scholarly journals Exploring the Effect of Nice Guidelines on Prescribing for Childhood Atopic Eczema in Primary Care with An Interrupted Time Series

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
LIW Schreuders ◽  
SJ Ersser ◽  
C Thompson
Keyword(s):  
Primary Care ◽  
Atopic Eczema ◽  
Best Practice ◽  
Secondary Analysis ◽  
Clinical Excellence ◽  
Population Level ◽  
Prescribing Practices ◽  
Nice Guideline ◽  
Primary Care Data ◽  
First Time

IntroductionAtopic eczema (AE) is a chronic inflammatory skin condition affecting 20-32% of UK children, typically diagnosed and treated in primary care. National Institute of Health and Clinical Excellence (NICE, 2007) guidelines recommend all children presenting with AE in primary care are prescribed emollient; topical corticosteroids (TCS) are co-prescribed if indicated by severity. The proportion of children receiving recommended treatment and NICE guideline impact on prescribing practices is unknown. This study was the first to access population-level UK-wide primary care dermatology data from SystmOne. Objectives and ApproachWe explored treatment patterns for childhood AE documented in primary care data from SystmOne. Secondary analysis of retrospective, longitudinal primary care data for childhood (<12yo) AE-related consultations from 2002 to 2013. Four treatment scenarios were compared: 1) emollient and TCS co-prescribed (NICE-recommended for moderate-high severity presentation), 2) emollient only (NICE-recommended for mild severity presentation), 3) TCS only (not recommended), or 4) no topical treatment prescribed (not recommended). ARIMA used to examine step and trend-change in prescribing following guideline release. ResultsNICE-recommended treatments were more common following guideline release: emollient+TCS increased 8% (95%CI 7.7,8.7%); emollient alone increased 8% (95%CI 7.8,8.8%); TCS alone decreased 5% (95%CI -4.2,-5.1%); and no treatment decreased 11% (95%CI -11.3,-12.3%). Longitudinal analysis indicated increased NICE-recommended prescribing was due to pre-existing trends not significantly altered by the guideline release. By December 2013, ~334 children per month were still not receiving recommended AE treatment (37% of ~900 first-time consultations/month). Conclusion / ImplicationsAdherence to best practice guidelines for treatment and management of childhood atopic eczema is currently sub-optimal. Significant barriers to optimal use of this data could be achieved by improving design of data input interfaces with secondary use for research in mind. As well as study findings, this presentation will share challenges associated with utilising routinely collected SystmOne data for research purposes for the first time in the UK.

scholarly journals Prevalence of Atopic Eczema Among Patients Seen in Primary Care: Data From The Health Improvement Network

2018 ◽  
Vol 170 (5) ◽  
pp. 354 ◽  
Author(s):  
Katrina Abuabara ◽  
Alexa Magyari ◽  
Charles E. McCulloch ◽  
Eleni Linos ◽  
David J. Margolis ◽  
...  
Keyword(s):  
Primary Care ◽  
Atopic Eczema ◽  
Health Improvement ◽  
Primary Care Data ◽  
The Health Improvement Network

scholarly journals Intervention to reduce benzodiazepine prescriptions in primary care, study protocol of a hybrid type 1 cluster randomised controlled trial: the BENZORED study

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022046 ◽  
Author(s):  
Caterina Vicens ◽  
Alfonso Leiva ◽  
Ferran Bejarano ◽  
Ermengol Sempere ◽  
Raquel María Rodríguez-Rincón ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Research ◽  
Best Practice ◽  
Controlled Trial ◽  
Intervention Group ◽  
Cluster Randomised Controlled Trial ◽  
Balearic Islands ◽  
Prescription Database ◽  
Prescribing Practices ◽  
Electronic Prescription

