Prevalence of Atopic Eczema Among Patients Seen in Primary Care: Data From The Health Improvement Network

BackgroundUnderuse of anticoagulants in atrial fibrillation (AF) is an international problem, which has often been attributed to the presence of contraindications to treatment. No studies have assessed the influence of contraindications on anticoagulant prescribing in the UK.AimTo determine the influence of contraindications on anticoagulant prescribing in patients with AF in the UK.Design and settingCross-sectional analysis of primary care data from 645 general practices contributing to The Health Improvement Network, a large UK database of electronic primary care records.MethodTwelve sequential cross-sectional analyses were carried out from 2004 to 2015. Patients with a diagnosis of AF aged ≥35 years and registered for at least 1 year were included. Outcome measure was prescription of anticoagulant medication.ResultsOver the 12 study years, the proportion of eligible patients with AF with contraindications who were prescribed anticoagulants increased from 40.1% (95% confidence interval [CI] = 38.3 to 41.9) to 67.2% (95% CI = 65.6 to 68.8), and the proportion of those without contraindications prescribed anticoagulants increased from 42.1% (95% CI = 41.6 to 42.6) to 67.7% (95% CI = 67.2 to 68.1). In patients with a recent history of major bleeding or aneurysm, prescribing rates increased from 44.3% (95% CI = 42.2 to 46.5) and 34.8% (95% CI = 29.4 to 40.6) in 2004 to 71.7% (95% CI = 69.9 to 73.5) and 63.2% (95% CI = 58.3 to 67.8) in 2015, respectively, comparable with rates in patients without contraindications.ConclusionThe presence or absence of recorded contraindications has little influence on the decision to prescribe anticoagulants for the prevention of stroke in patients with AF. The study analysis suggests that, nationally, 38 000 patients with AF with contraindications are treated with anticoagulants. This has implications for patient safety.

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Drug treatment patterns for the management of men with lower urinary tract symptoms associated with benign prostatic hyperplasia who have both storage and voiding symptoms: a study using the health improvement network UK primary care data

Current Medical Research and Opinion ◽

10.1185/03007995.2014.968704 ◽

2014 ◽

Vol 31 (1) ◽

pp. 43-50 ◽

Cited By ~ 12

Author(s):

Zalmai Hakimi ◽

Michelle Johnson ◽

Jameel Nazir ◽

Betina Blak ◽

Isaac A.O. Odeyemi

Keyword(s):

Primary Care ◽

Lower Urinary Tract ◽

Treatment Patterns ◽

Prostatic Hyperplasia ◽

Health Improvement ◽

Primary Care Data ◽

Voiding Symptoms ◽

Urinary Tract Symptoms ◽

The Health Improvement Network ◽

Lower Urinary

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Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

Family Medicine and Community Health ◽

10.1136/fmch-2020-000780 ◽

2021 ◽

Vol 9 (2) ◽

pp. e000780

Author(s):

Lisanne Andra Gitsels ◽

Ilyas Bakbergenuly ◽

Nicholas Steel ◽

Elena Kulinskaya

Keyword(s):

Primary Care ◽

Older People ◽

Clinical Information ◽

Cardiac Risk ◽

Health Improvement ◽

Network Database ◽

Statin Prescription ◽

The Health Improvement Network ◽

Care Practices ◽

Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

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Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽

10.1136/bmjopen-2018-027315 ◽

2019 ◽

Vol 9 (6) ◽

pp. e027315 ◽

Cited By ~ 1

Author(s):

Harjeet Kaur Bhachu ◽

Paul Cockwell ◽

Anuradhaa Subramanian ◽

Krishnarajah Nirantharakumar ◽

Derek Kyte ◽

...

Keyword(s):

Primary Care ◽

Kidney Disease ◽

Secondary Care ◽

Health Improvement ◽

Cross Sectional ◽

Risk Equation ◽

Failure Risk ◽

The Health Improvement Network ◽

The Uk ◽

The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

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The reporting and diagnosis of uterine fibroids (UF) in UK primary care, based on data from the health improvement network (thin)

Fertility and Sterility ◽

10.1016/j.fertnstert.2013.07.664 ◽

2013 ◽

Vol 100 (3) ◽

pp. S404

Author(s):

L.A. García Rodríguez ◽

E. Martín Merino ◽

M.-A. Wallander ◽

S. Andersson ◽

M.M. Soriano-Gabarró

Keyword(s):

Primary Care ◽

Uterine Fibroids ◽

Health Improvement ◽

The Health Improvement Network

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The effect of hormone replacement therapy on the survival of UK women: a retrospective cohort study 1984−2017

10.22541/au.162505075.57308701/v3 ◽

2021 ◽

Author(s):

