scholarly journals Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

2021 ◽  
Author(s):  
Neha Pathak ◽  
Claire X Zhang ◽  
Yamina Boukari ◽  
Rachel Burns ◽  
Rohini Mathur ◽  
...  
Keyword(s):  
Primary Care ◽  
Census Data ◽  
First Language ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Country Of Birth ◽  
Migrant Population ◽  
Migration Status ◽  
Electronic Health ◽  
The Uk

International migrants comprised 14% of the UK population in 2020, but migrant health in the UK has rarely been studied at a population level using primary care electronic health records (EHRs). Given the difficulty of determining migration status using EHRs, this study developed a migration phenotype and assessed its validity. We developed a phenotyping algorithm using codes for country of birth, visa status, non-English main/first language and non-UK origin. It was applied to a Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country of birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997-2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified using the phenotype. 178,749 (1.11%) of these migrants were identified by codes indicating foreign country of birth or visa status, 216,731 (1.35%) a non-English main/first language, and 8,288 (0.05%) non-UK origin. The cohort was similarly distributed compared to ONS migration statistics in terms of sex and region of birth. Recording of migration improved from identifying approximately one-tenth of the expected proportion of migrants according to the ONS in 2004 to a quarter in 2018. Younger migrants were better represented than those aged 50 and over. The migration phenotype identified a large number of migrants and can be used to undertake large-scale migration health research in CPRD GOLD to inform healthcare policy, practice and action. While the cohort was representative of the UK migrant population in terms of sex and region of birth, migration status was under-recorded in earlier years and older ages, and future studies for these groups should therefore be interpreted with caution.

scholarly journals Development and Validation of a Primary Care Electronic Health Record Phenotype to Study Migration and Health in the UK

2021 ◽  
Vol 18 (24) ◽  
pp. 13304
Author(s):  
Neha Pathak ◽  
Claire X. Zhang ◽  
Yamina Boukari ◽  
Rachel Burns ◽  
Rohini Mathur ◽  
...  
Keyword(s):  
Primary Care ◽  
Census Data ◽  
First Language ◽  
Population Level ◽  
Geographic Region ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Country Of Birth ◽  
Policy And Practice ◽  
Electronic Health

International migrants comprised 14% of the UK’s population in 2020; however, their health is rarely studied at a population level using primary care electronic health records due to difficulties in their identification. We developed a migration phenotype using country of birth, visa status, non-English main/first language and non-UK-origin codes and applied it to the Clinical Practice Research Datalink (CPRD) GOLD database of 16,071,111 primary care patients between 1997 and 2018. We compared the completeness and representativeness of the identified migrant population to Office for National Statistics (ONS) country-of-birth and 2011 census data by year, age, sex, geographic region of birth and ethnicity. Between 1997 to 2018, 403,768 migrants (2.51% of the CPRD GOLD population) were identified: 178,749 (1.11%) had foreign-country-of-birth or visa -status codes, 216,731 (1.35%) non-English-main/first-language codes, and 8288 (0.05%) non-UK-origin codes. The cohort was similarly distributed versus ONS data by sex and region of birth. Migration recording improved over time and younger migrants were better represented than those aged ≥50. The validated phenotype identified a large migrant cohort for use in migration health research in CPRD GOLD to inform healthcare policy and practice. The under-recording of migration status in earlier years and older ages necessitates cautious interpretation of future studies in these groups.

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.

scholarly journals Antibiotic prescribing for lower UTI in elderly patients in primary care and risk of bloodstream infection: a cohort study using electronic health records

2020 ◽  
Author(s):  
Laura Shallcross ◽  
Patrick Rockenschaub ◽  
Ruth Blackburn ◽  
Irwin Nazareth ◽  
Nick Freemantle ◽  
...  
Keyword(s):  
Primary Care ◽  
Bloodstream Infection ◽  
Census Data ◽  
Asymptomatic Bacteriuria ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Antibiotic Prescribing ◽  
The Public ◽  
Health Need ◽  
Community Onset

AbstractBackgroundResearch has questioned the safety of delaying or withholding antibiotics for suspected urinary tract infection (UTI) in older patients. We evaluated the association between antibiotic treatment for lower UTI and risk of bloodstream infection (BSI) in adults aged ≥65 years in primary care.MethodsWe analysed primary care records from patients aged ≥65 years in England with community-onset UTI using the Clinical Practice Research Datalink (2007-2015) linked to Hospital Episode Statistics and census data. The primary outcome was BSI within 60 days, comparing patients treated immediately with antibiotics and those not treated immediately.Findings147,334 patients were included representing 280,462 episodes of lower UTI. BSI occurred in 0·4% (1,025 / 244,963) of UTI episodes with immediate antibiotics versus 0·6% (228 / 35,499) of episodes without immediate antibiotics. The odds of BSI were equivalent in patients who were not treated with antibiotics immediately and those who were treated on the date of their UTI consultation (adjusted odds ratio aOR 1·13; 95%-CI: 0·97-1·31). However, delaying or withholding antibiotics was associated with increased odds of death in the subsequent 60 days (aOR 1·17; 95% CI: 1·09-1·26).InterpretationEvidence on the safety of delaying or withholding antibiotics in older adults with suspected UTI is conflicting. Given the prevalence of asymptomatic bacteriuria in this population, their risk of antibiotic-related side effects, and the public health need to tackle antibiotic resistance, we recommend a trial to address this uncertainty.

