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Domzaridou E, Carr MJ, Millar T, Webb RT, Ashcroft DM. Recognizing the complexities of co-prescriptions and life-style factors in opioid agonist treatment: A response from Eleni Domzaridou, Matthew J. Carr, Tim Millar, Roger T. Webb and Darren M. Ashcroft. Addiction 2024; 119:967-968. [PMID: 38317288 DOI: 10.1111/add.16447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Affiliation(s)
- Eleni Domzaridou
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew J Carr
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tim Millar
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Roger T Webb
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Tsang JY, Kontopantelis E, Ashcroft DM. Methodological Concerns and Potential Confounding Factors-Reply. JAMA Ophthalmol 2024:2817625. [PMID: 38662343 DOI: 10.1001/jamaophthalmol.2024.1030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Jung Yin Tsang
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Mok PLH, Carr MJ, Guthrie B, Morales DR, Sheikh A, Elliott RA, Camacho EM, van Staa T, Avery AJ, Ashcroft DM. Multiple adverse outcomes associated with antipsychotic use in people with dementia: population based matched cohort study. BMJ 2024; 385:e076268. [PMID: 38631737 PMCID: PMC11022137 DOI: 10.1136/bmj-2023-076268] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. DESIGN Population based matched cohort study. SETTING Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. POPULATION Adults (≥50 years) with a diagnosis of dementia between 1 January 1998 and 31 May 2018 (n=173 910, 63.0% women). Each new antipsychotic user (n=35 339, 62.5% women) was matched with up to 15 non-users using incidence density sampling. MAIN OUTCOME MEASURES The main outcomes were stroke, venous thromboembolism, myocardial infarction, heart failure, ventricular arrhythmia, fracture, pneumonia, and acute kidney injury, stratified by periods of antipsychotic use, with absolute risks calculated using cumulative incidence in antipsychotic users versus matched comparators. An unrelated (negative control) outcome of appendicitis and cholecystitis combined was also investigated to detect potential unmeasured confounding. RESULTS Compared with non-use, any antipsychotic use was associated with increased risks of all outcomes, except ventricular arrhythmia. Current use (90 days after a prescription) was associated with elevated risks of pneumonia (hazard ratio 2.19, 95% confidence interval (CI) 2.10 to 2.28), acute kidney injury (1.72, 1.61 to 1.84), venous thromboembolism (1.62, 1.46 to 1.80), stroke (1.61, 1.52 to 1.71), fracture (1.43, 1.35 to 1.52), myocardial infarction (1.28, 1.15 to 1.42), and heart failure (1.27, 1.18 to 1.37). No increased risks were observed for the negative control outcome (appendicitis and cholecystitis). In the 90 days after drug initiation, the cumulative incidence of pneumonia among antipsychotic users was 4.48% (4.26% to 4.71%) versus 1.49% (1.45% to 1.53%) in the matched cohort of non-users (difference 2.99%, 95% CI 2.77% to 3.22%). CONCLUSIONS Antipsychotic use compared with non-use in adults with dementia was associated with increased risks of stroke, venous thromboembolism, myocardial infarction, heart failure, fracture, pneumonia, and acute kidney injury, but not ventricular arrhythmia. The range of adverse outcomes was wider than previously highlighted in regulatory alerts, with the highest risks soon after initiation of treatment.
