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.

scholarly journals Sepsis Recording in Primary Care Electronic Health Records, Linked Hospital Episodes and Mortality Records: Population-based Cohort Study in England

2020 ◽  
Author(s):  
Emma Rezel-Potts ◽  
Martin C. Gulliford ◽  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recent Period ◽  
General Practices ◽  
Different Sources

AbstractObjectivesSepsis is a growing concern for health systems, but the epidemiology of sepsis is poorly characterised. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations.Methods and FindingsCohort study including 378 general practices in England from Clinical Practice Research Datalink (CPRD) GOLD database from 2002 to 2017 with 36,209,676 patient-years of follow-up with linked Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality registrations. Incident sepsis episodes were identified for each source. Concurrent records from different sources were identified and age-standardised and age-specific incidence rates compared. Logistic regression analysis evaluated associations of gender, age-group, fifth of deprivation and period of diagnosis with concurrent sepsis recording.There were 20,206 first episodes of sepsis from primary care, 20,278 from HES and 13,972 from ONS. There were 4,117 (20%) first HES sepsis events and 2,438 (17%) mortality records concurrent with incident primary care sepsis records within 30 days. Concurrent HES and primary care records of sepsis within 30 days before or after first diagnosis were higher at younger or older ages and for patients with the most recent period of diagnosis with those diagnosed during 2007:2011 less likely to have a concurrent HES record given CPRD compared to those diagnosed during 2012 to 2017 (odd ratio 0.65, 95% confidence interval 0.60 to 0.70). At age 85 and older, primary care incidence was 5.22 per 1,000 patient years (95% CI 1.75 to 11.97) in men and 3.55 (0.87 to 9.58) in women which increased to 10.09 (4.86 to 18.51) for men and 7.22 (2.96 to 14.72) for women after inclusion of all three sources.ConclusionExplicit recording of sepsis is inconsistent across healthcare sectors with a high proportion of non-concurrent records. Incidence estimates are higher when linked data are analysed.

scholarly journals Sepsis recording in primary care electronic health records, linked hospital episodes and mortality records: Population-based cohort study in England

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244764
Author(s):  
Emma Rezel-Potts ◽  
Martin C. Gulliford ◽  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recent Period ◽  
General Practices ◽  
Different Sources

Background Sepsis is a growing concern for health systems, but the epidemiology of sepsis is poorly characterised. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations. Methods and findings Cohort study including 378 general practices in England from Clinical Practice Research Datalink (CPRD) GOLD database from 2002–2017 with 36,209,676 patient-years of follow-up with linked Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality registrations. Incident sepsis episodes were identified for each source. Concurrent records from different sources were identified and age-standardised and age-specific incidence rates compared. Logistic regression analysis evaluated associations of gender, age-group, fifth of deprivation and period of diagnosis with concurrent sepsis recording. There were 20,206 first episodes of sepsis from primary care, 20,278 from HES and 13,972 from ONS. There were 4,117 (20%) first HES sepsis events and 2,438 (17%) mortality records concurrent with incident primary care sepsis records within 30 days. Concurrent HES and primary care records of sepsis within 30 days before or after first diagnosis were higher at younger or older ages and for patients with the most recent period of diagnosis. Those diagnosed during 2007:2011 were less likely to have a concurrent HES record given CPRD compared to those diagnosed during 2012–2017 (odd ratio 0.65, 95% confidence interval 0.60–0.70). At age 85 and older, primary care incidence was 5.22 per 1,000 patient years (95% CI 1.75–11.97) in men and 3.55 (0.87–9.58) in women which increased to 10.09 (4.86–18.51) for men and 7.22 (2.96–14.72) for women after inclusion of all three sources. Conclusion Explicit recording of ‘sepsis’ is inconsistent across healthcare sectors with a high proportion of non-concurrent records. Incidence estimates are higher when linked data are analysed.

scholarly journals Incidence of Lyme disease in the UK: a population-based cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e025916 ◽  
Author(s):  
Victoria Cairns ◽  
Christopher Wallenhorst ◽  
Stephan Rietbrock ◽  
Carlos Martinez
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Lyme Disease ◽  
Population Based ◽  
Incidence Rates ◽  
Annual Incidence ◽  
Secondary Outcome ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk

