scholarly journals The Impact of Demographic, Socio-Economic and Geographic Factors on Mortality Risk among People Living with Dementia in England (2002–2016)

2021 ◽  
Vol 18 (24) ◽  
pp. 13405
Author(s):  
James Watson ◽  
Frances Darlington-Pollock ◽  
Mark Green ◽  
Clarissa Giebel ◽  
Asangaedem Akpan
Keyword(s):  
Mortality Risk ◽  
Social Inequalities ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Geographic Factors ◽  
North East ◽  
Explanatory Factors ◽  
South Central ◽  
Health And Social Care ◽  
The Impact

Increasing numbers of people living with dementia (PLWD), and a pressured health and social care system, will exacerbate inequalities in mortality for PLWD. There is a dearth of research examining multiple factors in mortality risk among PLWD, including application of large administrative datasets to investigate these issues. This study explored variation mortality risk variation among people diagnosed with dementia between 2002–2016, based on: age, sex, ethnicity, deprivation, geography and general practice (GP) contacts. Data were derived from electronic health records from a cohort of Clinical Practice Research Datalink GP patients in England (n = 142,340). Cox proportional hazards regression modelled mortality risk separately for people with early- and later- onset dementia. Few social inequalities were observed in early-onset dementia; men had greater risk of mortality. For early- and later-onset, higher rates of GP observations—and for later-onset only dementia medications—are associated with increased mortality risk. Social inequalities were evident in later-onset dementia. Accounting for other explanatory factors, Black and Mixed/Other ethnicity groups had lower mortality risk, more deprived areas had greater mortality risk, and higher mortality was observed in North East, South Central and South West GP regions. This study provides novel evidence of the extent of mortality risk inequalities among PLWD. Variance in mortality risk was observed by social, demographic and geographic factors, and frequency of GP contact. Findings illustrate need for greater person-centred care discussions, prioritising tackling inequalities among PLWD. Future research should explore more outcomes for PLWD, and more explanatory factors of health outcomes.

scholarly journals Multimorbidity within households and use of health and social care

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0134
Author(s):  
Mai Stafford ◽  
Sarah Deeny ◽  
Kathryn Dreyer ◽  
Shand Jenny
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Social Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Long Term Conditions ◽  
Health And Social Care ◽  
Care Activity ◽  
The Impact

Background: The daily management of long-term conditions falls primarily on individuals and informal carers, but the impact of household context on health and social care activity among people with multimorbidity is understudied. Aim: To test whether co-residence with a multimorbid person (compared with a non-multimorbid co-resident) is associated with utilisation and cost of primary, community and secondary health care and formal social care. Design and Setting: Linked data from health providers and local government in Barking and Dagenham for a retrospective cohort of people aged 50+ in two-person households in 2016-2018. Methods: Two-part regression models were applied to estimate annualised use and cost of hospital, primary, community, mental health and social care by multimorbidity status of individuals and co-residents, adjusted for age, gender and deprivation. Applicability at the national level was tested using the Clinical Practice Research Datalink. Results: Over 45% of multimorbid people in two-person households were co-resident with another multimorbid person. They were 1.14 (95% CI 1.00, 1.30) times as likely to have community care activity and 1.24 (95% CI 0.99,1.54) times as likely to have mental health care activity compared to those co-resident with a healthy person. They had more primary care visits (8.5 (95% CI 8.2,8.8) vs 7.9 (95% CI 7.7,8.2)) and higher primary care costs. Outpatient care and elective admissions did not differ. Findings in national data were similar. Conclusions: Care utilisation for people with multimorbidity varies by household context. There may be potential for connecting health and community service input across household members.

scholarly journals Primary Care Consultations after Hospitalisation for Pneumonia: A Large Population-based Cohort Study

2020 ◽  
pp. BJGP.2020.0890
Author(s):  
Vadsala Baskaran ◽  
Fiona Pearce ◽  
Rowan H Harwood ◽  
Tricia McKeever ◽  
Wei Shen Lim
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Large Population ◽  
Significant Proportion ◽  
Antibiotic Use ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Respiratory Disorder ◽  
The Impact

