Epidemiology of alcohol dependence in UK primary care: Results from a large observational study using the Clinical Practice Research Datalink

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.

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Prescription of benzodiazepines, z-drugs, and gabapentinoids and mortality risk in people receiving opioid agonist treatment: Observational study based on the UK Clinical Practice Research Datalink and Office for National Statistics death records

PLoS Medicine ◽

10.1371/journal.pmed.1002965 ◽

2019 ◽

Vol 16 (11) ◽

pp. e1002965 ◽

Cited By ~ 10

Author(s):

John Macleod ◽

Colin Steer ◽

Kate Tilling ◽

Rosie Cornish ◽

John Marsden ◽

...

Keyword(s):

Clinical Practice ◽

Observational Study ◽

Mortality Risk ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Opioid Agonist ◽

Opioid Agonist Treatment ◽

National Statistics ◽

The Uk

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Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy

British Journal of General Practice ◽

10.3399/bjgp19x704309 ◽

2019 ◽

Vol 69 (684) ◽

pp. e462-e469 ◽

Cited By ~ 10

Author(s):

Jessica Watson ◽

Hayley E Jones ◽

Jonathan Banks ◽

Penny Whiting ◽

Chris Salisbury ◽

...

Keyword(s):

Primary Care ◽

Clinical Practice ◽

Test Performance ◽

Predictive Value ◽

Inflammatory Markers ◽

Inflammatory Marker ◽

Superior Performance ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Autoimmune Conditions

BackgroundResearch comparing C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma viscosity (PV) in primary care is lacking. Clinicians often test multiple inflammatory markers, leading to concerns about overuse.AimTo compare the diagnostic accuracies of CRP, ESR, and PV, and to evaluate whether measuring two inflammatory markers increases accuracy.Design and settingProspective cohort study in UK primary care using the Clinical Practice Research Datalink.MethodThe authors compared diagnostic test performance of inflammatory markers, singly and paired, for relevant disease, defined as any infections, autoimmune conditions, or cancers. For each of the three tests (CRP, ESR, and PV), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operator curve (AUC) were calculated.ResultsParticipants comprised 136 961 patients with inflammatory marker testing in 2014; 83 761 (61.2%) had a single inflammatory marker at the index date, and 53 200 (38.8%) had multiple inflammatory markers. For ‘any relevant disease’, small differences were seen between the three tests; AUC ranged from 0.659 to 0.682. CRP had the highest overall AUC, largely because of marginally superior performance in infection (AUC CRP 0.617, versus ESR 0.589, P<0.001). Adding a second test gave limited improvement in the AUC for relevant disease (CRP 0.682, versus CRP plus ESR 0.688, P<0.001); this is of debatable clinical significance. The NPV for any single inflammatory marker was 94% compared with 94.1% for multiple negative tests.ConclusionTesting multiple inflammatory markers simultaneously does not increase ability to rule out disease and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first-line test.

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