Observational study of ezetimibe discontinuation in primary care practices in the UK

ObjectivesTo study systematic errors in recording blood pressure (BP) as measured by end digit preference (EDP); to determine associations between EDP, uptake of Automated Office BP (AOBP) machines and cardiovascular outcomes.DesignRetrospective observational study using routinely collected electronic medical record data from 2006 to 2015 and a survey on year of AOBP acquisition in Toronto, Canada in 2017.SettingPrimary care practices in Canada and the UK.ParticipantsAdults aged 18 years or more.Main outcome measuresMean rates of EDP and change in rates. Rates of EDP following acquisition of an AOBP machine. Associations between site EDP levels and mean BP. Associations between site EDP levels and frequency of cardiovascular outcomes.Results707 227 patients in Canada and 1 558 471 patients in the UK were included. From 2006 to 2015, the mean rate of BP readings with both systolic and diastolic pressure ending in zero decreased from 26.6% to 15.4% in Canada and from 24.2% to 17.3% in the UK. Systolic BP readings ending in zero decreased from 41.8% to 32.5% in the 3 years following the purchase of an AOBP machine. Sites with high EDP had a mean systolic BP of 2.0 mm Hg in Canada, and 1.7 mm Hg in the UK, lower than sites with no or low EDP. Patients in sites with high levels of EDP had a higher frequency of stroke (standardised morbidity ratio (SMR) 1.15, 95% CI 1.12 to 1.17), myocardial infarction (SMR 1.16, 95% CI 1.14 to 1.19) and angina (SMR 1.25, 95% CI 1.22 to 1.28) than patients in sites with no or low EDP.ConclusionsAcquisition of an AOBP machine was associated with a decrease in EDP levels. Sites with higher rates of EDP had lower mean BPs and a higher frequency of adverse cardiovascular outcomes. The routine use of manual office-based BP measurement should be reconsidered.

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Efficiency of the implementation of cardiovascular risk management in primary care practices: an observational study

Implementation Science ◽

10.1186/s13012-016-0434-2 ◽

2015 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Eddy M. M. Adang ◽

Anne Gerritsma ◽

Elvira Nouwens ◽

Jan van Lieshout ◽

Michel Wensing

Keyword(s):

Primary Care ◽

Risk Management ◽

Cardiovascular Risk ◽

Observational Study ◽

Cardiovascular Risk Management ◽

Care Practices ◽

Primary Care Practices

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Feasibility and acceptability of breath research in primary care: a prospective, cross-sectional, observational study

BMJ Open ◽

10.1136/bmjopen-2020-044691 ◽

2021 ◽

Vol 11 (4) ◽

pp. e044691

Author(s):

Georgia Woodfield ◽

Ilaria Belluomo ◽

Piers R Boshier ◽

Annabelle Waller ◽

Maya Fayyad ◽

...

Keyword(s):

Primary Care ◽

Observational Study ◽

Phase Iii ◽

Study Phase ◽

Cross Sectional ◽

Hub And Spoke ◽

Breath Testing ◽

Care Practices ◽

Primary Care Practices ◽

Recruitment Model

ObjectivesTo examine the feasibility and acceptability of breath research in primary care.DesignNon-randomised, prospective, mixed-methods cross-sectional observational study.SettingTwenty-six urban primary care practices.Participants1002 patients aged 18–90 years with gastrointestinal symptoms.Main outcome measuresDuring the first 6 months of the study (phase 1), feasibility of patient enrolment using face-to-face, telephone or SMS-messaging (Short Message Service) enrolment strategies, as well as processes for breath testing at local primary care practices, were evaluated. A mixed-method iterative study design was adopted and outcomes evaluated using weekly Plan-Do-Study-Act cycles, focus groups and general practitioner (GP) questionnaires.During the second 6 months of the study (phase 2), patient and GP acceptability of the breath test and testing process was assessed using questionnaires. In addition a ‘single practice’ recruitment model was compared with a ‘hub and spoke’ centralised recruitment model with regards to enrolment ability and patient acceptability.Throughout the study feasibility of the collection of a large number of breath samples by clinical staff over multiple study sites was evaluated and quantified by the analysis of these samples using mass spectrometry.Results1002 patients were recruited within 192 sampling days. Both ‘single practice’ and ‘hub and spoke’ recruitment models were effective with an average of 5.3 and 4.3 patients accrued per day, respectively. The ‘hub and spoke’ model with SMS messaging was the most efficient combined method of patient accrual. Acceptability of the test was high among both patients and GPs. The methodology for collection, handling and analysis of breath samples was effective, with 95% of samples meeting quality criteria.ConclusionsLarge-scale breath testing in primary care was feasible and acceptable. This study provides a practical framework to guide the design of Phase III trials examining the performance of breath testing in primary care.

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Investigating the mechanism of impact of the Quality Premium initiative on antibiotic prescribing in primary care practices in England: a study protocol

BMJ Open ◽

10.1136/bmjopen-2019-030093 ◽

2019 ◽

Vol 9 (8) ◽

pp. e030093 ◽

Cited By ~ 3

Author(s):

Philip Emeka Anyanwu ◽

Sarah Tonkin-Crine ◽

Aleksandra Borek ◽

Ceire Costelloe

Keyword(s):

Primary Care ◽

Least Square ◽

System Level ◽

Health Concern ◽

Ethical Review ◽

Antibiotic Prescribing ◽

Care Practices ◽

The Uk ◽

Mechanism Of Impact ◽

Primary Care Practices

IntroductionThe persistent development and spread of resistance to antibiotics remain an important public health concern in the UK and globally. About 74% of antibiotics prescribed in England in 2016 was in primary care. The Quality Premium (QP) initiative that rewards Clinical Commissioning Groups (CCGs) financially based on the quality of specific health services commissioned is one of the National Health Service (NHS) England interventions to reduce antimicrobial resistance through reduced prescribing. Emerging evidence suggests a reduction in antibiotic prescribing in primary care practices in the UK following QP initiative. This study aims to investigate the mechanism of impact of this high-cost health-system level intervention on antibiotic prescribing in primary care practices in England.Methods and analysisThe study will constitute secondary analyses of antibiotic prescribing data for almost all primary care practices in England from the NHS England Antibiotic Quality Premium Monitoring Dashboard and OpenPrescribing covering the period 2013 to 2018. The primary outcome is the number of antibiotic items per Specific Therapeutic group Age-sex Related Prescribing Unit (STAR-PU) prescribed monthly in each practice or CCG. We will first conduct an interrupted time series using ordinary least square regression method to examine whether antibiotic prescribing rate in England has changed over time, and how such changes, if any, are associated with QP implementation. Single and sequential multiple-mediator models using a unified approach for the natural direct and indirect effects will be conducted to investigate the relationship between QP initiative, the potential mediators and antibiotic prescribing rate with adjustment for practice and CCG characteristics.Ethics and disseminationThis study will use secondary data that are anonymised and obtained from studies that have either undergone ethical review or generated data from routine collection systems. Multiple channels will be used in disseminating the findings from this study to academic and non-academic audiences.

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