Background: Up to 70% of patients report ongoing symptoms four weeks after hospitalisation for pneumonia, and the impact on primary care is poorly understood. Aim: To investigate the frequency of primary care consultations after hospitalisation for pneumonia, and the reasons for consultation. Design: Population-based cohort study. Setting: UK primary care database of anonymised medical records (Clinical Practice Research Datalink, CPRD) linked to Hospital Episode Statistics (HES), England. Methods: Adults with the first ICD-10 code for pneumonia (J12-J18) recorded in HES between July 2002-June 2017 were included. Primary care consultation within 30 days of discharge was identified as the recording of any medical Read code (excluding administration-related codes) in CPRD. Competing-risks regression analyses were conducted to determine the predictors of consultation and antibiotic use at consultation; death and readmission were competing events. Reasons for consultation were examined. Results: Of 56,396 adults, 55.9% (n=31,542) consulted primary care within 30 days of discharge. The rate of consultation was highest within 7 days (4.7 per 100 person-days). The strongest predictor for consultation was a higher number of primary care consultations in the year prior to index admission (adjusted sHR 8.98, 95% CI 6.42-12.55). The commonest reason for consultation was for a respiratory disorder (40.7%, n=12,840), 12% for pneumonia specifically. At consultation, 31.1% (n=9,823) received further antibiotics. Penicillins (41.6%, n=5,753) and macrolides (21.9%, n=3,029) were the commonest antibiotics prescribed. Conclusion: Following hospitalisation for pneumonia, a significant proportion of patients consulted primary care within 30 days, highlighting the morbidity experienced by patients during recovery from pneumonia.

Psychological distress and work and home roles: a focus on socio-economic differences in distress

2001 ◽  
Vol 31 (4) ◽  
pp. 725-736 ◽  
Author(s):  
S. MATTHEWS ◽  
C. POWER ◽  
S. STANSFELD
Keyword(s):  
Psychological Distress ◽  
Social Class ◽  
Social Inequalities ◽  
Social Gradient ◽  
Psychological Status ◽  
Men And Women ◽  
Class Differences ◽  
Explanatory Factors ◽  
Work Factors ◽  
The Impact

Background. Home and work factors have been linked to psychological status, but less is known about their contribution to social inequalities in psychological status. We examine whether social inequalities in psychological distress can be explained by work–home factors and whether the impact of these potential explanatory factors is similar for men and women.Methods. Data are from the 1958 British birth cohort study. We sought to explain social class differences in psychological distress at age 33. Explanatory factors were classified as work–home roles: i.e. employment, marital status, domestic responsibility, children and elderly care; and work–home characteristics: i.e. job-strain, insecurity, unsocial working hours, youngest child's age, number of children and level of involvement in childcare.Results. A social gradient in psychological distress was found: odds ratios for classes IV and V v. I and II were 2·65 (men) and 3·02 (women). Work factors had consistently stronger associations with psychological distress and with social class among men than women. Work factors had a greater impact on class differences in psychological distress in men. Associations for home roles and characteristics were less consistent and their combined effect on class differences in distress was negligible for both sexes.Conclusion. Explanations for the social gradient differ for men and women. Work may be more important for men than women, but the impact of home factors was not strong during the early adulthood of this cohort.

scholarly journals Cohort profile for the MASTERMIND study: using the Clinical Practice Research Datalink (CPRD) to investigate stratification of response to treatment in patients with type 2 diabetes

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017989 ◽  
Author(s):  
Lauren R Rodgers ◽  
Michael N Weedon ◽  
William E Henley ◽  
Andrew T Hattersley ◽  
Beverley M Shields
Keyword(s):  
Type 2 Diabetes ◽  
Clinical Practice ◽  
Treatment Response ◽  
Response To Treatment ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Data Quality Control ◽  
Data Set ◽  
The Impact

