scholarly journals Socioeconomic status and HRT prescribing: a study of practice-level data in England

2020 ◽  
Vol 70 (700) ◽  
pp. e772-e777 ◽  
Author(s):  
Sarah Hillman ◽  
Saran Shantikumar ◽  
Ali Ridha ◽  
Dan Todkill ◽  
Jeremy Dale
Keyword(s):  
Hormone Replacement ◽  
Unmet Need ◽  
Cross Sectional Study ◽  
List Size ◽  
Cross Sectional ◽  
Practice List ◽  
Practice Level ◽  
Disease Outcomes ◽  
Level Data ◽  
Index Of Multiple Deprivation

BackgroundConcerns have been raised that women from deprived backgrounds are less likely to be receiving hormone replacement therapy (HRT) treatment and its benefits, although evidence in support of this is lacking.AimTo investigate general practice HRT prescription trends and their association with markers of socioeconomic deprivation.Design and settingCross-sectional study of primary care prescribing data in England in 2018.MethodPractice-level prescribing rate was defined as the number of items of HRT prescribed per 1000 registered female patients aged ≥40 years. The association between Index of Multiple Deprivation (IMD) score and HRT prescribing rate was tested using multivariate Poisson regression, adjusting for practice proportions of obesity, smoking, hypertension, diabetes, coronary heart disease and cerebrovascular disease, and practice list size.ResultsThe overall prescribing rate of HRT was 29% lower in practices from the most deprived quintile compared with the most affluent (incidence rate ratio [IRR] = 0.71; 95% confidence interval [CI] = 0.68 to 0.73). After adjusting for all cardiovascular disease outcomes and risk factors, the prescribing rate in the most deprived quintile was still 18% lower than in the least deprived quintile (adjusted IRR = 0.82; 95% CI = 0.77 to 0.86). In more deprived practices, there was a significantly higher tendency to prescribe oral HRT than transdermal preparations (P<0.001).ConclusionThis study highlights inequalities associated with HRT prescription. This may reflect a large unmet need in terms of menopause care in areas of deprivation. Further research is needed to identify the factors from patient and GP perspectives that may explain this.

scholarly journals Socioeconomic deprivation and benzodiazepine/Z-drug prescribing: a cross-sectional study of practice-level data in England

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703229
Author(s):  
Stephanie Soyombo ◽  
Harpal Aujla ◽  
Rhian Stanbrook ◽  
David Capewell ◽  
Mary Shantikumar ◽  
...  
Keyword(s):  
Primary Care ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Socioeconomic Deprivation ◽  
Drug Prescribing ◽  
Cross Sectional ◽  
Practice Level ◽  
Level Data ◽  
Drug Doses ◽  
Age And Sex

BackgroundBenzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care in England. Prescribed for various indications, such as anxiolysis and insomnia, it has been previously reported that an association may exist with deprivation.AimTo determine whether there was an association between benzodiazepine/Z-drug prescribing (overall, and by individual drug) and practice-level socioeconomic deprivation in England.MethodMonthly primary care prescribing data for 2017, as well as practice age and sex profile, were downloaded from NHS Digital. Prescribing was aggregated by year. Drug doses were converted to their milligram-equivalent of diazepam to allow comparison. Practice-level Index of Multiple Deprivation (IMD 2015) scores were obtained from Public Health England. Multiple linear regression was used to examine the association between IMD and prescribing (for all benzodiazepines/Z-drugs, and individually), after adjusting for practice sex (% male) and older age (% >65 years) distribution. Practice-level prescribing was defined as milligrams of diazepam-equivalent per 1000 registered patients in 2017.ResultsOn univariate analysis, overall benzodiazepine prescribing was positively associated with practice-level IMD score, with more prescribing in more deprived practices (P<0.001). After adjusting for practice age and sex profile, IMD score remained an independent predictor of prescribing levels (P<0.001). These associations were consistent for all benzodiazepines/Z-drugs when analysed separately.ConclusionHigher practice-level socioeconomic deprivation, as described by IMD score, was associated with increased benzodiazepine/Z-drug prescribing. This may, in part, be a reflection of an underlying association of the indications for prescribing and socioeconomic deprivation. Further work is required to more accurately define the underlying reasons for these associations.

scholarly journals Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care

2007 ◽  
Vol 100 (6) ◽  
pp. 275-283 ◽  
Author(s):  
Christopher Millett ◽  
Josip Car ◽  
Darren Eldred ◽  
Kamlesh Khunti ◽  
Arch G Mainous ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
Outcome Measures ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
List Size ◽  
Cross Sectional ◽  
Practice List ◽  
Large Patient

Objective To examine the association between practice list size, deprivation and the quality of care of patients with diabetes. Design Population-based cross-sectional study using Quality and Outcomes Framework data. Setting England and Scotland. Participants 55 522 778 patients and 8970 general practices with 1 852 762 people with diabetes. Interventions None. Main outcome measures Seventeen process and surrogate outcome measures of diabetes care. Results The prevalence of diabetes was 3.3%. Prevalence differed with practice list size and deprivation: smaller and more deprived practices had a higher mean prevalence than larger and more affluent practices (3.8% versus 2.8%). Practices with large patient list sizes had the highest quality of care scores, even after stratifying for deprivation. However, with the exception of retinal screening, peripheral pulses and neuropathy testing, differences in achievement between small and large practices were modest (<5%). Small practices performed nearly as well as the largest practices in achievement of intermediate outcome targets for HbA1c, blood pressure and cholesterol (smallest versus largest practices: 57.4% versus 58.7%; 70.7% versus 70.7%; and 69.5% versus 72.7%, respectively). Deprivation had a negative effect on the achieved scores and this was more pronounced for smaller practices. Conclusion Our study provides some evidence of a volume-outcome association in the management of diabetes in primary care; this appears most pronounced in deprived areas.

