scholarly journals The healthcare resource impact of maternal mental illness on children and adolescents: UK retrospective cohort study

2021 ◽  
pp. 1-8
Author(s):  
Holly Hope ◽  
Cemre Su Osam ◽  
Evangelos Kontopantelis ◽  
Sian Hughes ◽  
Luke Munford ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rate Ratio ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Healthcare Use ◽  
Maternal Mental Illness

Background The general health of children of parents with mental illness is overlooked. Aims To quantify the difference in healthcare use of children exposed and unexposed to maternal mental illness (MMI). Method This was a retrospective cohort study of children aged 0–17 years, from 1 April 2007 to 31 July 2017, using a primary care register (Clinical Practice Research Datalink) linked to Hospital Episodes Statistics. MMI included non-affective/affective psychosis and mood, anxiety, addiction, eating and personality disorders. Healthcare use included prescriptions, primary care and secondary care contacts; inflation adjusted costs were applied. The rate and cost was calculated and compared for children exposed and unexposed to MMI using negative binomial regression models. The total annual cost to NHS England of children with MMI was estimated. Results The study included 489 255 children: 238 106 (48.7%) girls, 112 741 children (23.0%) exposed to MMI. Compared to unexposed children, exposed children had a higher rate of healthcare use (rate ratio 1.27, 95% CI 1.26–1.28), averaging 2.21 extra contacts per exposed child per year (95% CI 2.14–2.29). Increased healthcare use among exposed children occurred in inpatients (rate ratio 1.37, 95% CI 1.32–1.42), emergency care visits (rate ratio 1.34, 95% CI 1.33–1.36), outpatients (rate ratio 1.30, 95% CI 1.28–1.32), prescriptions (rate ratio 1.28, 95% CI 1.26–1.30) and primary care consultations (rate ratio 1.24, 95% CI 1.23–1.25). This costs NHS England an additional £656 million (95% CI £619–£692 million), annually. Conclusions Children of mentally ill mothers are a health vulnerable group for whom targeted intervention may create benefit for individuals, families, as well as limited NHS resources.

scholarly journals Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e027744
Author(s):  
Mark Gompels ◽  
Skevi Michael ◽  
Charlotte Davies ◽  
Tim Jones ◽  
John Macleod ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hiv Testing ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Infected People ◽  
The Uk ◽  
Clinical Records

ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.DesignRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.Setting404 general practices in England.Participants5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.OutcomesAnnual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000–2015.ResultsHIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16–44 years compared with older adults. Rates per 100 000 in women aged 16–44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16–44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.ConclusionsHIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Implications and further research neededOpportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.

scholarly journals The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study

2020 ◽  
Vol 35 (9) ◽  
pp. 879-889
Author(s):  
Cemre Su Osam ◽  
Matthias Pierce ◽  
Holly Hope ◽  
Darren M. Ashcroft ◽  
Kathryn M. Abel
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Substance Misuse ◽  
Childhood Vaccination ◽  
Health Concern ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Vaccination Uptake ◽  
Maternal Alcohol ◽  
Maternal Mental Illness

Abstract Reduced vaccination uptake is a growing and global public health concern. There is limited knowledge about the effect of maternal mental illness (MMI) on rates of childhood vaccination. This retrospective cohort study examined 479,949 mother-baby pairs born between 1993 and 2015 in the Clinical Practice Research Datalink (CPRD GOLD), a UK-based, primary health-care database. The influence of MMI on children’s vaccination status at two and five years of age was investigated using logistic regression adjusting for sex of the child, child ethnicity, delivery year, maternal age, practice level deprivation quintile and region. The vaccinations were: 5-in-1 (DTaP/IPV/Hib) and first dose MMR by the age of two; and all three doses of 5-in-1, first and second dose of MMR vaccines by the age of five. Exposure to MMI was defined using recorded clinical events for: depression, anxiety, psychosis, eating disorder, personality disorder and alcohol and substance misuse disorders. The likelihood that a child completed their recommended vaccinations by the age of two and five was significantly lower among children with MMI compared to children with mothers without mental illness [adjusted odds ratio (aOR) 0.86, 95% CI 0.84–0.88, p < 0.001]. The strongest effect was observed for children exposed to maternal alcohol or substance misuse (at two years aOR 0.50, 95% CI 0.44–0.58, p < 0.001). In the UK, an estimated five thousand more children per year would be vaccinated if children with MMI had the same vaccination rates as children with well mothers. Maternal mental illness is a hitherto largely unrecognised reason that children may be missing vital vaccinations at two and five years of age. This risk is highest for those children living with maternal alcohol or substance misuse.

