scholarly journals Safety of inadvertent administration of live zoster vaccine to immunosuppressed individuals in a UK-based observational cohort analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e034886 ◽  
Author(s):  
Daniel J Grint ◽  
Helen I McDonald ◽  
Jemma L Walker ◽  
Gayatri Amirthalingam ◽  
Nick Andrews ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Analysis ◽  
Care Staff ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Varicella Zoster ◽  
Related Disease ◽  
Observational Cohort ◽  
Primary Care Staff

ObjectivesTo investigate the safety of live attenuated varicella zoster vaccination when administered to immunosuppressed individuals.DesignProspective observational cohort study.SettingThe study used anonymised data from the Clinical Practice Research Datalink (CPRD), comprising a representative sample of routinely collected primary care data in England between 2013 and 2017 and and linked Hospital Episode Statistics data.Participants168 767 individuals age-eligible for varicella zoster vaccination registered at a general practice in England contributing data to CPRD.Main outcome measuresElectronic health records indicating immunosuppression, zoster vaccination, diagnoses of specific varicella-zoster virus (VZV)-related disease and non-specific rash/encephalitis compatible with VZV-related disease.ResultsBetween 1 September 2013 and 31 August 2017, a period of immunosuppression was identified for 9093/168 767 (5.4%; 95% CI: 5.3%–5.5%) individuals age-eligible for zoster vaccination. The overall rate of vaccination while immunosuppressed was 1742/5251 (33.2 per 100 adjusted person years at risk; 95% CI: 31.9%–34.5%). Follow-up of the 1742 individuals who were inadvertently vaccinated while immunosuppressed identified only two cases of VZV-related disease within 8 weeks of vaccination (0.1%; 95% CI: 0.01%–0.4%), both primary care diagnoses of ‘shingles’, neither with a related hospital admission.ConclusionsDespite evidence of inadvertent vaccination of immunosuppressed individuals with live zoster vaccination, there is a lack of evidence of severe consequences including hospitalisation. This should reassure primary care staff and encourage vaccination of mildly immunosuppressed individuals who do not meet current thresholds for contraindication. These findings support a review of the extent to which live zoster vaccination is contraindicated among the immunosuppressed.

scholarly journals Evidence of disparities in the provision of the maternal postpartum 6-week check in primary care in England, 2015–2018: an observational study using the Clinical Practice Research Datalink (CPRD)

2021 ◽  
pp. jech-2021-216640
Author(s):  
Yangmei Li ◽  
Jennifer J Kurinczuk ◽  
Christopher Gale ◽  
Dimitrios Siassakos ◽  
Claire Carson
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Policy Change ◽  
Post Partum ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Younger Women ◽  
Preterm Babies ◽  
Deprived Areas

BackgroundA maternal postpartum 6-week check (SWC) with a general practitioner (GP) is now considered an essential service in England, a recent policy change intended to improve women’s health. We aimed to provide an up-to-date snapshot of the prevalence of SWC prior to the policy change as a baseline, and to explore factors associated with having a late or no check.MethodsWe conducted a cohort study using primary care records in England (Clinical Practice Research Datalink (CPRD)). 34 337 women who gave birth between 1 July 2015 and 30 June 2018 and had ≥12 weeks of follow-up post partum were identified in the CPRD Pregnancy Register. The proportion who had evidence of an SWC with a GP was calculated, and regression analysis was used to assess the association between women’s characteristics and risks of a late or no check.ResultsSixty-two per cent (95% CI 58% to 67%) of women had an SWC recorded at their GP practice within 12 weeks post partum, another 27% had other consultations. Forty per cent had an SWC at the recommended 6–8 weeks, 2% earlier and 20% later. A late or no check was more common among younger women, mothers of preterm babies or those registered in more deprived areas.ConclusionsNearly 40% of women did not have a postpartum SWC recorded. Provision or uptake was not equitable; younger women and those in more deprived areas were less likely to have a record of such check, suggesting postpartum care in general practice may be missing some women who need it most.

