scholarly journals Temporal trends in use of tests in UK primary care, 2000-15: retrospective analysis of 250 million tests

BMJ ◽  
2018 ◽  
pp. k4666 ◽  
Author(s):  
Jack W O’Sullivan ◽  
Sarah Stevens ◽  
F D Richard Hobbs ◽  
Chris Salisbury ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Temporal Trends ◽  
Age Groups ◽  
Fold Increase ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Test Use ◽  
Over Time ◽  
Age And Sex ◽  
Total Test

Abstract Objectives To assess the temporal change in test use in UK primary care and to identify tests with the greatest increase in use. Design Retrospective cohort study. Setting UK primary care. Participants All patients registered to UK General Practices in the Clinical Practice Research Datalink, 2000/1 to 2015/16. Main outcome measures Temporal trends in test use, and crude and age and sex standardised rates of total test use and of 44 specific tests. Results 262 974 099 tests were analysed over 71 436 331 person years. Age and sex adjusted use increased by 8.5% annually (95% confidence interval 7.6% to 9.4%); from 14 869 tests per 10 000 person years in 2000/1 to 49 267 in 2015/16, a 3.3-fold increase. Patients in 2015/16 had on average five tests per year, compared with 1.5 in 2000/1. Test use also increased statistically significantly across all age groups, in both sexes, across all test types (laboratory, imaging, and miscellaneous), and 40 of the 44 tests that were studied specifically. Conclusion Total test use has increased markedly over time, in both sexes, and across all age groups, test types (laboratory, imaging, and miscellaneous) and for 40 of 44 tests specifically studied. Of the patients who underwent at least one test annually, the proportion who had more than one test increased significantly over time.

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 COVID-19 Demographics, Acute Care Resource Use and Mortality by Age and Sex in Ontario, Canada: Population-based Retrospective Cohort Analysis

2020 ◽  
Author(s):  
Stephen Mac ◽  
Kali Barrett ◽  
Yasin A. Khan ◽  
David MJ Naimark ◽  
Laura Rosella ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Use ◽  
Cohort Analysis ◽  
Invasive Mechanical Ventilation ◽  
Temporal Trends ◽  
Age Groups ◽  
Population Based ◽  
Term Care ◽  
Over Time ◽  
Age And Sex

AbstractBackgroundUnderstanding resource use for COVID-19 is critical. We conducted a population-based cohort study using public health data to describe COVID-19 associated age- and sex-specific acute care use, length of stay (LOS), and mortality.MethodsWe used Ontario’s Case and Contact Management (CCM) Plus database of individuals who tested positive for COVID-19 in Ontario from March 1 to September 30, 2020 to determine age- and sex-specific hospitalizations, intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV) use, LOS, and mortality. We stratified analyses by month of infection to study temporal trends and conducted subgroup analyses by long-term care residency.ResultsDuring the observation period, 56,476 COVID-19 cases were reported (72% < 60 years, 52% female). The proportion of cases shifted from older populations (> 60 years) to younger populations (10-39 years) over time. Overall, 10% of individuals were hospitalized, of those 22% were admitted to ICU, and 60% of those used IMV. Mean LOS for individuals in the ward, ICU without IMV, and ICU with IMV was 12.8, 8.5, 20.5 days, respectively. Mortality for individuals receiving care in the ward, ICU without IMV, and ICU with IMV was 24%, 30%, and 45%, respectively. All outcomes varied by age and decreased over time, overall and within age groups.InterpretationThis descriptive study shows acute care use and mortality varying by age, and decreasing between March and September in Ontario. Improvements in clinical practice and changing risk distributions among those infected may contribute to fewer severe outcomes among those infected with COVID-19.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sai P Polineni ◽  
Fadar O Otite ◽  
Seemant Chaturvedi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Age Groups ◽  
The United States ◽  
Decompressive Hemicraniectomy ◽  
Study Results ◽  
Over Time ◽  
Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

scholarly journals Dynamics of multimorbidity in England between 2004 and 2019: a descriptive epidemiology study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Head ◽  
K Fleming ◽  
C Kypridemos ◽  
P Schofield ◽  
M O'Flaherty
Keyword(s):  
Chronic Conditions ◽  
Large Population ◽  
Temporal Trends ◽  
Population Level ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
The Uk ◽  
Three Body ◽  
Over Time