IntroductionBenzodiazepines (BZDs) are mainly used to treat anxiety and sleep disorders, and are often prescribed for long durations, even though prescription guidelines recommend short-term use due to the risk of dependence, cognitive impairment, and falls and fractures. Education of general practitioners (GPs) regarding the prescription of BZDs may reduce the overuse and of these drugs.The aims of this study are to analyse the effectiveness of an intervention targeted to GPs to reduce BZD prescription and evaluate the implementation process.Methods and analysisThe healthcare centres in three regions of Spain (Balearic Islands, Catalonia and Community of Valencia) will be randomly allocated to receive a multifactorial intervention or usual care (control). GPs in the intervention group will receive a 2-hour workshop about best-practice regarding BZD prescription and BZD deprescribing, monthly feedback about their BZD prescribing practices and access to a support web page. Outcome measures for each GP are the defined daily dosage per 1000 inhabitants per day and the proportion of long-term BZD users at 12 months. Data will be collected from the electronic prescription database of the public health system, and will be subjected to intention-to-treat analysis. Implementation will be evaluated by mixed methods following the five domains of the Consolidated Framework For Implementation Research.Ethics and disseminationThis study was approved by the Balearic Islands Ethical Committee of Clinical Research (IB3065/15), l’IDIAP Jordi Gol Ethical Committee of Clinical Research (PI 15/0148) and Valencia Primary Care Ethical Committee of Clinical Research (P16/024). The results will be submitted for publication in peer-reviewed journals.Trial registration numberISRCTN28272199.

scholarly journals Impact of the COVID-19 Pandemic on the Prescribing Patterns of First-Line Antibiotics in English Primary Care: A Longitudinal Analysis of National Prescribing Dataset

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 591
Author(s):  
Alisha Zubair Hussain ◽  
Vibhu Paudyal ◽  
Muhammad Abdul Hadi
Keyword(s):  
Primary Care ◽  
Secondary Analysis ◽  
Clinical Excellence ◽  
Public Access ◽  
Prescribing Patterns ◽  
Access To Health Services ◽  
First Line ◽  
Government Data ◽  
Tract Infections ◽  
The Impact

The COVID-19 pandemic has impacted on public access to health services. This study aimed to investigate the impact of COVID-19 pandemic on commonly prescribed first-line antibiotics in English primary care. A secondary analysis of publicly available government data pertaining to primary care prescribing was conducted. A list of twenty first-line antibiotics used to treat common infections was developed following the National Institute of Clinical Excellence (NICE) guidelines. All primary care prescription and cost data pertaining to commonly prescribed first-line antibiotics in England between March and September of 2018–2020 were extracted and adjusted for inflation. Analysis suggests prescribing of antibiotics significantly reduced by 15.99% (p = 0.018) and 13.5% (p = 0.002) between March and September 2020 compared with same time period for 2018 and 2019, respectively. The most noticeable decrease in 2020 was noticed for prescribing for meningitis (−62.3%; p = 0.002) followed by respiratory tract infections (−39.13%; p = 0.035), in terms of indications. These results are suggestive of reduced transmission of infections in the community due to national lockdowns, social distancing and hygiene practices. In addition, the impact of reduced face-to-face consultations in general practices needs to be investigated as a potential reason for reduced prescribing. The pandemic also offers an opportunity to rationalize antibiotics use in the community.

scholarly journals Association of opioid prescribing practices with chronic pain and benzodiazepine co-prescription: a primary care data linkage study

2018 ◽  
Vol 120 (6) ◽  
pp. 1345-1355 ◽  
Author(s):  
N. Torrance ◽  
R. Mansoor ◽  
H. Wang ◽  
S. Gilbert ◽  
G.J. Macfarlane ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Data Linkage ◽  
Linkage Study ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Primary Care Data

scholarly journals Incidence of shoulder dislocations in the UK, 1995–2015: a population-based cohort study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016112 ◽  
Author(s):  
Anjali Shah ◽  
Andrew Judge ◽  
Antonella Delmestri ◽  
Katherine Edwards ◽  
Nigel K Arden ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Shoulder Dislocation ◽  
National Database ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Unexpected Finding ◽  
Primary Care Data ◽  
The Uk ◽  
First Time