scholarly journals Twin pregnancy and severe maternal mental illness: A Canadian population-based retrospective cohort study

2022 ◽  
Vol 226 (1) ◽  
pp. S242-S243
Author(s):  
Stephanie C. Lapinsky ◽  
Hilary K. Brown ◽  
Joel G. Ray ◽  
Kellie E. Murphy ◽  
Tyler S. Kaster ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Twin Pregnancy ◽  
Population Based ◽  
Canadian Population ◽  
Maternal Mental Illness

scholarly journals GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

2020 ◽  
Vol 70 (693) ◽  
pp. e221-e229
Author(s):  
Stuart Jarvis ◽  
Roger C Parslow ◽  
Catherine Hewitt ◽  
Sarah Mitchell ◽  
Lorna K Fraser
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Young People ◽  
Retrospective Cohort Study ◽  
Secondary Care ◽  
Retrospective Cohort ◽  
Clinical Practice Research Datalink ◽  
Children And Young People ◽  
Attendance Patterns ◽  
Significant Difference

BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

Health, performance and conduct concerns among older doctors: A retrospective cohort study of notifications received by medical regulators in Australia

2018 ◽  
Vol 23 (2) ◽  
pp. 54-62 ◽  
Author(s):  
Laura A Thomas ◽  
Eleanor Milligan ◽  
Holly Tibble ◽  
Lay S Too ◽  
David M Studdert ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cohort Study ◽  
Incidence Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Rate Ratio ◽  
Substance Misuse ◽  
Incidence Rate Ratio ◽  
Health Performance ◽  
Rate Ratios

Objectives To determine whether ‘older doctors’ (aged over 65) are at higher risk of notifications to the medical regulator than ‘younger doctors’ (aged 36–60 years) regarding their health, performance and/or conduct. Design Retrospective cohort study. Setting National dataset of 12,878 notifications lodged with medical regulators in Australia between 1 January 2011 and 31 December 2014. Participants All registered doctors in Australia aged 36–60 and >65 years during the study period. Main outcome measures Incidence rates of notifications and incidence rate ratios of notifications (older versus younger doctors). Results Older doctors had higher notification rates (90.9 compared with 66.6 per 1000 practitioner years, p < 0.001). Sex-adjusted incidence rate ratios showed that older doctors had a higher risk of notifications relating to physical illness or cognitive decline (incidence rate ratio = 15.54), inadequate record keeping (incidence rate ratio = 1.98), unlawful use or supply of medications (incidence rate ratio = 2.26), substandard certificates/reports (incidence rate ratio = 2.02), inappropriate prescribing (incidence rate ratio = 1.99), disruptive behaviours (incidence rate ratio = 1.37) and substandard treatment (incidence rate ratio = 1.24). Older doctors had lower notification rates relating to mental illness and substance misuse (incidence rate ratio = 0.58) and for performance issues relating to problems with procedures (incidence rate ratio = 0.61). Conclusions Older doctors were at higher risk for notifications relating to physical or cognitive impairment, records and reports, prescribing or supply of medicines, disruptive behaviour and treatment. They were at lower risk for notifications about mental illness or substance misuse. Incorporating knowledge of these patterns into regulatory practices, workplace adjustments and continuing education/assessment could enhance patient care.

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