scholarly journals Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajad Vahedi ◽  
Amin Torabipour ◽  
Amirhossein Takian ◽  
Saeed Mohammadpur ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Health System ◽  
Age Groups ◽  
Unmet Need ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Outpatient Services ◽  
Self Medication ◽  
Cross Sectional ◽  
Organizational Policies ◽  
Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

scholarly journals Exogenous female sex steroid hormones and risk of asthma and asthma-like symptoms: a cross sectional study of the general population

Thorax ◽  
2001 ◽  
Vol 56 (8) ◽  
pp. 613-616
Author(s):  
P Lange ◽  
J Parner ◽  
E Prescott ◽  
C Suppli Ulrik ◽  
J Vestbo
Keyword(s):  
General Population ◽  
Postmenopausal Women ◽  
Hormone Replacement ◽  
Premenopausal Women ◽  
Cross Sectional Study ◽  
Asthma Medication ◽  
Hormonal Contraceptives ◽  
Cross Sectional ◽  
Heart Study ◽  
Prescription Practice

BACKGROUNDRecent evidence suggests a role for hormonal factors in the aetiology of asthma.METHODSData from a large study of women selected from the general population were used to relate treatment with oral hormonal contraceptives (OCP) and postmenopausal hormone replacement therapy (HRT) to the following asthma indicators: self-reported asthma, wheezing, cough at exertion, and use of medication for asthma. The study sample comprised 1536 premenopausal and 3016 postmenopausal women who participated in the third round of the Copenhagen City Heart Study in 1991–4. A total of 377 women were taking OCP (24.5% of premenopausal women) and 458 were on HRT (15.2% of postmenopausal women).RESULTSIn premenopausal women 4.8% reported having asthma. The prevalence of self-reported asthma, wheeze, use of asthma medication, and cough at exertion was not significantly related to use of OCP. In postmenopausal women the prevalence of self-reported asthma was 6.2%. A weak but consistent association was observed between HRT and self-reported asthma (OR 1.42 (95% CI 0.95 to 2.12)), wheeze (OR 1.29 (95% CI 1.02 to 1.64)), cough at exertion (OR 1.34 (95% CI 1.01 to 1.77)), and use of asthma medication (OR 1.45 (95% CI 0.97 to 2.18)).CONCLUSIONSIn this study of the general population no relationship was found between the use of OCP and asthma. Although an association was observed between HRT and asthma and asthma-like symptoms, this was relatively weak and it is concluded that there is no necessity to change present prescription practice.

scholarly journals Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nervana Elbakary ◽  
Sami Ouanes ◽  
Sadaf Riaz ◽  
Oraib Abdallah ◽  
Islam Mahran ◽  
...  
Keyword(s):  
Median Time ◽  
Cox Regression ◽  
Cross Sectional Study ◽  
Therapeutic Interventions ◽  
Patient Treatment ◽  
Cross Sectional ◽  
Disease Outcomes ◽  
Younger Age ◽  
Risk Predictors ◽  
Subsequent Failure

Abstract Background Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. Methods This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using several cox regression models. Results A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. The factors statistically associated with higher hazard of IAD change were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Conclusions Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. Our findings offered some clues to help clinicians identify the high-risk predictors of short survival and subsequent failure of IAD.

scholarly journals Associations between socioeconomic deprivation and pharmaceutical prescribing in primary care in England

2020 ◽  
pp. postgradmedj-2020-138944
Author(s):  
Jessica Mooney ◽  
Roger Yau ◽  
Haseeb Moiz ◽  
Farah Kidy ◽  
Andrew Evans ◽  
...  
Keyword(s):  
Primary Care ◽  
Hormone Replacement ◽  
Rank Correlation ◽  
Socioeconomic Deprivation ◽  
Care Practice ◽  
P Value ◽  
Pharmaceutical Drugs ◽  
Cross Sectional ◽  
Practice List ◽  
Drug Classes

BackgroundSocioeconomic deprivation is associated with health inequality. Previous studies have described associations between primary care prescribing rates and deprivation for individual drugs or drug classes. We explore the correlation between socioeconomic deprivation and the rate of prescribing of individual pharmaceutical drugs, and drug classes, in primary care in England, to identify prescribing inequalities that would require further investigation.MethodsIn this cross-sectional study, national primary care prescribing data, by primary care practice, were retrieved for the calendar year 2019 in England. Socioeconomic deprivation was quantified using the Index of Multiple Deprivation (IMD) score. Correlations were calculated using Spearman’s rank correlation coefficient (ρ), adjusting for practice list size and demographics, with a Bonferroni-corrected p value threshold of 5×10–5.ResultsWe included 1.05 billion prescription items dispensed from 6896 England practices. 142/206 (69%) drug classes and 505/774 (65%) drugs were significantly correlated with IMD score (p<5×10−5). Of the 774 included drugs, 31 (4%) were moderately positively associated with IMD score (ρ>0.4). Only one was moderately negatively correlated with IMD score (ρ<−0.4), suggesting higher prescribing rates in more affluent areas. The drug classes most strongly associated with IMD score included opioid and non-opioid analgesics, antipsychotics and reflux medications. Drug classes most strongly associated with affluence included epinephrine, combined oral contraceptives and hormone replacement therapy.ConclusionWe identify novel associations of prescribing with deprivation. Further work is required to identify the underlying reasons for these associations so that appropriate interventions can be formulated to address drivers of inequality.

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