ObjectiveThis cohort study evaluates the unknown age-specific and gender-specific incidence of primary shoulder dislocations in the UK.SettingUK primary care data from the Clinical Practice Research Datalink (CPRD) were used to identify patients aged 16–70 years with a shoulder dislocation during 1995–2015. Coding of primary shoulder dislocations was validated using the CPRD general practitioner questionnaire service.ParticipantsA cohort of 16 763 patients with shoulder dislocation aged 16–70 years during 1995–2015 were identified.Primary outcome measureIncidence rates per 100 000 person-years and 95% CIs were calculated.ResultsCorrect coding of shoulder dislocation within CPRD was 89% (95% CI 83% to 95%), and confirmation that the dislocation was a ‘primary’ was 76% (95% CI 67% to 85%). Seventy-two percent of shoulder dislocations occurred in men. The overall incidence rate in men was 40.4 per 100 000 person-years (95% CI 40.4 to 40.4), and in women was 15.5 per 100 000 person-years (95% CI 15.5 to 15.5). The highest incidence was observed in men aged 16–20 years (80.5 per 100 000 person-years; 95% CI 80.5 to 80.6). Incidence in women increased with age to a peak of 28.6 per 100 000 person-years among those aged 61–70 years.ConclusionsThis is the first time the incidence of shoulder dislocations has been studied using primary care data from a national database, and the first time the results for the UK have been produced. While most primary dislocations occurred in young men, an unexpected finding was that the incidence increased in women aged over 50 years, but not in men. The reasons for this are unknown. Further work is commissioned by the National Institute for Health Research to examine treatments and predictors for recurrent shoulder dislocation.Study registrationThe design of this study was approved by the Independent Scientific Advisory Committee (15_260) for the Medicines & Healthcare products Regulatory Agency.

scholarly journals Is the NICE traffic light system fit-for-purpose for children presenting with undifferentiated acute illness in primary care?

2021 ◽  
pp. archdischild-2021-322768
Author(s):  
Megan Hedd Blyth ◽  
Rebecca Cannings-John ◽  
Alastair D Hay ◽  
Christopher C Butler ◽  
Kathryn Hughes
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Secondary Analysis ◽  
Clinical Excellence ◽  
Sensitivity Analyses ◽  
Practice Research ◽  
Traffic Light ◽  
Light System ◽  
Care Assessment ◽  
Fit For Purpose

BackgroundThe National Institute of Clinical Excellence (NICE) traffic light system uses children’s symptoms and signs to categorise acute infections into red, amber and green. To our knowledge, no study has described the proportion of children with acute undifferentiated illness who fall into these categories in primary care, which is important since red and amber children are considered at higher risk of serious illness requiring urgent secondary care assessment.AimTo estimate the proportion of acutely unwell children presenting to primary care classified by the NICE traffic light system as red, amber or green, and to describe their initial management.Design and settingSecondary analysis of the Diagnosis of Urinary Tract infection in Young children prospective cohort study.Method6797 children under 5 years presenting to 225 general practices with acute undifferentiated illness were retrospectively mapped to the NICE traffic light system by a panel of general practitioners.Results6406 (94%) children were classified as NICE red (32%) or amber (62%) with 1.6% red and 0.3%, respectively, referred the same day for hospital assessment; and 46% and 31%, respectively, treated with antibiotics. The remaining 385 (6%) were classified green, with none referred and 27% treated with antibiotics. Results were robust to sensitivity analyses.ConclusionThe majority of children presenting to UK primary care with acute undifferentiated illness meet red or amber NICE traffic light criteria,with only 6% classified as low risk, making it unfit for use in general practice. Research is urgently needed to establish as triage system suitable for general practice.

scholarly journals Construction and Validation of a Frailty Index in Primary Care in Italy: The Health-Search Frailty Index

