scholarly journals Prescription rates of adrenaline auto-injectors for children in UK general practice: a retrospective cohort study

2017 ◽  
Vol 67 (657) ◽  
pp. e300-e305 ◽  
Author(s):  
Lavanya Diwakar ◽  
Carole Cummins ◽  
Ronan Ryan ◽  
Tom Marshall ◽  
Tracy Roberts
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
High Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Improvement ◽  
Number Of Children ◽  
Prescription Rates ◽  
The Uk ◽  
Primary Care Practices

BackgroundAdrenaline auto-injectors (AAI) should be provided to individuals considered to be at high risk of anaphylaxis. There is some evidence that the rate of AAI prescription is increasing, but the true extent has not been previously quantified.Aim To estimate the trends in annual GP-issued prescriptions for AAI among UK children between 2000 and 2012.Design and setting Retrospective cohort study using data from primary care practices that contributed to The Health Improvement Network (THIN) database.MethodChildren and young people aged between 0–17 years of age with a prescription for AAIs were identified, and annual AAI device prescription rates were estimated using Stata (version 12).ResultsA total of 1.06 million UK children were identified, providing 5.1 million person years of follow-up data. Overall, 23 837 children were deemed high risk by their GPs, and were prescribed 98 737 AAI devices. This equates to 4.67 children (95% confidence interval [CI] = 4.66 to 4.69), and 19.4 (95% CI = 19.2 to 19.5) devices per 1000 person years. Between 2000 and 2012, there has been a 355% increase in the number of children prescribed devices, and a 506% increase in the total number of AAI devices prescribed per 1000 person years in the UK. The number of devices issued per high-risk child during this period has also increased by 33%.ConclusionThe number of children being prescribed AAI devices and the number of devices being prescribed in UK primary care between 2000 and 2012 has significantly increased. A discussion to promote rational prescribing of AAIs in the NHS is needed.

scholarly journals Frequencies and patterns of microbiology test requests from primary care in Oxfordshire, UK, 2008–2018: a retrospective cohort study of electronic health records to inform point-of-care testing

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e048527
Author(s):  
JM Ordóñez-Mena ◽  
Thomas R Fanshawe ◽  
Dona Foster ◽  
Monique Andersson ◽  
Sarah Oakley ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Urine Culture ◽  
Point Of Care ◽  
Temporal Trends ◽  
Secondary Outcome ◽  
Point Of Care Test ◽  
Primary Care Practices

ObjectivesTo inform point-of-care test (POCT) development, we quantified the primary care demand for laboratory microbiology tests by describing their frequencies overall, frequencies of positives, most common organisms identified, temporal trends in testing and patterns of cotesting on the same and subsequent dates.DesignRetrospective cohort study.SettingPrimary care practices in Oxfordshire.Participants393 905 patients (65% female; 49% aged 18–49).Primary and secondary outcome measuresThe frequencies of all microbiology tests requested between 2008 and 2018 were quantified. Patterns of cotesting were investigated with heat maps. All analyses were done overall, by sex and age categories.Results1 596 752 microbiology tests were requested. Urine culture±microscopy was the most common of all tests (n=673 612, 42%), was mainly requested without other tests and was the most common test requested in follow-up within 7 and 14 days. Of all urine cultures, 180 047 (27%) were positive and 172 651 (26%) showed mixed growth, and Escherichia coli was the most prevalent organism (132 277, 73% of positive urine cultures). Antenatal urine cultures and blood tests in pregnancy (hepatitis B, HIV and syphilis) formed a common test combination, consistent with their use in antenatal screening.ConclusionsThe greatest burden of microbiology testing in primary care is attributable to urine culture ± microscopy; genital and routine antenatal urine and blood testing are also significant contributors. Further research should focus on the feasibility and impact of POCTs for these specimen types.