scholarly journals Sepsis Recording in Primary Care Electronic Health Records, Linked Hospital Episodes and Mortality Records: Population-based Cohort Study in England

2020 ◽  
Author(s):  
Emma Rezel-Potts ◽  
Martin C. Gulliford ◽  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recent Period ◽  
General Practices ◽  
Different Sources

AbstractObjectivesSepsis is a growing concern for health systems, but the epidemiology of sepsis is poorly characterised. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations.Methods and FindingsCohort study including 378 general practices in England from Clinical Practice Research Datalink (CPRD) GOLD database from 2002 to 2017 with 36,209,676 patient-years of follow-up with linked Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality registrations. Incident sepsis episodes were identified for each source. Concurrent records from different sources were identified and age-standardised and age-specific incidence rates compared. Logistic regression analysis evaluated associations of gender, age-group, fifth of deprivation and period of diagnosis with concurrent sepsis recording.There were 20,206 first episodes of sepsis from primary care, 20,278 from HES and 13,972 from ONS. There were 4,117 (20%) first HES sepsis events and 2,438 (17%) mortality records concurrent with incident primary care sepsis records within 30 days. Concurrent HES and primary care records of sepsis within 30 days before or after first diagnosis were higher at younger or older ages and for patients with the most recent period of diagnosis with those diagnosed during 2007:2011 less likely to have a concurrent HES record given CPRD compared to those diagnosed during 2012 to 2017 (odd ratio 0.65, 95% confidence interval 0.60 to 0.70). At age 85 and older, primary care incidence was 5.22 per 1,000 patient years (95% CI 1.75 to 11.97) in men and 3.55 (0.87 to 9.58) in women which increased to 10.09 (4.86 to 18.51) for men and 7.22 (2.96 to 14.72) for women after inclusion of all three sources.ConclusionExplicit recording of sepsis is inconsistent across healthcare sectors with a high proportion of non-concurrent records. Incidence estimates are higher when linked data are analysed.

scholarly journals Sepsis recording in primary care electronic health records, linked hospital episodes and mortality records: Population-based cohort study in England

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244764
Author(s):  
Emma Rezel-Potts ◽  
Martin C. Gulliford ◽  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recent Period ◽  
General Practices ◽  
Different Sources

Background Sepsis is a growing concern for health systems, but the epidemiology of sepsis is poorly characterised. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations. Methods and findings Cohort study including 378 general practices in England from Clinical Practice Research Datalink (CPRD) GOLD database from 2002–2017 with 36,209,676 patient-years of follow-up with linked Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality registrations. Incident sepsis episodes were identified for each source. Concurrent records from different sources were identified and age-standardised and age-specific incidence rates compared. Logistic regression analysis evaluated associations of gender, age-group, fifth of deprivation and period of diagnosis with concurrent sepsis recording. There were 20,206 first episodes of sepsis from primary care, 20,278 from HES and 13,972 from ONS. There were 4,117 (20%) first HES sepsis events and 2,438 (17%) mortality records concurrent with incident primary care sepsis records within 30 days. Concurrent HES and primary care records of sepsis within 30 days before or after first diagnosis were higher at younger or older ages and for patients with the most recent period of diagnosis. Those diagnosed during 2007:2011 were less likely to have a concurrent HES record given CPRD compared to those diagnosed during 2012–2017 (odd ratio 0.65, 95% confidence interval 0.60–0.70). At age 85 and older, primary care incidence was 5.22 per 1,000 patient years (95% CI 1.75–11.97) in men and 3.55 (0.87–9.58) in women which increased to 10.09 (4.86–18.51) for men and 7.22 (2.96–14.72) for women after inclusion of all three sources. Conclusion Explicit recording of ‘sepsis’ is inconsistent across healthcare sectors with a high proportion of non-concurrent records. Incidence estimates are higher when linked data are analysed.

scholarly journals Primary Care Prescriptions of Potentially Nephrotoxic Medications in Children with CKD

2019 ◽  
Vol 15 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Claire E. Lefebvre ◽  
Kristian B. Filion ◽  
Pauline Reynier ◽  
Robert W. Platt ◽  
Michael Zappitelli
Keyword(s):  
Primary Care ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Kidney Injury ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Converting Enzyme Inhibitors