Nurunnahar Akter ◽

Elena Kulinskaya ◽

Nicholas Steel ◽

Ilyas Bakbergenuly

Keyword(s):

Primary Care ◽

Cohort Study ◽

Hormone Replacement Therapy ◽

Replacement Therapy ◽

Cox Regression ◽

Hormone Replacement ◽

Health Improvement ◽

All Cause Mortality ◽

The Health Improvement Network

Objective: To estimate the effect of oestrogen-only and combined hormone replacement therapy (HRT) on the hazards of overall and age-specific all-cause mortality in healthy women aged 46 to 65 at first prescription. Design: Matched cohort study. Setting: Electronic primary care records from The Health Improvement Network (THIN) database, UK (1984−2017). Population: 105,199 HRT users (cases) and 224,643 non-users (controls) matched on age and general practice. Methods: Weibull-Double-Cox regression models adjusted for age at first treatment, birth cohort, type 2 diabetes, hypertension and hypertension treatment, coronary heart disease, oophorectomy/hysterectomy, body mass index, smoking, and deprivation status. Main outcome measures: All-cause mortality. Results: A total of 21,751 women died over an average of 13.5 years follow-up per participant, of whom 6,329 were users and 15,422 non-users. The adjusted hazard ratio (HR) of overall all-cause mortality in combined HRT users was 0.91 (95%CI 0.88−0.94), and in oestrogen-only users was 0.99 (0.93−1.07), compared to non-users. Age-specific adjusted HRs for participants aged 46-50, 51-55, 56-60, and 61-65 years at first treatment were 0.98 (0.92−1.04), 0.87 (0.82−0.92), 0.88 (0.82−0.93), and 0.92 (0.85−0.98), for combined HRT users compared to non-users, and 1.01 (0.84−1.21), 1.03 (0.89−1.18), 0.98 (0.86−1.12), and 0.93 (0.81−1.07) for oestrogen-only users, respectively. Conclusions: Combined HRT was associated with a 9% lower risk of all-cause mortality and oestrogen-only formulation was not associated with any significant changes. Funding: IFoA. Keywords: Hormone replacement therapy, menopause, mortality, primary care records, THIN. Tweetable abstract: Oestrogen-only HRT is not associated with all-cause mortality and combined HRT reduces the risks.

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Trends in the incidence of testing for vitamin D deficiency in primary care in the UK: a retrospective analysis of The Health Improvement Network (THIN), 2005–2015

BMJ Open ◽

10.1136/bmjopen-2018-028355 ◽

2019 ◽

Vol 9 (6) ◽

pp. e028355 ◽

Cited By ~ 12

Author(s):

Francesca L Crowe ◽

Kate Jolly ◽

Christine MacArthur ◽

Semira Manaseki-Holland ◽

Neil Gittoes ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Vitamin D ◽

Ethnic Minority ◽

Vitamin D Deficiency ◽

Future Research ◽

Health Improvement ◽

Economically Deprived ◽

The Health Improvement Network ◽

The Uk

ObjectiveTo investigate trends in the incidence of testing for vitamin D deficiency and the prevalence of patients with circulating concentrations of 25-hydroxyvitamin D (25(OH)D) indicative of deficiency (<30 nmol/L) between 2005 and 2015.DesignLongitudinal analysis of electronic health records in The Health Improvement Network primary care database.SettingUK primary care.InterventionNone.ParticipantsThe analysis included 6 416 709 participants aged 18 years and older.Primary outcomesIncidence of having a blood test for vitamin D deficiency between 2005 and 2015, the prevalence with blood 25(OH)D <30 nmol/L and the effects of age, ethnicity and socioeconomic status on these measures were assessed.ResultsAfter a mean follow-up time of 5.4 (SD 3.7) years, there were 210 502 patients tested for vitamin D deficiency. The incidence of vitamin D testing rose from 0.29 per 1000 person-years at risk (PYAR) (95% CI 0.27 to 0.31) in 2005 to 16.1 per 1000 PYAR (95% CI 15.9 to 16.2) in 2015. Being female, older, non-white ethnicity and more economically deprived were all strongly associated with being tested. One-third (n=69 515) had 25(OH)D <30 nmol/L, but the per cent deficient among ethnic minority groups ranged from 43% among mixed ethnicity to 66% in Asians. Being male, younger and more economically deprived were also all associated with vitamin D deficiency (p<0.001).ConclusionsTesting for vitamin D deficiency increased over the past decade among adults in the UK. One-third of UK adults who had a vitamin D test performed in primary care were vitamin D deficient, and deficiency was much higher among ethnic minority patients. Future research should focus on strategies to ensure population intake of vitamin D, particularly in at-risk groups, meets recommendations to reduce the risk of deficiency and need for testing.

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