PurposeThis is a retrospective cohort study using observational data from anonymised primary care records. We identify and extract all patients with type 2 diabetes and associated clinical data from the Clinical Practice Research Datalink (CPRD) to inform models of disease progression and stratification of treatment.ParticipantsData were extracted from CPRD on 8 August 2016. The initial data set contained all patients (n=313 485) in the database who had received a type 2 diabetes medication. Criteria were applied to identify and exclude those with type 1 diabetes, polycystic ovarian syndrome or other forms of diabetes (n=40 204), and for data quality control (n=12). We identified 251 338 patients for inclusion in future analyses of diabetes progression and treatment response.Findings to dateFor 6-month response to treatment, measured by change in glycated haemoglobin (HbA1c), we have 91 765 patients with 119 785 treatment response episodes. The greatest impact on reduction of HbA1c occurs with first-line and second-line treatments, metformin and sulfonylurea. Patients moving to third-line treatments tend to have greater weights and higher body mass index. We have investigated the impact of non-adherence to commonly used glucose-lowering medications on HbA1c. For baseline-adjusted HbA1c change over 1 year, non-adherent patients had lower HbA1c reductions than adherent patients, with mean and 95% CI of −4.4 (−4.7 to −4.0) mmol/mol (−0.40 (−0.43 to −0.37) %).Future plansFindings from studies using these data will help inform future treatment plans and guidelines. Additional data are added with updates from CPRD. This will increase the numbers of patients on newer medications and add more data on those already receiving treatment. There are several ongoing studies investigating different hypotheses regarding differential response to treatment and progression of diabetes. For side effects, links to Hospital Episode Statistics data, where severe events such as hypoglycaemia will be recorded, will also be explored.

scholarly journals Consultation length by multimorbidity and deprivation: observational study using electronic patient records

2020 ◽  
Author(s):  
Anya Gopfert ◽  
Sarah Deeny ◽  
Rebecca Fisher ◽  
Mai Stafford
Keyword(s):  
Random Effect ◽  
Electronic Record ◽  
Health Condition ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Electronic Patient Records ◽  
Opening And Closing ◽  
Multimorbid Patients ◽  
The Impact ◽  
Deprived Areas

AbstractBackgroundLonger GP consultations are recommended for people with multimorbidity. In Scotland, multimorbid patients in deprived areas did not have longer consultations though their counterparts in the least deprived areas did. We are not aware of research testing this particular example of the inverse care law in England.AimTo assess length of GP consultation for patients with and without multimorbidity and whether this varies by socioeconomic deprivation.Design and SettingRandom sample of over 1.2 million consultations between 1st April 2014 and 31st March 2016 for 185,755 adults in England drawn from the Clinical Practice Research Datalink.MethodConsultation duration was derived from time of opening and closing the patient’s electronic record. Duration was modelled as a function of multimorbidity status, index of multiple deprivation, and their interaction, with adjustment for age, sex, GP trainee status and patient level random effect.ResultsMean adjusted consultation length in the most deprived fifth of areas was 10.8 (95% CI 10.7,10.9) minutes for people with 2+ physical conditions and 11.0 (95% CI 10.9,11.1) minutes for people with 2+ conditions including a mental health condition. This compares with 11.0 (95% CI 10.9,11.0) minutes for non-multimorbid people in the least deprived fifth of areas.ConclusionConsultation length for people with multimorbidity in the most deprived areas is no higher than that for non-multimorbid people in the least deprived areas. Further research is needed to assess the impact of consultation length on patient and system outcomes for people with multimorbidity.

scholarly journals Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records

2020 ◽  
pp. bjgp20X714029
Author(s):  
Anya Gopfert ◽  
Sarah R Deeny ◽  
Rebecca Fisher ◽  
Mai Stafford
Keyword(s):  
Electronic Record ◽  
Health Condition ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Electronic Patient Records ◽  
Inverse Care Law ◽  
Care Consultation ◽  
Opening And Closing ◽  
The Impact ◽  
Deprived Areas

BackgroundLonger GP consultations are recommended as one way of improving care for people with multimorbidity. In Scotland, patients who are multimorbid and living in deprived areas do not have longer consultations, although their counterparts in the least deprived areas do. This example of the inverse care law has not been examined in England.AimTo assess GP consultation length by socioeconomic deprivation and multimorbidity.Design and settingRandom sample of 1.2 million consultations from 1 April 2014 to 31 March 2016 for 190 036 adults in England drawn from the Clinical Practice Research Datalink.MethodConsultation duration was derived from time of opening and closing the patient’s electronic record. Mean duration was estimated by multimorbidity level and type, adjusted for number of consultations and other patient and staff characteristics and patient and practice random effects.ResultsConsultations lasted 10.9 minutes on average and mean duration increased with number of conditions. Patients with ≥6 conditions had 0.9 (95% confidence interval [CI] = 0.8 to 1.0) minutes longer than those with none. Patients who are multimorbid and with a mental health condition had 0.5 (CI = 0.4 to 0.5) minutes longer than patients who were not multimorbid. However, consultations were 0.5 (CI = 0.4 to 0.5) minutes shorter in the most compared with the least deprived fifth of areas at all levels of multimorbidity.ConclusionGPs in England spend longer with patients who have more conditions, but, at all multimorbidity levels, those in deprived areas have less time per GP consultation. Further research is needed to assess the impact of consultation length on patient and system outcomes for those with multimorbidity.