Background and objectivesPediatric CKD management focuses on limiting kidney injury, including avoiding nephrotoxic medications. Nephrotoxic medication prescription practices for children with CKD are unknown. Our objective was to determine the prevalence and rates of primary care prescriptions for potentially nephrotoxic medications in children with CKD versus without CKD.Design, setting, participants, & measurementsWe conducted a retrospective, matched population-based cohort study of patients aged <18 years, registered at a general practice participating in the UK Clinical Practice Research Datalink (CPRD) from 1997 to 2017. Children with a clinical code indicating an incident diagnosis of CKD were matched 1:4 to patients without CKD on CKD diagnosis date, sex, age, CPRD practice, and number of general practitioner visits in the year before cohort entry. We calculated the prevalence and the rate of potentially nephrotoxic medication prescriptions throughout the follow-up period in patients with versus without CKD. Primary analyses included the following medication classes: aminoglycosides, antivirals, nonsteroidal anti-inflammatory drugs, salicylates, proton pump inhibitors, and immunomodulators. Secondary analyses used an expanded nephrotoxicity definition that also included, among others, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Adjusted prescription rates were calculated using multivariable binomial regression.ResultsFrom 1,535,816 eligible patients, we identified 1018 incident CKD and 4072 non-CKD matches (mean age, 9.8 years [range, 1.1–17.9 years]; 52% male; mean follow-up time, 3.3 years). Overall, 26% of patients with and 15% of patients without CKD were prescribed one or more potentially nephrotoxic medication during follow-up. The overall rate of nephrotoxic medication prescriptions was 71 (95% confidence interval [95% CI], 55 to 93) prescriptions per 100 person-years in patients with CKD and eight (95% CI, 7 to 9) prescriptions per 100 person-years in patients without CKD (adjusted rate ratio, 4.1; 95% CI, 2.7 to 6.1).ConclusionsPotentially nephrotoxic medications are prescribed at high rates to children with CKD.

scholarly journals Prediction of type 2 diabetes risk in people with non-diabetic hyperglycaemia: model derivation and validation using UK primary care data

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e037937
Author(s):  
Briana Coles ◽  
Kamlesh Khunti ◽  
Sarah Booth ◽  
Francesco Zaccardi ◽  
Melanie J Davies ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Prognostic Models ◽  
Predictor Variables ◽  
Validation Dataset ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Primary Care Data

ObjectiveUsing primary care data, develop and validate sex-specific prognostic models that estimate the 10-year risk of people with non-diabetic hyperglycaemia developing type 2 diabetes.DesignRetrospective cohort study.SettingPrimary care.Participants154 705 adult patients with non-diabetic hyperglycaemia.Primary outcomeDevelopment of type 2 diabetes.MethodsThis study used data routinely collected in UK primary care from general practices contributing to the Clinical Practice Research Datalink. Patients were split into development (n=109 077) and validation datasets (n=45 628). Potential predictor variables, including demographic and lifestyle factors, medical and family history, prescribed medications and clinical measures, were included in survival models following the imputation of missing data. Measures of calibration at 10 years and discrimination were determined using the validation dataset.ResultsIn the development dataset, 9332 patients developed type 2 diabetes during 293 238 person-years of follow-up (31.8 (95% CI 31.2 to 32.5) per 1000 person-years). In the validation dataset, 3783 patients developed type 2 diabetes during 115 113 person-years of follow-up (32.9 (95% CI 31.8 to 33.9) per 1000 person-years). The final prognostic models comprised 14 and 16 predictor variables for males and females, respectively. Both models had good calibration and high levels of discrimination. The performance statistics for the male model were: Harrell’s C statistic of 0.700 in the development and 0.701 in the validation dataset, with a calibration slope of 0.974 (95% CI 0.905 to 1.042) in the validation dataset. For the female model, Harrell’s C statistics were 0.720 and 0.718, respectively, while the calibration slope was 0.994 (95% CI 0.931 to 1.057) in the validation dataset.ConclusionThese models could be used in primary care to identify those with non-diabetic hyperglycaemia most at risk of developing type 2 diabetes for targeted referral to the National Health Service Diabetes Prevention Programme.