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Affiliation(s)
- Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Daniel R Morales
- Population Health and Genomics, University of Dundee, Dundee, UK
| | - Aziz Sheikh
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel A Elliott
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Elizabeth M Camacho
- Manchester Centre for Health Economics, Division of Population Health, Manchester, UK
| | - Tjeerd van Staa
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
- Centre for Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, M13 9PT, UK
- Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, UK
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4
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Ajabnoor AM, Parisi R, Zghebi SS, Ashcroft DM, Faivre-Finn C, Morris C, Mamas MA, Kontopantelis E. Oral anticoagulant prescribing among patients with cancer and atrial fibrillation in England, 2009-2019. Cancer 2024; 130:1316-1329. [PMID: 38115738 DOI: 10.1002/cncr.35152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Anticoagulation of patients with atrial fibrillation (AF) and cancer is challenging because of their high risk for stroke and bleeding. Little is known of the variations of oral anticoagulant (OAC) prescribing in patients with AF with and without cancer. METHODS Patients with first-time AF during 2009-2019 from the Clinical Practice Research Datalink were included. Cancer diagnosis was defined as a history of breast, prostate, colorectal, lung, or hematological cancer. Competing-risk analysis was used to assess the risk of OAC prescribing in patients with AF and cancer adjusted for clinical and sociodemographic factors. RESULTS Of 177,065 patients with AF, 11.7% had cancer. Compared to patients without cancer, patients with cancer were less likely to receive OAC: prostate cancer (subhazard ratio [SHR], 0.95; 95% CI, 0.91-0.99), breast cancer (SHR, 0.93; 95% CI, 0.89-0.98), colorectal cancer (SHR, 0.93; 95% CI, 0.88-0.99), hematological cancer (SHR, 0.70; 95% CI, 0.65-0.75), and lung cancer (SHR, 0.44; 95% CI, 0.38-0.50). The cumulative incidence function (CIF) of OAC prescribing was lowest for patients with lung cancer and hematological cancer compared with patients without cancer. The difference between the CIF of OAC prescribing in patients with and without cancer becomes narrower in the most deprived areas. Elderly patients (aged ≥85 years) overall had the lowest CIF of OAC prescribing regardless of cancer status. CONCLUSIONS In patients with AF, underprescribing of OAC is independently associated with certain cancer types. Patients with hematological and lung cancer are the least likely to receive anticoagulation therapy compared with patients without cancer. Underprescribing of OAC in cancer is linked to old age. Further studies of patients with AF and cancer are warranted to assess the net clinical benefit of anticoagulation in certain cancer types.
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Affiliation(s)
- Alyaa M Ajabnoor
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Salwa S Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR), Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Corinne Faivre-Finn
- Christie National Health Service Foundation Trust and University of Manchester, Manchester, UK
| | - Charlotte Morris
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Andrade DDBC, Nzundu R, Rodrigues RRD, Romiti R, Santana YRT, Kurizky PS, de Lima APR, Carvalho A, Ashcroft DM, Gomes CM, Griffiths CEM. The epidemiology of atopic dermatitis and psoriasis in the indigenous people of Brazil. J Eur Acad Dermatol Venereol 2024. [PMID: 38577814 DOI: 10.1111/jdv.19984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Débora D B C Andrade
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
| | | | - Rodolfo R D Rodrigues
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
| | - Ricardo Romiti
- Department of Dermatology, Universidade de São Paulo, São Paulo, Brasil
| | - Yago R T Santana
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
- Ministério da Saúde Do Brasil, Brasília, Brazil
| | - Patrícia S Kurizky
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
| | - Ana P R de Lima
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
| | | | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, UK
| | - Ciro M Gomes
- Programa de Pós-Graduação Em Ciências Médicas, Universidade de Brasília, Brasília, Brazil
- Programa de Pós-Graduação Em Patologia Molecular, Universidade de Brasília, Brasília, Brazil
| | - Christopher E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
- Department of Dermatology, King's College Hospital, King's College London, London, UK
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Sutherland AB, Phipps DL, Grant S, Hughes J, Tomlin S, Ashcroft DM. Understanding the informal aspects of medication processes to maintain patient safety in hospitals: a sociotechnical ethnographic study in paediatric units. Ergonomics 2024:1-15. [PMID: 38557363 DOI: 10.1080/00140139.2024.2333396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024]
Abstract
Adverse drug events (ADEs) are common in hospitals, affecting one in six child in-patients. Medication processes are complex systems. This study aimed to explore the work-as-done of medication safety in three English paediatric units using direct observation and semi-structured interviews. We found that a combination of the physical environment, traditional work systems and team norms were among the systemic barriers to medicines safety. The layout of wards discouraged teamworking and reinforced professional boundaries. Workspaces were inadequate, and interruptions were uncontrollable. A less experienced workforce undertook prescribing and verification while more experienced nurses undertook administration. Guidelines were inadequate, with actors muddling through together. Formal controls against ADEs included checking (of prescriptions and administration) and barcode administration systems, but these did not integrate into workflows. Families played an important part in the safe administration of medication and provision of information about their children but were isolated from other parts of the system.