Risk of ischemic stroke in asymptomatic atrial fibrillation incidentally-detected in primary care compared with other clinical presentations

2021 ◽  
Author(s):  
Christopher Wallenhorst ◽  
Carlos Martinez ◽  
Ben FREEDMAN
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
Ischemic Stroke ◽  
Stroke Risk ◽  
Practice Research ◽  
Mortality Data ◽  
Clinical Practice Research Datalink ◽  
Primary Hospital ◽  
Ischemic Stroke Risk ◽  
The Uk

Background: It is uncertain whether stroke risk of asymptomatic ambulatory atrial fibrillation (AA-AF) incidentally-detected in primary care is comparable with other clinical AF presentations in primary care or hospital. Methods: The stoke risk of 22,035 patients with incident non-valvular AF from the UK primary care Clinical Practice Research Datalink with linkage to hospitalization and mortality data, was compared to 23,605 controls without AF (age and sex-matched 5:1 to 5,409 AA-AF patients). Incident AF included 5,913 with symptomatic ambulatory AF (SA-AF); 4,989 with Primary and 5,724 with non-Primary Hospital AF discharge diagnosis (PH-AF and Non-PH-AF); and 5,409 with AA-AF. Ischemic stroke adjusted subhazard ratios (aSHR) within 3 years of AA-AF were compared with SA-AF, PH-AF, Non-PH-AF and controls, accounting for mortality as competing risk and adjusted for ischemic stroke risk factors. Results: There were 1026 ischemic strokes in 49,544 person-years in patients with incident AF (crude incidence rate 2.1 ischemic strokes/100 person-years). Ischemic stroke aSHR over 3 years showed no differences between AA-AF, and SA-AF, PH-AF and nonPH-AF groups (aSHR 0.87-1.01 vs AA-AF). All AF groups showed a significantly higher aSHR compared to controls. (subhazard rate ratio 0.40 [0.34 - 0.47]. Conclusion: Ischemic stroke risk in patients with AA-AF incidentally-detected in primary care is far from benign, and not less than incident AF presenting clinically in general practice or hospital. This provides justification for identification of previously undetected AF, e.g. by opportunistic screening, and subsequent stroke prevention with thromboprophylaxis, to reduce the approximately 10% of ischemic strokes related to unrecognized AF.

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 O16 Incidence, prevalence and associated comorbidity of axSpA within the UK: a retrospective database analysis

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Christopher L. I Morgan ◽  
Abigail White ◽  
Mark Tomlinson ◽  
Amie Scott ◽  
Haijun Tian
Keyword(s):  
Primary Care ◽  
Index Date ◽  
Practice Research ◽  
Care Practice ◽  
Clinical Practice Research Datalink ◽  
Case Ascertainment ◽  
International Statistical Classification ◽  
The Uk ◽  
Primary Care Practices ◽  
Incident Cases

Abstract Background This study reports the incidence and prevalence of axial spondyloarthritis (axSpA) in the UK, and describes the baseline characteristics and comorbidities associated with the condition. Methods This study was conducted using the Clinical Practice Research Datalink, a large routine primary care database in the UK. Approximately 60% of contributing English primary care practices are linked to Hospital Episode Statistics (HES) secondary care data. AxSpA and relevant comorbidities were identified from Read or International Statistical Classification of Diseases and Related Health Problems-10 codes in primary care or HES datasets, respectively. The date of first axSpA diagnosis defined the index date. Patients with ≥90 days between practice registration and first axSpA diagnosis were classified as incident cases. The incidence and prevalence of axSpA were calculated annually from 2003-2017 for the UK as a whole, each constituent nation and English practices linked to HES data, to maximise case ascertainment. Comorbidities occurring prior to the index date (inclusive) were reported and compared with non-axSpA patients matched for age, sex, primary care practice and concurrent practice registration. Results Overall, 20,199 axSpA patients were identified, of whom 8,387 (41.5%) were classified as incident cases. Of the incident cases, 2,600 (31.0%) were female. Mean age at first diagnosis was 45.5 years (standard deviation [SD]: 17.2), mean body mass index was 27.2 kg/m2 (SD: 5.9) and 2,481 (29.6%) patients were current smokers. In 2017, the incidence of axSpA was 8.0 per 100,000 person-years and the prevalence was 15.8 per 10,000 population, an increase from 12.7 per 10,000 population in 2003. For patients from English practices linked to HES data, the incidence was 10.8 per 100,000 person-years and the prevalence was 17.5 per 10,000 population. 8,385 (∼100.0%) axSpA patients could be matched to non-axSpA controls. At baseline, all selected comorbidities were significantly increased in axSpA cases vs controls (Table). Conclusion This study reports an increasing prevalence of axSpA over the study period and higher rates of specific comorbidities in patients with axSpA vs matched controls. Caveats related to routine database studies, including secular changes in case ascertainment and observation bias, should be considered when interpreting these results. Disclosures C.L.I. Morgan: Other; Employee of: Pharmatelligence. A. White: Shareholder/stock ownership; Novartis. Other; Employee of: Novartis. M. Tomlinson: Consultancies; Novartis. A. Scott: Consultancies; Novartis. H. Tian: Other; Employee of: Novartis.