scholarly journals Prevalence and patterns of antidepressant switching amongst primary care patients in the UK

2017 ◽  
Vol 31 (5) ◽  
pp. 553-560 ◽  
Author(s):  
Becky Mars ◽  
Jon Heron ◽  
David Gunnell ◽  
Richard M Martin ◽  
Kyla H Thomas ◽  
...  
Keyword(s):  
Primary Care ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Treatment ◽  
Cohort Analysis ◽  
Antidepressant Therapy ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Line Treatment ◽  
Second Line ◽  
The Uk

Objective: Non-response to antidepressant treatment is a substantial problem in primary care, and many patients with depression require additional second-line treatments. This study aimed to examine the prevalence and patterns of antidepressant switching in the UK, and identify associated demographic and clinical factors. Method: Cohort analysis of antidepressant prescribing data from the Clinical Practice Research Datalink, a large, anonymised UK primary care database. The sample included 262,844 patients who initiated antidepressant therapy between 1 January 2005 and 31 June 2011. Results: 9.3% of patients switched to a different antidepressant product, with most switches (60%) occurring within 8 weeks of the index date. The proportion switching was similar for selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and other antidepressants (9.3%, 9.8% and 9.2%, respectively). Most switches were to an SSRI (64.5%), and this was the preferred option regardless of initial antidepressant class. Factors predictive of switching included male gender, age, and history of self-harm and psychiatric illness. Conclusion: Over one in every 11 patients who initiates antidepressant therapy will switch medication, suggesting that initial antidepressant treatment has been unsatisfactory. Evidence to guide choice of second-line treatment for individual patients is currently limited. Additional research comparing different pharmacological and psychological second-line treatment strategies is required in order to inform guidelines and improve patient outcomes.

scholarly journals Nutrition interventions by primary care staff: a survey of involvement, knowledge and attitude

2002 ◽  
Vol 5 (4) ◽  
pp. 531-536 ◽  
Author(s):  
Helen Moore ◽  
Ashley J Adamson
Keyword(s):  
Primary Care ◽  
Care Staff ◽  
Nutritional Knowledge ◽  
Nutrition Interventions ◽  
Dietary Changes ◽  
North East ◽  
Knowledge And Attitude ◽  
Primary Care Staff

AbstractObjective:To undertake a survey to investigate the quality and format of nutrition health promotion in UK primary care. Data from both primary care practitioners – i.e. level of nutritional knowledge and attitude towards nutrition interventions – and patients – i.e. the format and quality of dietary consultations – are presented.Design:A self-completion questionnaire was used to assess nutritional knowledge and attitude of primary care staff towards nutrition interventions. Data regarding the format and quality of the dietary consultation were collected from patients using a screening question and follow-up questionnaire.Setting:Twelve general practices in a city in north-east England.Subjects:One hundred and nine primary care staff, and 2400 consecutive patients recruited from the 12 practices.Results:Seventy-seven per cent of primary care staff completed the questionnaire. Sixty-five per cent of the knowledge questions were answered correctly by most practitioners. Questions containing complex nutritional terminology were answered poorly. Most practitioners believed primary care teams have an essential role in giving dietary advice. Thirteen per cent of patients reported that they had discussed diet. Of these, 40% were asked to make dietary changes; 20% discussed how they cooked or prepared food; and 33% were asked to make a follow-up appointment.Conclusion:Encouraging signs included good levels of nutritional knowledge and belief amongst staff that they should be involved in nutrition interventions. Patients reported that they understood and felt able to achieve the dietary changes suggested. Less encouraging were little evidence of discussion about the practical aspects of food and fairly low rates of follow-up being arranged.

scholarly journals Cancer recording in patients with type 2 diabetes in primary care and hospital admission data