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Affiliation(s)
- Adam B Sutherland
- Medicines Optimisation Research Group, School of Pharmacy & Medical Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
- Pharmacy Department, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Denham L Phipps
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
| | - Suzanne Grant
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, UK
| | | | - Stephen Tomlin
- Children's Medicines Research & Innovation Centre, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Manchester, UK
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Grigoroglou C, Walshe K, Kontopantelis E, Ferguson J, Stringer G, Ashcroft DM, Allen T. Comparing the clinical practice and prescribing safety of locum and permanent doctors: observational study of primary care consultations in England. BMC Med 2024; 22:126. [PMID: 38532468 DOI: 10.1186/s12916-024-03332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Temporary doctors, known as locums, are a key component of the medical workforce in the NHS but evidence on differences in quality and safety between locum and permanent doctors is limited. We aimed to examine differences in the clinical practice, and prescribing safety for locum and permanent doctors working in primary care in England. METHODS We accessed electronic health care records (EHRs) for 3.5 million patients from the CPRD GOLD database with linkage to Hospital Episode Statistics from 1st April 2010 to 31st March 2022. We used multi-level mixed effects logistic regression to compare consultations with locum and permanent GPs for several patient outcomes including general practice revisits; prescribing of antibiotics; strong opioids; hypnotics; A&E visits; emergency hospital admissions; admissions for ambulatory care sensitive conditions; test ordering; referrals; and prescribing safety indicators while controlling for patient and practice characteristics. RESULTS Consultations with locum GPs were 22% more likely to involve a prescription for an antibiotic (OR = 1.22 (1.21 to 1.22)), 8% more likely to involve a prescription for a strong opioid (OR = 1.08 (1.06 to 1.09)), 4% more likely to be followed by an A&E visit on the same day (OR = 1.04 (1.01 to 1.08)) and 5% more likely to be followed by an A&E visit within 1 to 7 days (OR = 1.05 (1.02 to 1.08)). Consultations with a locum were 12% less likely to lead to a practice revisit within 7 days (OR = 0.88 (0.87 to 0.88)), 4% less likely to involve a prescription for a hypnotic (OR = 0.96 (0.94 to 0.98)), 15% less likely to involve a referral (OR = 0.85 (0.84 to 0.86)) and 19% less likely to involve a test (OR = 0.81 (0.80 to 0.82)). We found no evidence that emergency admissions, ACSC admissions and eight out of the eleven prescribing safety indicators were different if patients were seen by a locum or a permanent GP. CONCLUSIONS Despite existing concerns, the clinical practice and performance of locum GPs did not appear to be systematically different from that of permanent GPs. The practice and performance of both locum and permanent GPs is likely shaped by the organisational setting and systems within which they work.
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Affiliation(s)
- Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK.
