Impact of emergency hospital admissions on patterns of primary care prescribing: a retrospective cohort analysis of electronic records in England

BackgroundLittle is known about the impact of hospitalisation on prescribing in UK clinical practice.AimTo investigate whether an emergency hospital admission drives increases in polypharmacy and potentially inappropriate prescriptions (PIPs).Design and settingA retrospective cohort analysis set in primary and secondary care in England.MethodChanges in number of prescriptions and PIPs following an emergency hospital admission in 2014 (at admission and 4 weeks post-discharge), and 6 months post-discharge were calculated among 37 761 adult patients. Regression models were used to investigate changes in prescribing following an admission.ResultsEmergency attendees surviving 6 months (N = 32 657) had a mean of 4.4 (standard deviation [SD] = 4.6) prescriptions before admission, and a mean of 4.7 (SD = 4.7; P<0.001) 4 weeks after discharge. Small increases (<0.5) in the number of prescriptions at 4 weeks were observed across most hospital specialties, except for surgery (−0.02; SD = 0.65) and cardiology (2.1; SD = 2.6). The amount of PIPs increased after hospitalisation; 4.0% of patients had ≥1 PIP immediately before pre-admission, increasing to 8.0% 4 weeks post-discharge. Across hospital specialties, increases in the proportion of patients with a PIP ranged from 2.1% in obstetrics and gynaecology to 8.0% in cardiology. Patients were, on average, prescribed fewer medicines at 6 months compared with 4 weeks post-discharge (mean = 4.1; SD = 4.6; P<0.001). PIPs decreased to 5.4% (n = 1751) of patients.ConclusionPerceptions that hospitalisation is a consistent factor driving rises in polypharmacy are unfounded. Increases in prescribing post-hospitalisation reflect appropriate clinical response to acute illness, whereas decreases are more likely in patients who are multimorbid, reflecting a focus on deprescribing and medicines optimisation in these individuals. Increases in PIPs remain a concern.

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The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012–2016

BMJ Open ◽

10.1136/bmjopen-2019-029103 ◽

2019 ◽

Vol 9 (9) ◽

pp. e029103 ◽

Cited By ~ 5

Author(s):

Peter Tammes ◽

Rupert A Payne ◽

Chris Salisbury ◽

Melanie Chalder ◽

Sarah Purdy ◽

...

Keyword(s):

Hospital Admission ◽

Continuity Of Care ◽

Hospital Admissions ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Post Intervention ◽

Emergency Hospital ◽

Emergency Hospital Admissions ◽

Emergency Hospital Admission ◽

The Impact

ObjectiveTo investigate whether the introduction of a named general practitioner (GP, family physician) improved patients’ healthcare for patients aged 75 and over in England.SettingRandom sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics.DesignProspective cohort approach, measuring patients’ GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling.InterventionNational Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014.Main outcome measures(A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions.ResultsThe intervention was associated with a decrease in continuity index-scores of −0.024 (95% CI −0.030 to −0.018, p<0.001); there were no differences in the decrease between the two age groups (−0.005, 95% CI −0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001).ConclusionThe introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.

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PMS9 A Retrospective Cohort Analysis of the Impact of Osteoarthritis on Disability Leave, Worker's Compensation Claims, and Healthcare Payments

Value in Health ◽

10.1016/j.jval.2021.04.686 ◽

2021 ◽

Vol 24 ◽

pp. S139-S140

Author(s):

S. Thakkar ◽

B. Gifford ◽

H. Sell ◽

P. Schepman ◽

R. Robinson ◽

...

Keyword(s):

Retrospective Cohort ◽

Cohort Analysis ◽

Worker's Compensation ◽

Disability Leave ◽

Worker’S Compensation ◽

Retrospective Cohort Analysis ◽

Compensation Claims ◽

The Impact

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The impact of long-term systemic glucocorticoid use in severe asthma: A UK retrospective cohort analysis

Journal of Asthma ◽

10.1080/02770903.2017.1353612 ◽

2017 ◽

Vol 55 (6) ◽

pp. 651-658 ◽

Cited By ~ 18

Author(s):

Jonas Daugherty ◽

Xiwu Lin ◽

Richard Baxter ◽

Robert Suruki ◽

Eric Bradford

Keyword(s):

Severe Asthma ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Systemic Glucocorticoid ◽

Retrospective Cohort Analysis ◽

The Impact

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The Impact of Routine Pulse Oximetry Use on Outcomes in COVID-19-Infected Patients at Increased Risk of Severe Disease: A Retrospective Cohort Analysis

SSRN Electronic Journal ◽

10.2139/ssrn.3804758 ◽

2021 ◽

Author(s):

Noluthando Nematswerani ◽

Shirley Collie ◽

Tommy Chen ◽

Michael Cohen ◽

Jared Champion ◽

...