scholarly journals Concomitant diagnosis of asthma and COPD: a quantitative study in UK primary care

2018 ◽  
Vol 68 (676) ◽  
pp. e775-e782 ◽  
Author(s):  
Francis Nissen ◽  
Daniel R Morales ◽  
Hana Mullerova ◽  
Liam Smeeth ◽  
Ian J Douglas ◽  
...  
Keyword(s):  
Primary Care ◽  
Practice Research ◽  
Chronic Obstructive ◽  
Clinical Practice Research Datalink ◽  
Read Code ◽  
Care Environment ◽  
Missed Opportunities ◽  
Obstructive Pulmonary Disease ◽  
Additional Information ◽  
The Uk

BackgroundAsthma and chronic obstructive pulmonary disease (COPD) share many characteristics and symptoms, and the differential diagnosis between the two diseases can be difficult in primary care. This study explored potential overlap between both diseases in a primary care environment.AimTo quantify how commonly patients with COPD have a concomitant diagnosis of asthma, and how commonly patients with asthma have a concomitant diagnosis of COPD in UK primary care. Additionally, the study aimed to determine the extent of possible misdiagnosis and missed opportunities for diagnosis.Design and settingPatients with validated asthma and patients with validated COPD in primary care were identified from the UK Clinical Practice Research Datalink (CPRD) in separate validation studies, and the diseases were confirmed by review of GP questionnaires.MethodThe prevalence of concurrent asthma and COPD in validated cases of either disease was examined based on CPRD coding, GP questionnaires, and requested additional information.ResultsIn total, 400 patients with COPD and 351 patients with asthma in primary care were identified. Of the patients with validated asthma, 15% (n = 52) had previously received a diagnostic COPD Read code, although COPD was only likely in 14.8% (95% confidence interval [CI] = 11.3 to 19.0) of patients with validated asthma. More than half (52.5%, n = 210) of patients with validated COPD had previously received a diagnostic asthma Read code. However, when considering additional evidence to support a diagnosis of asthma, concurrent asthma was only likely in 14.5% (95% CI = 11.2 to 18.3) of patients with validated COPD.ConclusionA concurrent asthma and COPD diagnosis appears to affect a relative minority of patients with COPD (14.5%) or asthma (14.8%). Asthma diagnosis may be over-recorded in people with COPD.

scholarly journals Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173272 ◽  
Author(s):  
Andrew Thompson ◽  
Darren M. Ashcroft ◽  
Lynn Owens ◽  
Tjeerd P. van Staa ◽  
Munir Pirmohamed
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Alcohol Dependence ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

scholarly journals Retrospective, multicohort analysis of the Clinical Practice Research Datalink (CPRD) to determine differences in the cost of medication wastage, dispensing fees and prescriber time of issuing either short (<60 days) or long (≥60 days) prescription lengths in primary care for common, chronic conditions in the UK

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019382 ◽  
Author(s):  
Brett Doble ◽  
Rupert Payne ◽  
Amelia Harshfield ◽  
Edward C F Wilson
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Lipid Management ◽  
Medication Wastage ◽  
The Uk ◽  
The Cost ◽  
Repeat Prescriptions

ObjectivesTo investigate patterns of early repeat prescriptions and treatment switching over an 11-year period to estimate differences in the cost of medication wastage, dispensing fees and prescriber time for short (<60 days) and long (≥60 days) prescription lengths from the perspective of the National Health Service in the UK.SettingRetrospective, multiple cohort study of primary care prescriptions from the Clinical Practice Research Datalink.ParticipantsFive random samples of 50 000 patients each prescribed oral drugs for (1) glucose control in type 2 diabetes mellitus (T2DM); (2) hypertension in T2DM; (3) statins (lipid management) in T2DM; (4) secondary prevention of myocardial infarction; and (5) depression.Primary and secondary outcome measuresThe volume of medication wastage from early repeat prescriptions and three other types of treatment switches was quantified and costed. Dispensing fees and prescriber time were also determined. Total unnecessary costs (TUC; cost of medication wastage, dispensing fees and prescriber time) associated with <60 day and ≥60 day prescriptions, standardised to a 120-day period, were then compared.ResultsLonger prescription lengths were associated with more medication waste per prescription. However, when including dispensing fees and prescriber time, longer prescription lengths resulted in lower TUC. This finding was consistent across all five cohorts. Savings ranged from £8.38 to £12.06 per prescription per 120 days if a single long prescription was issued instead of multiple short prescriptions. Prescriber time costs accounted for the largest component of TUC.ConclusionsShorter prescription lengths could potentially reduce medication wastage, but they may also increase dispensing fees and/or the time burden of issuing prescriptions.

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