| | - Kieran Walshe
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Gemma Stringer
- Alliance Manchester Business School, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
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Muntyanu A, Milan R, Kaouache M, Ringuet J, Gulliver W, Pivneva I, Royer J, Leroux M, Chen K, Yu Q, Litvinov IV, Griffiths CEM, Ashcroft DM, Rahme E, Netchiporouk E. Tree-Based Machine Learning to Identify Predictors of Psoriasis Incidence at the Neighborhood Level: A Populational Study from Quebec, Canada. Am J Clin Dermatol 2024:10.1007/s40257-024-00854-3. [PMID: 38498268 DOI: 10.1007/s40257-024-00854-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Psoriasis is a major global health burden affecting ~ 60 million people worldwide. Existing studies on psoriasis focused on individual-level health behaviors (e.g. diet, alcohol consumption, smoking, exercise) and characteristics as drivers of psoriasis risk. However, it is increasingly recognized that health behavior arises in the context of larger social, cultural, economic and environmental determinants of health. We aimed to identify the top risk factors that significantly impact the incidence of psoriasis at the neighborhood level using populational data from the province of Quebec (Canada) and advanced tree-based machine learning (ML) techniques. METHODS Adult psoriasis patients were identified using International Classification of Disease (ICD)-9/10 codes from Quebec (Canada) populational databases for years 1997-2015. Data on environmental and socioeconomic factors 1 year prior to psoriasis onset were obtained from the Canadian Urban Environment Health Consortium (CANUE) and Statistics Canada (StatCan) and were input as predictors into the gradient boosting ML. Model performance was evaluated using the area under the curve (AUC). Parsimonious models and partial dependence plots were determined to assess directionality of the relationship. RESULTS The incidence of psoriasis varied geographically from 1.6 to 325.6/100,000 person-years in Quebec. The parsimonious model (top 9 predictors) had an AUC of 0.77 to predict high psoriasis incidence. Amongst top predictors, ultraviolet (UV) radiation, maximum daily temperature, proportion of females, soil moisture, urbanization, and distance to expressways had a negative association with psoriasis incidence. Nighttime light brightness had a positive association, whereas social and material deprivation indices suggested a higher psoriasis incidence in the middle socioeconomic class neighborhoods. CONCLUSION This is the first study to highlight highly variable psoriasis incidence rates on a jurisdictional level and suggests that living environment, notably climate, vegetation, urbanization and neighborhood socioeconomic characteristics may have an association with psoriasis incidence.
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Affiliation(s)
- Anastasiya Muntyanu
- Department of Experimental Medicine, McGill University, Montreal, Canada
- Division of Dermatology, University of Toronto, Toronto, Canada
| | - Raymond Milan
- Department of Experimental Medicine, McGill University, Montreal, Canada
| | - Mohammed Kaouache
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Julien Ringuet
- Centre de Recherche Dermatologique de Québec, Québec, Canada
| | - Wayne Gulliver
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | | | | | | | | | - Qiuyan Yu
- Ecological and Biological Sciences, Exponent Inc, Menlo Park, USA
| | - Ivan V Litvinov
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada
| | | | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Global Psoriasis Atlas, Manchester, UK
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal General Hospital, Montreal, QC, Canada.
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Wang Y, Steinke D, Gavan SP, Chen TC, Carr MJ, Ashcroft DM, Cheung KL, Chen LC. Survival Outcomes in Older Women with Oestrogen-Receptor-Positive Early-Stage Breast Cancer: Primary Endocrine Therapy vs. Surgery by Comorbidity and Frailty Levels. Cancers (Basel) 2024; 16:749. [PMID: 38398140 PMCID: PMC10886896 DOI: 10.3390/cancers16040749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
Primary endocrine therapy (PET) offers non-surgical treatment for older women with early-stage breast cancer who are unsuitable for surgery due to frailty or comorbidity. This research assessed all-cause and breast cancer-specific mortality of PET vs. surgery in older women (≥70 years) with oestrogen-receptor-positive early-stage breast cancer by frailty and comorbidity levels. This study used UK secondary data to analyse older female patients from 2000 to 2016. Patients were censored until 31 May 2019 and grouped by the Charlson comorbidity index (CCI) and hospital frailty risk score (HFRS). Cox regression models compared all-cause and breast cancer-specific mortality between PET and surgery within each group, adjusting for patient preferences and covariates. Sensitivity analyses accounted for competing risks. There were 23,109 patients included. The hazard ratio (HR) comparing PET to surgery for overall survival decreased significantly from 2.1 (95%CI: 2.0, 2.2) to 1.2 (95%CI: 1.1, 1.5) with increasing HFRS and from 2.1 (95%CI: 2.0, 2.2) to 1.4 (95%CI 1.2, 1.7) with rising CCI. However, there was no difference in BCSM for frail older women (HR: 1.2; 0.9, 1.9). There were no differences in competing risk profiles between other causes of death and breast cancer-specific mortality with PET versus surgery, with a subdistribution hazard ratio of 1.1 (0.9, 1.4) for high-level HFRS (p = 0.261) and CCI (p = 0.093). Given limited survival gains from surgery for older patients, PET shows potential as an effective option for frail older women with early-stage breast cancer. Despite surgery outperforming PET, surgery loses its edge as frailty increases, with negligible differences in the very frail.