Keyword(s):

Pulse Oximetry ◽

Retrospective Cohort ◽

Severe Disease ◽

Cohort Analysis ◽

Retrospective Cohort Analysis ◽

Increased Risk ◽

The Impact ◽

Routine Pulse Oximetry

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Investigating the discriminative value of Early Warning Scores in patients with respiratory disease using a retrospective cohort analysis of admissions to Nottingham University Hospitals Trust over a 2-year period

BMJ Open ◽

10.1136/bmjopen-2017-020269 ◽

2018 ◽

Vol 8 (7) ◽

pp. e020269 ◽

Cited By ~ 3

Author(s):

Sarah Forster ◽

Gemma Housley ◽

Tricia M McKeever ◽

Dominick E Shaw

Keyword(s):

Respiratory Disease ◽

Early Warning ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Scoring Systems ◽

University Hospitals ◽

Retrospective Cohort Analysis ◽

Early Warning Scores ◽

The Impact ◽

Higher Sensitivity

ObjectiveEarly Warning Scores (EWSs) are used to monitor patients for signs of imminent deterioration. Although used in respiratory disease, EWSs have not been well studied in this population, despite the underlying cardiopulmonary pathophysiology often present. We examined the performance of two scoring systems in patients with respiratory disease.DesignRetrospective cohort analysis of vital signs observations of all patients admitted to a respiratory unit over a 2-year period. Scores were linked to outcome data to establish the performance of the National EWS (NEWS) compared results to a locally adapted EWS.SettingNottingham University Hospitals National Health Service Trust respiratory wards. Data were collected from an integrated electronic observation and task allocation system employing a local EWS, also generating mandatory referrals to clinical staff at set scoring thresholds.Outcome measuresProjected workload, and sensitivity and specificity of the scores in predicting mortality based on outcome within 24 hours of a score being recorded.Results8812 individual patient episodes occurred during the study period. Overall, mortality was 5.9%. Applying NEWS retrospectively (vs local EWS) generated an eightfold increase in mandatory escalations, but had higher sensitivity in predicting mortality at the protocol cut points.ConclusionsThis study highlights issues surrounding use of scoring systems in patients with respiratory disease. NEWS demonstrated higher sensitivity for predicting death within 24 hours, offset by reduced specificity. The consequent workload generated may compromise the ability of the clinical team to respond to patients needing immediate input. The locally adapted EWS has higher specificity but lower sensitivity. Statistical evaluation suggests this may lead to missed opportunities for intervention, however, this does not account for clinical concern independent of the scores, nor ability to respond to alerts based on workload. Further research into the role of warning scores and the impact of chronic pathophysiology is urgently needed.

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Hydroxyethyl Starch 130/0.42 Effect’s on Renal Function in Patients After Cardiac Surgery: A Retrospective Cohort Analysis

10.21203/rs.3.rs-100124/v1 ◽

2020 ◽

Author(s):

Benedict Morath ◽

Andreas Meid ◽

Johannes Rickmann ◽

Jasmin Soethoff ◽

Markus Verch ◽

...

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Cardiac Surgery ◽

Kidney Function ◽

Hydroxyethyl Starch ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Kidney Injury ◽

Retrospective Cohort Analysis ◽

The Impact

Abstract Background: Fluid management is an everyday challenge in intensive care units worldwide. Data from recent trials suggest that the use of hydroxyethyl starch leads to a higher rate of acute kidney injury and mortality in septic patients. Evidence on the safety of hydroxyethyl starch used in postoperative cardiac surgery patients is lacking Methods: The aim was to determine the impact of postoperatively administered hydroxyethylstarch 130/0.42 on renal function and 90-day mortality compared to with or without balanced crystalloids in patients after elective cardiac surgery. A retrospective cohort analysis was performed including 2245 patients undergoing elective coronary artery bypass grafting or, aortic valve replacement, or a combination of both between 2015 - 2019. Acute kidney injury was defined according to the ‘kidney disease improving global outcomes’ criteria. Multivariate logistic regression yielded adjusted associations of postoperative hydroxyethyl starch administration with acute kidney injury during hospital stay and 90-day mortality. Linear mixed-effects models predicted trajectories of estimated glomerular filtration rates over the postoperative period to explore the impact of dosage and timing of hydroxyethyl starch administration.Results: A total of 1009 patients (45.0 %) suffered from acute kidney injury. Significantly less acute kidney injury of any stage occurred in patients receiving hydroxyethyl starch compared to patients receiving only crystalloids for fluid resuscitation (43.7 % vs. 51.2 % p=0.008). In multivariate analysis, the administration of hydroxyethyl starch showed a protective effect (OR 0.89 95% confidence interval (CI) (0.82-0.96)) which was less prominent in patients receiving only crystalloids (OR 0.98, 95% CI (0.95-1.00)). No association between hydroxyethyl starch and 90-day mortality (OR 1.05 95% CI (0.88-1.25)) was detected. Renal function trajectories were dose-dependent and biphasic and hydroxyethyl starch could even slow down the late postoperative decline of kidney function.Conclusion: This study showed no association between hydroxyethyl starch and the postoperative occurrence of acute kidney injury and may add evidence to the discussion about the use of hydroxyethyl starch in cardiac surgery patients. In addition, hydroxyethyl starch administered early after surgery in adequate low doses might even prevent the decline of the kidney function after cardiac surgery.

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