scholarly journals Use of multiple inflammatory marker tests in primary care: using Clinical Practice Research Datalink to evaluate accuracy

2019 ◽  
Vol 69 (684) ◽  
pp. e462-e469 ◽  
Author(s):  
Jessica Watson ◽  
Hayley E Jones ◽  
Jonathan Banks ◽  
Penny Whiting ◽  
Chris Salisbury ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Test Performance ◽  
Predictive Value ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Superior Performance ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Autoimmune Conditions

BackgroundResearch comparing C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma viscosity (PV) in primary care is lacking. Clinicians often test multiple inflammatory markers, leading to concerns about overuse.AimTo compare the diagnostic accuracies of CRP, ESR, and PV, and to evaluate whether measuring two inflammatory markers increases accuracy.Design and settingProspective cohort study in UK primary care using the Clinical Practice Research Datalink.MethodThe authors compared diagnostic test performance of inflammatory markers, singly and paired, for relevant disease, defined as any infections, autoimmune conditions, or cancers. For each of the three tests (CRP, ESR, and PV), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operator curve (AUC) were calculated.ResultsParticipants comprised 136 961 patients with inflammatory marker testing in 2014; 83 761 (61.2%) had a single inflammatory marker at the index date, and 53 200 (38.8%) had multiple inflammatory markers. For ‘any relevant disease’, small differences were seen between the three tests; AUC ranged from 0.659 to 0.682. CRP had the highest overall AUC, largely because of marginally superior performance in infection (AUC CRP 0.617, versus ESR 0.589, P<0.001). Adding a second test gave limited improvement in the AUC for relevant disease (CRP 0.682, versus CRP plus ESR 0.688, P<0.001); this is of debatable clinical significance. The NPV for any single inflammatory marker was 94% compared with 94.1% for multiple negative tests.ConclusionTesting multiple inflammatory markers simultaneously does not increase ability to rule out disease and should generally be avoided. CRP has marginally superior diagnostic accuracy for infections, and is equivalent for autoimmune conditions and cancers, so should generally be the first-line test.

scholarly journals Added value and cascade effects of inflammatory marker tests in UK primary care: a cohort study from the Clinical Practice Research Datalink

2019 ◽  
Vol 69 (684) ◽  
pp. e470-e478 ◽  
Author(s):  
Jessica Watson ◽  
Chris Salisbury ◽  
Penny Whiting ◽  
Jonathan Banks ◽  
Yvette Pyne ◽  
...  
Keyword(s):  
Primary Care ◽  
Inflammatory Markers ◽  
Primary Outcome ◽  
Inflammatory Marker ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Blood Tests ◽  
Autoimmune Conditions ◽  
Cascade Effects ◽  
Rule Out

BackgroundInflammatory markers (C-reactive protein, erythrocyte sedimentation rate, and plasma viscosity) are commonly used in primary care. Though established for specific diagnostic purposes, there is uncertainty around their utility as a non-specific marker to rule out underlying disease in primary care.AimTo identify the value of inflammatory marker testing in primary care as a rule-out test, and measure the cascade effects of testing in terms of further blood tests, GP appointments, and referrals.Design and settingCohort study of 160 000 patients with inflammatory marker testing in 2014, and 40 000 untested age, sex, and practice-matched controls, using UK primary care data from the Clinical Practice Research Datalink.MethodThe primary outcome was incidence of relevant disease, including infections, autoimmune conditions, and cancers, among those with raised versus normal inflammatory markers and untested controls. Process outcomes included rates of GP consultations, blood tests, and referrals in the 6 months after testing.ResultsThe overall incidence of disease following a raised inflammatory marker was 15%: 6.3% infections, 5.6% autoimmune conditions, 3.7% cancers. Inflammatory markers had an overall sensitivity of <50% for the primary outcome, any relevant disease (defined as any infections, autoimmune conditions, or cancers). For 1000 inflammatory marker tests performed, the authors would anticipate 236 false-positives, resulting in an additional 710 GP appointments, 229 phlebotomy appointments, and 24 referrals in the following 6 months.ConclusionInflammatory markers have poor sensitivity and should not be used as a rule-out test. False-positive results are common and lead to increased rates of follow-on GP consultations, tests, and referrals.

scholarly journals Evidence of disparities in the provision of the maternal postpartum 6-week check in primary care in England, 2015–2018: an observational study using the Clinical Practice Research Datalink (CPRD)

2021 ◽  
pp. jech-2021-216640
Author(s):  
Yangmei Li ◽  
Jennifer J Kurinczuk ◽  
Christopher Gale ◽  
Dimitrios Siassakos ◽  
Claire Carson
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Policy Change ◽  
Post Partum ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Younger Women ◽  
Preterm Babies ◽  
Deprived Areas

BackgroundA maternal postpartum 6-week check (SWC) with a general practitioner (GP) is now considered an essential service in England, a recent policy change intended to improve women’s health. We aimed to provide an up-to-date snapshot of the prevalence of SWC prior to the policy change as a baseline, and to explore factors associated with having a late or no check.MethodsWe conducted a cohort study using primary care records in England (Clinical Practice Research Datalink (CPRD)). 34 337 women who gave birth between 1 July 2015 and 30 June 2018 and had ≥12 weeks of follow-up post partum were identified in the CPRD Pregnancy Register. The proportion who had evidence of an SWC with a GP was calculated, and regression analysis was used to assess the association between women’s characteristics and risks of a late or no check.ResultsSixty-two per cent (95% CI 58% to 67%) of women had an SWC recorded at their GP practice within 12 weeks post partum, another 27% had other consultations. Forty per cent had an SWC at the recommended 6–8 weeks, 2% earlier and 20% later. A late or no check was more common among younger women, mothers of preterm babies or those registered in more deprived areas.ConclusionsNearly 40% of women did not have a postpartum SWC recorded. Provision or uptake was not equitable; younger women and those in more deprived areas were less likely to have a record of such check, suggesting postpartum care in general practice may be missing some women who need it most.

scholarly journals Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study

PLoS ONE ◽  
2017 ◽  
Vol 12 (3) ◽  
pp. e0173272 ◽  
Author(s):  
Andrew Thompson ◽  
Darren M. Ashcroft ◽  
Lynn Owens ◽  
Tjeerd P. van Staa ◽  
Munir Pirmohamed
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Drug Therapy ◽  
Alcohol Dependence ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
The Uk
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