ObjectivesThe purpose of this study was to estimate the annual incidence of Lyme disease (LD) in the UK.DesignThis was a retrospective descriptive cohort study.SettingStudy data were extracted from the Clinical Practice Research Datalink (CPRD), a primary care database covering about 8% of the population in the UK in 658 primary care practices.ParticipantsCohort of 8.4 million individuals registered with general practitioners with 52.4 million person-years of observation between 1 January 2001 and 31 December 2012.Primary and secondary outcome measuresLD was identified from recorded medical codes, notes indicating LD, laboratory tests and use of specific antibiotics. Annual incidence rates and the estimated total number of LD cases were calculated separately for each UK region.ResultsThe number of cases of LD increased rapidly over the years 2001 to 2012, leading to an estimated incidence rate of 12.1 (95% CI 11.1 to 13.2) per 100 000 individuals per year and a UK total of 7738 LD cases in 2012. LD was detected in every UK region with highest incidence rates and largest number of cases in Scotland followed by South West and South England. If the number of cases has continued to rise since the end of the study period, then the number in the UK in 2019 could be over 8000.ConclusionsThe incidence of LD is about threefold higher than previously estimated, and people are at risk throughout the UK. These results should lead to increased awareness of the need for preventive measures.Trial registration numberThis study was approved by the Independent Scientific Advisory Committee for CPRD research (Protocol number 13_210R).

scholarly journals Trends in healthcare use in children aged less than 15 years: a population-based cohort study in England from 2007 to 2017

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e033761 ◽  
Author(s):  
Judith Ruzangi ◽  
Mitch Blair ◽  
Elizabeth Cecil ◽  
Geva Greenfield ◽  
Alex Bottle ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hospital Admissions ◽  
Population Based ◽  
Urgent Care ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Emergency Hospital ◽  
Outpatient Visits ◽  
Ed Visits

ObjectiveTo describe changing use of primary care in relation to use of urgent care and planned hospital services by children aged less than 15 years in England in the decade following major primary care reforms from 2007 to 2017DesignPopulation-based retrospective cohort study.MethodsWe used linked data from the Clinical Practice Research Datalink to study children’s primary care consultations and use of hospital care including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists.ResultsBetween 1 April 2007 and 31 March 2017, there were 7 604 024 general practitioner (GP) consultations, 981 684 ED visits, 287 719 emergency hospital admissions, 2 253 533 outpatient visits and 194 034 elective admissions among 1 484 455 children aged less than 15 years. Age-standardised GP consultation rates fell (−1.0%/year) to 1864 per 1000 child-years in 2017 in all age bands except infants rising by 1%/year to 6722 per 1000/child-years in 2017. ED visit rates increased by 1.6%/year to 369 per 1000 child-years in 2017, with steeper rises of 3.9%/year in infants (780 per 1000 child-years in 2017). Emergency hospital admission rates rose steadily by 3%/year to 86 per 1000 child-years and outpatient visit rates rose to 724 per 1000 child-years in 2017.ConclusionsOver the past decade since National Health Service primary care reforms, GP consultation rates have fallen for all children, except for infants. Children’s use of hospital urgent and outpatient care has risen in all ages, especially infants. These changes signify the need for better access and provision of specialist and community-based support for families with young children.

scholarly journals Concordance in the recording of stroke across UK primary and secondary care datasets: a population-based cohort study

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0117
Author(s):  
Ann Dorothy Morgan ◽  
Sarah-Jo Sinnott ◽  
Liam Smeeth ◽  
Caroline Minassian ◽  
Jennifer Quint
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Cohort Study ◽  
Time Window ◽  
Research Question ◽  
Population Based ◽  
Hospital Episode Statistics ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Hospital Records

Background: Previous work has demonstrated that the recording of acute health outcomes, such as myocardial infarction, may be suboptimal in primary healthcare databases. Aim: The aim of this analysis is to assess the completeness and accuracy of the recording of stroke in UK primary care. Design and setting: This is a population-based longitudinal cohort study. Methods: Cases of stroke were identified separately in Clinical Practice Research Datalink (CPRD) primary care records and linked Hospital Episode Statistics (HES). The recording of events in the same patient across the two datasets was compared. The reliability of strategies to identify fatal strokes in primary care and hospital records was also assessed. Results: Of the 75,674 stroke events that were identified in either CPRD or HES data during the period of our study, 54,929 (72.6%) were recorded in CPRD and 51,013 (67.4%) were recorded in HES. Two fifths (n=30,268) of all recorded strokes were found in both datasets (allowing for a time window of 120 days). Among these “matched” strokes the subtype was recorded accurately in approximately 75% of CPRD records (compared to coding in HES): however, 43.5% of ischaemic strokes in HES were coded as “non-specific” strokes in CPRD data. Furthermore, 48% had same day-recordings, and 56% were date-matched within ±1 day. Conclusion: The completeness and accuracy of stroke recording is improved by the use of linked hospital and primary care records. For studies that have a time-sensitive research question, we strongly recommend the use of linked, as opposed to stand-alone, CPRD data.