Abstract Background An estimated 25% of GP patients within the UK have multimorbidity, a large proportion of which is attributable to non-communicable diseases, many of them preventable. The heterogeneity of existing study methodologies limits comparisons to assess temporal trends. This study aims to use a large population-representative dataset to describe changes over time in multimorbidity incidence and prevalence. Methods We used two measures of multimorbidity a) basic: two or more chronic conditions; b) complex: at least three chronic conditions affecting at least three body systems. Chronic conditions for inclusion were discussed by a multidisciplinary team. A 1m random sample of patients registered between 2004 and 2019 at GP practices in England were drawn from the UK Clinical Practice Research Datalink. We calculated crude and age-sex standardised annual multimorbidity prevalence and incidence using standard formulae. Analyses were conducted using R v3.6.3. Participants will be linked to the 2015 Index of Multiple Deprivation to describe equity trends over time. Results Preliminary results show that age-sex standardised annual prevalence increased from 32.9% (95% CI: 32.7% - 33.1%) with basic multimorbidity and 14.9% (95% CI: 14.7%-15.0%) with complex multimorbidity in 2004 to 51.0% (95% CI: 50.8% - 51.3%) and 29.9% (95% CI: 29.7% - 30.1%) in 2019. Basic multimorbidity incidence per 10,000 person-years showed little change, however there was an increase in the incidence of complex multimorbidity from 322 (95% CI: 315- 330) to 418 (95% CI: 407 - 430). Conclusions The burden of multimorbidity has increased substantially over the last 15 years. Complex multimorbidity incidence and prevalence have increased more rapidly than for basic multimorbidity. This highlights the need for improved population-level prevention strategies to postpone and prevent the onset of long-term conditions. Next, we will assess whether there are socioeconomic differences in these temporal trends. Key messages The burden of multimorbidity increased between 2004 and 2019. The increase in incidence and prevalence of complex multimorbidity was greater than for basic multimorbidity.

scholarly journals Impact of financial incentives for primary care to give long acting reversible contraceptive advice

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Ma ◽  
E Cecil ◽  
R French ◽  
A Bottle ◽  
S Saxena
Keyword(s):  
Primary Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Pay For Performance ◽  
Age Groups ◽  
Step Change ◽  
Practice Research ◽  
Care Practice ◽  
Clinical Practice Research Datalink ◽  
Long Acting

Abstract Background Long acting reversible contraceptives (LARC) are cost-effective but uptake remains poor even in high income settings. In 2009/10, a pay-for-performance (P4P) scheme in the United Kingdom was introduced for primary care physicians to offer advice about LARC to women attending for contraceptive care. We examined the equity and impact of this scheme on LARC uptake and abortions Methods We examined records of women aged 13 to 54 years registered with a primary care practice in the UK Clinical Practice Research Datalink from 2004/05 to 2013/14. We used interrupted time series analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age, region and deprivation groups, before and after P4P was introduced in 2009/10. Results LARC uptake among women of all ages increased immediately after P4P with step change of 5.36 per 1,000 women (95% CI 5.26 to 5.45). Largest increase was in women aged 20 to 24 years (8.40, 8.34 to 8.47). NLHC uptake fell in all women with a step change of -22.9 (-24.5 to -21.2). Among LARC methods, contraceptive injection and implant had the greatest increase after P4P; step changes were 1.68 (1.67 to 1.70) and 1.64 (1.63 to 1.65) respectively. Abortion rates fell across all 12 regions in UK and in all women immediately after P4P with a step change of -2.28 (-2.99 to -1.57). The largest falls occurred in women aged 13 to 19 years (step change -5.04, -7.56 to -2.51) and women from the most deprived group (step change -4.40, -6.89 to -1.91). Conclusions Pay-for-performance scheme for primary care physicians to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile. Key messages Pay-for-performance scheme for primary care practitioners to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

scholarly journals International impact of large multi-centre surgical trials of arthroscopic subacromial decompression

2021 ◽  
Author(s):  
James Andrew Smith ◽  
Kristin Kostka ◽  
David J Beard ◽  
Andrew J Carr ◽  
Jonathan L Rees ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Temporal Trends ◽  
Practice Research ◽  
Sex Characteristics ◽  
Clinical Practice Research Datalink ◽  
Subacromial Decompression ◽  
Shoulder Impingement ◽  
The Uk ◽  
Arthroscopic Subacromial Decompression ◽  
Over Time

Objectives To examine temporal trends in incidence of arthroscopic subacromial decompression (ASAD) surgery internationally during conduct and after publication of placebo controlled trials finding no evidence of meaningful benefit of ASAD for shoulder impingement. Design Observational study of incidence rates. Setting Large routinely collected datasets were used: outpatient data from Belgium and UK, and insurance claims and outpatient data from US. UK data were from Clinical Practice Research Datalink and Belgium and US data were from IQVIA. US and UK data spanned 2005 - 2019 and Belgium data 2011 - 2019. Participants Patients were eligible for inclusion in the study if they had at least one visit recorded in the database in a given year and cases were defined as patients undergoing ASAD for the first time in their records in a given year. Outcome measures We calculated incidence of ASAD over time, overall and stratified by age and sex. Characteristics of patients undergoing ASAD were also assessed over time. Results UK incidence has fallen since a peak of 4.7 per 10,000 person years in 2011 (when the CSAW trial began) to 1.8 in 2019. US incidence shows no clear pattern and remains consistently higher than the UK, at 11.5 per 100,000 person years in 2019. Changes in incidence patterns were similar across different age groups and sexes. The number of cases in Belgium was too small for meaningful conclusions. Conclusions We found ASAD rates have fallen in the UK during conduct and after publication of two large surgical RCTs from the UK and Finland that questioned the effectiveness of ASAD for shoulder impingement. A similar impact on clinical practice has not been seen in US. Further work to understand the barriers or concerns preventing international uptake of high quality evidence into clinical practice is needed.