scholarly journals Continuity of care as a predictor of ongoing frequent attendance in primary care: a retrospective cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101083
Author(s):  
Adam McDermott ◽  
Emily Sanderson ◽  
Christopher Metcalfe ◽  
Rebecca Barnes ◽  
Clare Thomas ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Continuity Of Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariable Logistic Regression Analysis ◽  
Relational Continuity ◽  
Care Access ◽  
Frequent Attendance ◽  
The Uk

BackgroundFrequent attenders (FAs) in primary care receive considerable resources with uncertain benefit. Only some FAs attend persistently. Modestly successful models have been built to predict persistent attendance. Nevertheless, an association between relational continuity of care and persistent frequent attendance remains unclear, and could be important considering both the UK government and Royal College of General Practitioner’s (RCGP) aim of improving continuity.AimTo identify predictive measures (including continuity) for persistent frequent attendance that may be modified in future interventions.Design & settingThis is a retrospective cohort study sampling 35 926 adult patients registered in seven Bristol practices.MethodThe top 3% (1227) of patients by frequency of GP consultations over 6 months were classed as FAs. Individual relational continuity was measured over the same period using the Usual Provider Continuity (UPC) index. Attendance change was calculated for the following 6 months. Multivariable logistic regression analysis was used to determine variables that predicted attendance change.ResultsFAs were on average 8.41 years older (difference 95% confidence interval [CI] = 7.33 to 9.50, P<0.001) and more likely to be female (65.36% versus 57.88%) than non-FAs. In total, 79.30% of FAs decreased attendance over the subsequent 6 months. No association was found between continuity and subsequent attendance. Increasing age was associated with maintained frequent attendance.ConclusionContinuity does not predict change in frequent attendance. In addition to improving continuity, recent government policy is focused on increasing primary care access. If both aims are achieved it will be interesting to observe any effect on frequent attendance.

scholarly journals Trends in HIV testing in the UK primary care setting: a 15-year retrospective cohort study from 2000 to 2015

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e027744
Author(s):  
Mark Gompels ◽  
Skevi Michael ◽  
Charlotte Davies ◽  
Tim Jones ◽  
John Macleod ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Hiv Testing ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Infected People ◽  
The Uk ◽  
Clinical Records

ObjectivesTo estimate trends in HIV testing, positivity and prevalence in UK primary care for 2000–2015 as part of a wider investigation into reasons for late diagnosis of HIV.DesignRetrospective cohort study using the Clinical Practice Research Datalink (CPRD) which is derived from computerised clinical records produced during consultations in primary care.Setting404 general practices in England.Participants5 979 598 adults aged ≥16 years registered between 2000 and 2015 with 45 093 761 person years of observation.OutcomesAnnual HIV testing rates, proportion of positive tests and prevalence of HIV-infected people recorded in primary care 2000–2015.ResultsHIV testing in primary care increased from 2000 to 2010, but then declined. Testing was higher in females than in males and in those aged 16–44 years compared with older adults. Rates per 100 000 in women aged 16–44 years were 177 (95% CI 167 to 188); 1309 (95% CI 1282 to 1336); 1789 (95% CI 1757 to 1821) and 839 (95% CI 817 to 862) in 2000, 2005, 2010 and 2015, respectively, and for non-pregnant women: 22.5 (95% CI 19 to 26); 134 (95% CI 125 to 143); 262 (95% CI 250 to 275); 190 (95% CI 179 to 201). For men aged 16–44 years rates were: 26 (95% CI 22 to 29); 107 (95% CI 100 to 115); 196 (95% CI 185 to 206); 137 (95% CI 127 to 146). Over the study period, there were approximately two positive results per 1000 HIV tests. Men were eightfold more likely to test positive than women. The percentage of HIV diagnoses among adults recorded in CPRD may be as low as 55% in London and 67% in the rest of the UK.ConclusionsHIV testing rates in primary care peaked in 2010 and subsequently declined. Access to testing was higher for women despite the prevalence of HIV being higher in men.Implications and further research neededOpportunities remain in primary care for increasing HIV testing to prevent costly late diagnoses and decrease HIV transmission. Interventions to improve targeting of tests and increase adherence to HIV testing guidelines are needed in primary care.

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