scholarly journals Clinical prediction tools to identify patients at highest risk of myeloma in primary care: a retrospective open cohort study

2021 ◽  
Vol 71 (706) ◽  
pp. e347-e355
Author(s):  
Constantinos Koshiaris ◽  
Ann Van den Bruel ◽  
Brian D Nicholson ◽  
Sarah Lay-Flurrie ◽  
FD Richard Hobbs ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Clinical Practice ◽  
External Validation ◽  
Area Under The Curve ◽  
Full Blood Count ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Clinical Prediction ◽  
The Impact

BackgroundPatients with myeloma experience substantial delays in their diagnosis, which can adversely affect their prognosis.AimTo generate a clinical prediction rule to identify primary care patients who are at highest risk of myeloma.Design and settingRetrospective open cohort study using electronic health records data from the UK’s Clinical Practice Research Datalink (CPRD) between 1 January 2000 and 1 January 2014.MethodPatients from the CPRD were included in the study if they were aged ≥40 years, had two full blood counts within a year, and had no previous diagnosis of myeloma. Cases of myeloma were identified in the following 2 years. Derivation and external validation datasets were created based on geographical region. Prediction equations were estimated using Cox proportional hazards models including patient characteristics, symptoms, and blood test results. Calibration, discrimination, and clinical utility were evaluated in the validation set.ResultsOf 1 281 926 eligible patients, 737 (0.06%) were diagnosed with myeloma within 2 years. Independent predictors of myeloma included: older age; male sex; back, chest and rib pain; nosebleeds; low haemoglobin, platelets, and white cell count; and raised mean corpuscular volume, calcium, and erythrocyte sedimentation rate. A model including symptoms and full blood count had an area under the curve of 0.84 (95% CI = 0.81 to 0.87) and sensitivity of 62% (95% CI = 55% to 68%) at the highest risk decile. The corresponding statistics for a second model, which also included calcium and inflammatory markers, were an area under the curve of 0.87 (95% CI = 0.84 to 0.90) and sensitivity of 72% (95% CI = 66% to 78%).ConclusionThe implementation of these prediction rules would highlight the possibility of myeloma in patients where GPs do not suspect myeloma. Future research should focus on the prospective evaluation of further external validity and the impact on clinical practice.

scholarly journals Quantifying the impact of pre-existing conditions on the stage of oesophagogastric cancer at diagnosis: a primary care cohort study using electronic medical records

2020 ◽  
Author(s):  
Myra Quiroga ◽  
Elizabeth A Shephard ◽  
Luke T A Mounce ◽  
Madeline Carney ◽  
William T Hamilton ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Odds Ratio ◽  
Cancer Site ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Advanced Stage ◽  
Stage Disease ◽  
The Impact ◽  
Oesophagogastric Cancer

Abstract Background Pre-existing conditions interfere with cancer diagnosis by offering diagnostic alternatives, competing for clinical attention or through patient surveillance. Objective To investigate associations between oesophagogastric cancer stage and pre-existing conditions. Methods Retrospective cohort study using Clinical Practice Research Datalink (CPRD) data, with English cancer registry linkage. Participants aged ≥40 years had consulted primary care in the year before their incident diagnosis of oesophagogastric cancer in 01/01/2010–31/12/2015. CPRD records pre-diagnosis were searched for codes denoting clinical features of oesophagogastric cancer and for pre-existing conditions, including those providing plausible diagnostic alternatives for those features. Logistic regression analysed associations between stage and multimorbidity (≥2 conditions; reference category: no multimorbidity) and having ‘diagnostic alternative(s)’, controlling for age, sex, deprivation and cancer site. Results Of 2444 participants provided, 695 (28%) were excluded for missing stage, leaving 1749 for analysis (1265/1749, 72.3% had advanced-stage disease). Multimorbidity was associated with stage [odds ratio 0.63, 95% confidence interval (CI) 0.47–0.85, P = 0.002], with moderate evidence of an interaction term with sex (1.76, 1.08–2.86, P = 0.024). There was no association between alternative explanations and stage (odds ratio 1.18, 95% CI 0.87–1.60, P = 0.278). Conclusions In men, multimorbidity is associated with a reduced chance of advanced-stage oesophagogastric cancer, to levels seen collectively for women.