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 533-534
Author(s):  
Davide Vetrano ◽  
Alberto Zucchelli ◽  
Graziano Onder ◽  
Roberto Bernabei ◽  
Laura Fratiglioni ◽  
...  
Keyword(s):  
Primary Care ◽  
Frailty Index ◽  
External Validation ◽  
Geographical Area ◽  
Population Level ◽  
Survival Models ◽  
National Study ◽  
Personalized Care ◽  
Primary Care Data ◽  
Data Driven Approach

Abstract Recognizing frailty in primary care is important to implement personalized care pathways and for prognostication. The aim of this study was to build and validate a frailty index based on routinely collected primary care data in Italy. We used clinical data from 308,280 Italian primary care patients 60+ with at least 5 years of follow-up, part of the Health Search Database. A heuristic algorithm was used to select the deficits to be included in a highly performant frailty index. The fitness of the index was assessed through the c-statistics derived by survival models. Results were externally validated using the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). After testing 3.4 million of deficits combinations, 25 deficits were selected to be included in the Health Search Frailty Index (HS-FI). After adjusting by sex, age and geographical area, the HS-FI was associated with 5-year mortality (HR per 0.1 increase 1.99; 95%CI 1.95-2.02) and hospitalization rate (HR per 0.1 increase 1.25; 95%CI 1.23-1.27). In the external validation cohort, HS-FI independently predicted mortality, hospitalization, incident disability, incident dementia, and incident falls. This is the first frailty index built following a data-driven approach, using national representative primary care data. The implementation of such tool – derived by routinely collected data – in primary care software will ease the prompt, comparable and reliable recognition of frailty at the population level.

scholarly journals Identifying all persons in Wales with type 1 diabetes mellitus using routinely collected linked data

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
James Rafferty ◽  
Ashley Akbari ◽  
Mark D Atkinson ◽  
Stephen Bain ◽  
Stephen Luzio ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
False Positive ◽  
Secondary Care ◽  
Population Level ◽  
International Classification Of Disease ◽  
Primary Care Data ◽  
Diagnosis Codes ◽  
Diabetes Status ◽  
Autoimmune Condition

IntroductionType 1 diabetes mellitus (T1DM) is an autoimmune condition characterised by hyperglycaemia, caused by the destruction of insulin producing β-cells in the pancreas. Previous epidemiological population level studies of T1DM and its complications have typically used recorded T1DM diagnoses to determine diabetes status and define cohorts. Objectives and ApproachThe objective was to identify all persons with T1DM in Wales from Primary (~70\% population coverage) and Secondary Care (100% coverage) data held in the Secure Anonymised Information Linkage (SAIL) databank. People with a coded T1DM diagnosis (using Read codes in Primary Care data and International Classification of Disease (ICD10) codes in Secondary Care data), plus either insulin prescribed shortly after diagnosis or a hospital admission for diabetic ketoacidosis were identified as having T1DM. A sub-group of this SAIL e-cohort were validated using a register of persons diagnosed with T1DM in Wales under 15 years old (Brecon cohort). Results18,285 people had a T1DM diagnosis and 10,539 had more T1DM than type 2 diabetes mellitus (T2DM) diagnoses. 6,375 persons were identified with T1DM in Primary Care data using our criteria, with a median diagnosis age of 19.2 years (interquartile range 11.0, 35.5). 47.5\% were diagnosed under 18 years of age. 39.6% of people with a T1DM diagnosis did not have T1DM using our criteria. False positive and negative rates of 4.8% and 4.5% respectively were achieved by comparing persons in the SAIL e-cohort against the Brecon cohort. Clinician estimated false positive and negative rates were 1.4% and 3.9% respectively. The prevalence of T1DM in Wales in 2016 was 0.37% or 11,049 people. Conclusion/ImplicationsOur criteria for identifying people with T1DM was more reliable than using diagnosis codes alone, allowing for a more accurate, efficient and reproducible means of identifying individuals with T1DM for researchers utilising the SAIL databank, and other national health repositories.

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