scholarly journals Prevalence and incidence of neuromuscular conditions in the UK between 2000 and 2019: A retrospective study using primary care data

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261983
Author(s):  
Iain M. Carey ◽  
Emma Banchoff ◽  
Niranjanan Nirmalananthan ◽  
Tess Harris ◽  
Stephen DeWilde ◽  
...  
Keyword(s):  
Primary Care ◽  
Muscular Dystrophy ◽  
Myasthenia Gravis ◽  
Neuromuscular Disease ◽  
Large Scale ◽  
Temporal Trends ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Hospital Discharges ◽  
The Uk

Background In the UK, large-scale electronic primary care datasets can provide up-to-date, accurate epidemiological information on rarer diseases, where specialist diagnoses from hospital discharges and clinic letters are generally well recorded and electronically searchable. Current estimates of the number of people living with neuromuscular disease (NMD) have largely been based on secondary care data sources and lacked direct denominators. Objective To estimate trends in the recording of neuromuscular disease in UK primary care between 2000–2019. Methods The Clinical Practice Research Datalink (CPRD) database was searched electronically to estimate incidence and prevalence rates (per 100,000) for a range of NMDs in each year. To compare trends over time, rates were age standardised to the most recent CPRD population (2019). Results Approximately 13 million patients were actively registered in each year. By 2019, 28,230 active patients had ever received a NMD diagnosis (223.6), which was higher among males (239.0) than females (208.3). The most common classifications were Guillain-Barre syndrome (40.1), myasthenia gravis (33.7), muscular dystrophy (29.5), Charcot-Marie-Tooth (29.5) and inflammatory myopathies (25.0). Since 2000, overall prevalence grew by 63%, with the largest increases seen at older ages (≥65-years). However, overall incidence remained constant, though myasthenia gravis incidence has risen steadily since 2008, while new cases of muscular dystrophy fell over the same period. Conclusions Lifetime recording of many NMDs on primary care records exceed current estimates of people living with these conditions; these are important data for health service and care planning. Temporal trends suggest this number is steadily increasing, and while this may partially be due to better recording, it cannot be simply explained by new cases, as incidence remained constant. The increase in prevalence among older ages suggests increases in life expectancy among those living with NMDs may have occurred.

scholarly journals Antibiotic prescribing records in two UK primary care electronic health record systems. Comparison of the CPRD GOLD and CPRD Aurum databases

2020 ◽  
Author(s):  
Martin C Gulliford ◽  
Xiaohui Sun ◽  
Thamina Anjuman ◽  
Eleanor Yelland ◽  
Tarita Murray-Thomas
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
Health Record ◽  
Similar Data ◽  
Electronic Health ◽  
Tract Infections ◽  
Age And Sex

ABSTRACTObjectiveWe evaluated whether recording of antibiotic prescribing across two primary care electronic health record (EHR) systems is similar. Data were analysed from the Clinical Practice Research Datalink (CPRD) databases: CPRD GOLD (Vision data) and CPRD Aurum (EMIS data).MethodsCohorts of patients were randomly sampled from both databases, stratifying by general practice, age-group and gender. All antibiotic prescriptions in 2017 were identified. Age- and sex-standardised antibiotic prescribing rates per 1,000 person years were calculated. Prescribing of individual antibiotic products and associated medical diagnosis recorded on the same date was also evaluated. English CPRD GOLD general practices were analysed as a subgroup, because all CPRD Aurum practices sampled were in England.ResultsThere were 101,360 antibiotic prescriptions among 158,305 sampled patients at 883 CPRD Aurum practices, and 112,931 prescriptions among 160,394 sampled patients at 290 CPRD GOLD practices. The age- and sex-standardised antibiotic prescribing rate in 2017 was 512.6 (95% confidence interval 510.4 to 514.9) per 1,000 person years in CPRD Aurum and 584.3 (582.1 to 586.5) per 1,000 person years in CPRD GOLD [505.2 (501.6 to 508.9) per 1,000 person years if restricted to practices in England]. The 25 most frequently prescribed antibiotic products were similar in both databases. One or more medical codes were recorded on the same date as an antibiotic prescription for 72,989 (74%) prescriptions in CPRD Aurum, 84,756 (78%) in CPRD GOLD, and 28,471 (78%) for CPRD GOLD in England. Skin, respiratory and genito-urinary tract infections were recorded for 39,035 (40%) prescriptions in CPRD Aurum, 41,326 (38%) in CPRD GOLD, with 15,481 (42%) in English CPRD GOLD practices only.ConclusionSimilar estimates for antibiotic prescribing and infection recording were found for both databases suggesting similar recording across EMIS and Vision systems. Future research on antimicrobial stewardship can be conducted in CPRD Aurum informed by previous results from CPRD GOLD. It may also be possible to combine CPRD GOLD and CPRD Aurum data in research on antibiotic prescribing.

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.

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