scholarly journals Trends in systematic recording errors of blood pressure and association with outcomes in Canadian and UK primary care data: a retrospective observational study

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Sumeet Kalia ◽  
Michelle Greiver
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Observational Study ◽  
Nearest Neighbor ◽  
Bootstrap Method ◽  
Cardiovascular Outcomes ◽  
Retrospective Observational Study ◽  
Optimal Decision ◽  
Systematic Bias ◽  
K Nearest Neighbor

IntroductionEnd digit preference (EDP) or systematic bias in the recording of blood pressure (BP) measurement is prevalent in primary care: up to 60% of BP readings end in zero. High blood pressure (BP) is a leading cause of increased morbidity in adults and errors in measurement may contribute to increased rate of adverse cardiovascular outcomes. Objectives and ApproachWe studied EDP trends, uptake of Automated Office BP (AOBP) measurement, and cardiovascular outcomes in the UK and Canada.This is a retrospective observational study using routinely collected Electronic Medical Record data for patients age 18 or more. We used bootstrap method to estimate the odds ratios where logistic regression was fitted on one thousand independently sampled replicates of the CPCSSN and RCGP datasets. We implemented the unsupervised algorithm of k-nearest neighbor across all sites to find the optimal decision boundary to classify the sites into the three categories: (1) strong EDP; (2) some EDP; (3) no EDP. ResultsThe mean rate of end digit zero for both systolic and diastolic BP decreased from 26.6% in 2006 to 15.4% in 2015 in Canada and from 24.2% in 2001 to 17.3% in 2015 in the U.K. There was a gradual decline in EDP in the three years following the purchase of an AOBP machine. Sites categorized as having high levels of EDP had lower mean sBP levels than sites with potentially no EDP in both Canada and UK. Patients in sites with high levels of EDP had higher yearly prevalence of stroke (Standardized morbidity ration or SMR 1.11), myocardial infarcts (SMR 1.15), and angina (SMR 1.27) than patients in sites with no EDP. Conclusion/ImplicationsThere is systematic recording errors including rounding down of BP readings associated with higher rates of EDP and presumably more use of manual BP measurement. Higher rates of EDP were associated with greater prevalence of adverse cardiovascular outcomes. Consideration should be given to using AOBP machines in primary care.

scholarly journals Trends in end digit preference for blood pressure and associations with cardiovascular outcomes in Canadian and UK primary care: a retrospective observational study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024970 ◽  
Author(s):  
Michelle Greiver ◽  
Sumeet Kalia ◽  
Teja Voruganti ◽  
Babak Aliarzadeh ◽  
Rahim Moineddin ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Observational Study ◽  
Diastolic Pressure ◽  
Cardiovascular Outcomes ◽  
Retrospective Observational Study ◽  
Digit Preference ◽  
The Mean ◽  
The Uk ◽  
Primary Care Practices

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.

Off-label prescribing to children in primary care: retrospective observational study

2004 ◽  
Vol 60 (5) ◽  
Author(s):  
Suzie Ekins-Daukes ◽  
PeterJ. Helms ◽  
ColinR. Simpson ◽  
MichaelW. Taylor ◽  
JamesS. McLay
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Retrospective Observational Study ◽  
Off Label

scholarly journals Primary care chaplaincy: an intervention for complex presentation

2018 ◽  
Vol 20 ◽  
Author(s):  
Gordon W. Macdonald
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Observational Study ◽  
Social Isolation ◽  
Well Being ◽  
Retrospective Observational Study ◽  
Holistic Care ◽  
Presenting Symptoms ◽  
Routinely Collected Data ◽  
Mental Well Being

Abstract Aim To determine the responsiveness of primary care chaplaincy (PCC) to the current variety of presenting symptoms seen in primary care. This was done with a focus on complex and undifferentiated illness. Background Current presentations to primary care are often complex, undifferentiated and display risk factors for social isolation and loneliness. These are frequently associated with loss of well-being and spiritual issues. PCC provides holistic care for such patients but its efficacy is unknown in presentations representative of such issues. There is therefore a need to assess the characteristics of those attending PCC. The effectiveness of PCC relative to the type and number of presenting symptoms should also be analysed whilst evaluating impact on GP workload. Methods This was a retrospective observational study based on routinely collected data. In total, 164 patients attended PCC; 75 were co-prescribed antidepressants (AD) and 89 were not (No-AD). Pre- and post-PCC well-being was assessed by the Warwick–Edinburgh mental well-being score. Presenting issue(s) data were collected on a separate questionnaire. GP appointment utilisation was measured for three months pre- and post-PCC. Findings Those displaying undifferentiated illness and risk factors for social isolation and loneliness accessed PCC. PCC (No-AD) was associated with a clinically meaningful and statistically significant improvement in well-being in all presenting issues. This effect was maintained in those with multiple presenting issues. PCC was associated with a reduction in GP appointment utilisation in those not co-prescribed AD.

scholarly journals How sensitive are avoidable emergency department attendances to primary care quality? Retrospective observational study

2020 ◽  
pp. bmjqs-2020-011651
Author(s):  
Beth Parkinson ◽  
Rachel Meacock ◽  
Kath Checkland ◽  
Matt Sutton
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Observational Study ◽  
Care Quality ◽  
National Average ◽  
Retrospective Observational Study ◽  
Clinical Quality ◽  
Care Access ◽  
Primary Care Quality ◽  
Rate Ratios

BackgroundImprovements in primary care quality are often proposed as a solution to rises in emergency department (ED) attendances. However, there is little agreement on what constitutes an avoidable attendance, and the relationship between primary care quality and ED demand remains poorly understood.ObjectiveTo estimate the size of the associations between primary care quality and volumes of ED attendances classified as avoidable.MethodsRetrospective observational study of all attendances at EDs in England during 2015/2016, applying three definitions of avoidable attendance. We linked practice-level counts of attendances to seven measures of primary care access, patient experience and clinical quality for 7521 practices. We used count data regressions to associate attendance counts with levels of quality. We then calculated proportions of attendances associated with levels of primary care quality below the national average.ResultsAttendance volumes were negatively related to three of the seven quality measures. Incidence rate ratios (IRRs) for all attendances associated with 10 percentage-point differences in quality were 0.987 for clinical quality and 0.987 for easy telephone access and 0.978 for ability to get an appointment. These associations were relatively stronger for narrower definitions of avoidable attendances (for the narrowest definition, IRRs=0.966, 0.976 and 0.934, respectively) but represented fewer attendances in absolute terms. 341 000 (2.4%) attendances were associated with levels of primary care quality below the national average in 2015/2016.ConclusionED attendances are sensitive to primary care quality, but magnitudes of these associations are small. Attendances are much less responsive to differences in primary care quality than indicated by estimates of the prevalence of avoidable attendances. This may explain the failure of initiatives to reduce attendances through primary care improvements.

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