scholarly journals Impact of changes to national guidelines on hypertension related workload

2020 ◽  
pp. bjgp21X714281
Author(s):  
Sarah Lay-Flurrie ◽  
James Sheppard ◽  
Richard J Stevens ◽  
Christian Mallen ◽  
Carl Heneghan ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Interrupted Time Series Analysis ◽  
National Guidelines ◽  
Nice Guidelines ◽  
Face To Face ◽  
General Practices ◽  
The Impact

Background: In 2011, National Institute for Health and Care Excellence (NICE) guidelines recommended the routine use of out-of-office blood pressure (BP) monitoring for the diagnosis of hypertension. These changes were predicted to reduce unnecessary treatment costs and workload associated with misdiagnosis. Aim: To assess the impact of guideline change on rates of hypertension-related consultation in general practice. Design and Setting: Cohort study in adults registered with English general practices contributing to the Clinical Practice Research Datalink between 1/4/2006 and 31/3/2017. Method: The primary outcome was the rate of face-to-face, telephone and visit consultations related to hypertension with a GP or nurse. Age and sex standardized rates were analysed using interrupted time-series analysis. Results: In 3,937,191 adults (median follow-up = 4.2 years) there were 12,253,836 hypertension related consultations. The rate of hypertension related consultation was 71.0 per 100 person-years (95% CI 67.8 to 74.2) in April 2006, which remained flat prior to 2011. The introduction of the NICE hypertension guideline in 2011 was associated with a change in yearly trend (change in trend = -3.60 per 100 person-years, 95% CI -5.12 to -2.09). The rate of consultation subsequently decreased to 59.2 per 100 person-years (95% CI 56.5 to 61.8) in March 2017. These changes occurred around the time of diagnosis and persisted when accounting for wider trends in all consultations. Conclusion: Hypertension-related workload has declined in the last decade, in association with guideline changes. This is due to changes in workload at the time of diagnosis, rather than reductions in misdiagnosis.

scholarly journals Risk of Recurrent Bleeding Events in Nonvalvular Atrial Fibrillation Treated with Vitamin K Antagonists: A Clinical Practice Research Datalink Study

TH Open ◽  
2019 ◽  
Vol 03 (04) ◽  
pp. e316-e324 ◽  
Author(s):  
Raza Alikhan ◽  
Cinira Lefevre ◽  
Ian Menown ◽  
Steven Lister ◽  
Alex Bird ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Clinical Practice ◽  
Vitamin K ◽  
Vitamin K Antagonists ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recurrent Bleeding ◽  
Bleeding Events ◽  
Nonvalvular Atrial Fibrillation ◽  
The Impact

Abstract Background There is little evidence on how the occurrence of a bleed in individuals on vitamin K antagonists (VKAs) impacts the risk of subsequent bleeds, and thromboembolic and ischemic events. Such information would help to inform treatment decisions following bleeds. Objective To estimate the impact of bleeding events on the risk of subsequent bleeds, venous thromboembolism (VTE), stroke, and myocardial infarction (MI) among patients initiating VKA treatment for new-onset nonvalvular atrial fibrillation (NVAF). Methods We conducted an observational cohort study using a linked Clinical Practice Research Datalink—Hospital Episode Statistics dataset. Among a cohort of individuals with NVAF, the risk of clinically relevant bleeding, VTE, stroke, and MI was compared between the period prior to the first bleed and the periods following each subsequent bleed. The rate and cost of general practitioner (GP) consultations, prescriptions, and hospitalizations were also compared across these periods. Results The risk of clinically relevant bleeding events was observed to be elevated at least twofold in all periods following the first bleeding event. The risk of VTE, stroke, and MI was not found to differ according to the number of clinically relevant bleeding events. The rate and cost of GP consultations, GP prescriptions, and hospitalizations were increased in all periods relative to the period prior to the first bleed. Conclusions The doubling in the risk of bleeding following the first bleed, taken alongside the stable risk of MI, VTE, and stroke, suggests that the risk–benefit balance for VKA treatment should be reconsidered following the first clinically relevant bleed.

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