scholarly journals Validity of an algorithm to identify cardiovascular deaths from administrative health records: a multi-database population-based cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa M. Lix ◽  
Shamsia Sobhan ◽  
Audray St-Jean ◽  
Jean-Marc Daigle ◽  
Anat Fisher ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Mortality ◽  
Population Based ◽  
Vital Statistics ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Health Records ◽  
Predictive Values ◽  
Site Specific ◽  
Hospital Deaths

Abstract Background Cardiovascular death is a common outcome in population-based studies about new healthcare interventions or treatments, such as new prescription medications. Vital statistics registration systems are often the preferred source of information about cause-specific mortality because they capture verified information about the deceased, but they may not always be accessible for linkage with other sources of population-based data. We assessed the validity of an algorithm applied to administrative health records for identifying cardiovascular deaths in population-based data. Methods Administrative health records were from an existing multi-database cohort study about sodium-glucose cotransporter-2 (SGLT2) inhibitors, a new class of antidiabetic medications. Data were from 2013 to 2018 for five Canadian provinces (Alberta, British Columbia, Manitoba, Ontario, Quebec) and the United Kingdom (UK) Clinical Practice Research Datalink (CPRD). The cardiovascular mortality algorithm was based on in-hospital cardiovascular deaths identified from diagnosis codes and select out-of-hospital deaths. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were calculated for the cardiovascular mortality algorithm using vital statistics registrations as the reference standard. Overall and stratified estimates and 95% confidence intervals (CIs) were computed; the latter were produced by site, location of death, sex, and age. Results The cohort included 20,607 individuals (58.3% male; 77.2% ≥70 years). When compared to vital statistics registrations, the cardiovascular mortality algorithm had overall sensitivity of 64.8% (95% CI 63.6, 66.0); site-specific estimates ranged from 54.8 to 87.3%. Overall specificity was 74.9% (95% CI 74.1, 75.6) and overall PPV was 54.5% (95% CI 53.7, 55.3), while site-specific PPV ranged from 33.9 to 72.8%. The cardiovascular mortality algorithm had sensitivity of 57.1% (95% CI 55.4, 58.8) for in-hospital deaths and 72.3% (95% CI 70.8, 73.9) for out-of-hospital deaths; specificity was 88.8% (95% CI 88.1, 89.5) for in-hospital deaths and 58.5% (95% CI 57.3, 59.7) for out-of-hospital deaths. Conclusions A cardiovascular mortality algorithm applied to administrative health records had moderate validity when compared to vital statistics data. Substantial variation existed across study sites representing different geographic locations and two healthcare systems. These variations may reflect different diagnostic coding practices and healthcare utilization patterns.

Epidemiology of first and recurrent venous thromboembolism: A population-based cohort study in patients without active cancer

2014 ◽  
Vol 112 (08) ◽  
pp. 255-263 ◽  
Author(s):  
Alexander T. Cohen ◽  
Luke Bamber ◽  
Stephan Rietbrock ◽  
Carlos Martinez
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
The Elderly ◽  
Population Based ◽  
Incidence Rates ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Recurrence Rates ◽  
Recurrent Vte ◽  
Active Cancer

SummaryContemporary data from population studies on the incidence and complications of venous thromboembolism (VTE) are limited. An observational cohort study was undertaken to estimate the incidence of first and recurrent VTE. The cohort was identified from all patients in the UK Clinical Practice Research Datalink (CPRD) with additional linked information on hospitalisation and cause of death. Between 2001 and 2011, patients with first VTE were identified and the subset without active cancer-related VTE observed for up to 10 years for recurrent VTE. The 10-year cumulative incidence rates (CIR) were derived with adjustment for mortality as a competing risk event. A total of 35,373 first VTE events (12,073 provoked, 16,708 unprovoked and 6592 active cancer-associated VTE) among 26.9 million person-years of observation were identified. The overall incidence rate (IR) of VTE was 131.5 (95% CI, 130.2–132.9) per 100,000 person-years and 107.0 (95% CI, 105.8–108.2) after excluding cancer-associated VTE. DVT was more common in the young and PE was more common in the elderly. VTE recurrence occurred in 3671 (CIR 25.2%). The IR for recurrence peaked in the first six months at around 11 per 100 person years. It levelled out after three years and then remained at around 2 per 100 person years from year 4–10 of follow-up. The IRs for recurrences were particularly high in young men. In conclusion, VTE is common and associated with high recurrence rates. Effort is required to prevent VTE and to reduce recurrences.

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