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Rachael Williams ◽  
Arlene Gallagher ◽  
Tjeerd Van Staa ◽  
Tarek Hammad ◽  
Bert Leufkens ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Site ◽  
Practice Research ◽  
Cancer Case ◽  
Clinical Practice Research Datalink ◽  
Diabetic Patients ◽  
Hospital Data ◽  
Antidiabetic Therapy ◽  
Primary Care Data

ABSTRACTObjectiveElectronic health records are increasingly used to investigate associations between antidiabetic therapy and cancer. Misclassification can impact results, especially if differential between comparators. The objective of this study was to estimate cancer misclassification when using primary care or hospital data alone. ApproachAdults aged ≥40 years with an insulin or oral antidiabetic prescription in Clinical Practice Research Datalink (CPRD) primary care data at least a year after start of data collection, and no record of type 1 diabetes, were included. Patients were matched by year of birth (stepwise within 5 years), sex and GP practice to up to 1 non-diabetic patient. The cohort was restricted to those eligible for Hospital Episode Statistics (HES) linkage with follow-up during the study period (01/04/97-31/12/06). Follow-up started at the maximum of the registration date with the practice, practice up-to-standard date (a CPRD quality metric), and start of study period. Follow-up ended at the minimum of when the patient left the practice, the date CPRD last collected data from the practice, and end of study period. Cancer was identified in CPRD via Read codes and in HES via ICD10 codes. For each cancer case in CPRD, analysis evaluated whether there was a corresponding record in HES coded with same, different or unspecified site. Analysis was repeated for cancers identified in HES. Results53,585 diabetic patients were matched to 47,435 non-diabetic patients. 83% of cancer cases in CPRD had a corresponding record in HES (78% with the same type). Misclassification varied by cancer site, ranging from 3% (stomach cancer) to 57% (nonmelanoma skin cancer). 83% of cancer cases in HES had a corresponding record in CPRD, with all misclassification rates <20%. ConclusionA good level of concordance and low level of misclassification of cancer exist between CPRD primary care data and HES. The value of linking these data for establishing cancer outcomes lies more in the complimentary variables held than in reducing misclassification.

scholarly journals Opportunities to reduce antibiotic prescribing for patients with COPD in primary care: a cohort study using electronic health records from the Clinical Practice Research Datalink (CPRD)

2019 ◽  
Vol 75 (1) ◽  
pp. 243-251
Author(s):  
Patrick Rockenschaub ◽  
Arnoupe Jhass ◽  
Nick Freemantle ◽  
Anna Aryee ◽  
Meena Rafiq ◽  
...  
Keyword(s):  
Primary Care ◽  
Antibiotic Stewardship ◽  
Severe Disease ◽  
Significant Risk ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
Copd Patients ◽  
Severe Copd

Abstract Background In primary care there is uncertainty about which patients with acute exacerbations of COPD (AECOPD) benefit from antibiotics. Objectives To identify which types of COPD patients get the most antibiotics in primary care to support targeted antibiotic stewardship. Methods Observational study of COPD patients using a large English primary care database with 12 month follow-up. We estimated the incidence of and risk factors for antibiotic prescribing relative to the number of AECOPD during follow-up, considering COPD severity, smoking, obesity and comorbidity. Results From 157 practices, 19594 patients were diagnosed with COPD, representing 2.6% of patients and 11.5% of all prescribed antibiotics. Eight hundred and thirty-three (4.5%) patients with severe COPD and frequent AECOPD were prescribed six to nine prescriptions per year and accounted for 13.0% of antibiotics. Individuals with mild to moderate COPD and zero or one AECOPD received one to three prescriptions per year but accounted for 42.5% of all prescriptions. In addition to COPD severity, asthma, chronic heart disease, diabetes, heart failure and influenza vaccination were independently associated with increased antibiotic use. Conclusions Patients with severe COPD have the highest rates of antibiotic prescribing but most antibiotics are prescribed for patients with mild to moderate COPD. Antibiotic stewardship should focus on the dual goals of safely reducing the volume of prescribing in patients with mild to moderate COPD, and optimizing prescribing in patients with severe disease who are at significant risk of drug resistance.

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