal air quality sensors, environmental exposure modelling and electronic health records through the recruitment of patients from consenting GPs contributing to the Clinical Practice Research Datalink (CPRD).MethodThe study made use of Electronic Healthcare Records (EHR) from CPRD, an anonymised GP records database to screen and locate patients within GP practices in Central London. Personal air monitors were used to capture data on individual activities and environmental exposures. Output from the monitors were then linked with the EHR data to obtain information on COPD management, severity, comorbidities and exacerbations. Symptom changes not equating to full exacerbations were captured on diary cards. Linear regression was used to investigate the relationship between subject peak flow, symptoms, exacerbation events and exposure data.ResultsPreliminary results on the first 80 patients who have completed the study indicate variable susceptibility to environmental stressors in COPD patients. Some individuals appear highly susceptible to environmental stress and others appear to have unrelated triggers.ConclusionRecruiting patients through EHR for a study is feasible and allows easy collection of data for long term follow up. Portable environmental sensors could now be used to develop personalised models to predict risk of COPD exacerbations in susceptible individuals. Identification of direct links between participant health and activities would allow improved health management thus cost savings.

FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

2015 ◽  
pp. 1-2
Author(s):  
A. SINCLAIR
Keyword(s):  
Primary Care ◽  
Target Population ◽  
Population Based ◽  
Care Staff ◽  
Long Term Conditions ◽  
Primary Care Research ◽  
Wide Range ◽  
Primary Care Practitioners ◽  
Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

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