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Affiliation(s)
- Yubo Wang
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
| | - Douglas Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
| | - Sean P. Gavan
- Manchester Centre for Health Economics, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK;
| | - Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
| | - Matthew J. Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), The University of Manchester, Manchester M13 9PT, UK
| | - Kwok-Leung Cheung
- Royal Derby Hospital Centre, School of Medicine, University of Nottingham, Uttoxeter Road, Derby DE22 3DT, UK;
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK; (D.S.); (T.-C.C.); (M.J.C.); (D.M.A.); (L.-C.C.)
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Morgan C, Ashcroft DM, Chew-Graham CA, Sperrin M, Webb RT, Francis A, Scott J, Yung AR. Identifying prior signals of bipolar disorder using primary care electronic health records: a nested case-control study. Br J Gen Pract 2024:BJGP.2022.0286. [PMID: 38325893 PMCID: PMC10877620 DOI: 10.3399/bjgp.2022.0286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/24/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Bipolar disorders are serious mental illnesses, yet evidence suggests that the diagnosis and treatment of bipolar disorder can be delayed by around 6 years. AIM To identify signals of undiagnosed bipolar disorder using routinely collected electronic health records. DESIGN AND SETTING A nested case-control study conducted using the UK Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. 'Cases' were adult patients with incident bipolar disorder diagnoses between 1 January 2010 and 31 July 2017. METHOD The patients with bipolar disorder (the bipolar disorder group) were matched by age, sex, and registered general practice to 20 'controls' without recorded bipolar disorder (the control group). Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events before the index (diagnosis) date. RESULTS There were 2366 patients with incident bipolar disorder diagnoses and 47 138 matched control patients (median age 40 years and 60.4% female: n = 1430/2366 with bipolar disorder and n = 28 471/47 138 without). Compared with the control group, the bipolar disorder group had a higher incidence of diagnosed depressive, psychotic, anxiety, and personality disorders and escalating self-harm up to 10 years before a bipolar disorder diagnosis. Sleep disturbance, substance misuse, and mood swings were more frequent among the bipolar disorder group than the control group. The bipolar disorder group had more frequent face-to-face consultations, and were more likely to miss multiple scheduled appointments and to be prescribed ≥3 different psychotropic medication classes in a given year. CONCLUSION Psychiatric diagnoses, psychotropic prescriptions, and health service use patterns might be signals of unreported bipolar disorder. Recognising these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment, and initiation of appropriate treatments.
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Affiliation(s)
- Catharine Morgan
- Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | | | - Matthew Sperrin
- School of Health Sciences, Division of Informatics, Imaging & Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Roger T Webb
- Centre for Mental Health & Risk, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, NIHR Greater Manchester Patient Safety Research Collaboration, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Anya Francis
- Centre for Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Jan Scott
- Institute of Neuroscience, Newcastle University, Newcastle-upon-Tyne, UK; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway; Department of Mental Health, Université de Paris, Paris, France; Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Research Translation, Deakin University, Geelong, Australia; emeritus professor of psychiatry, Centre for Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
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Tsang JY, Wright A, Carr MJ, Dickinson C, Harper RA, Kontopantelis E, Van Staa T, Munford L, Blakeman T, Ashcroft DM. Risk of Falls and Fractures in Individuals With Cataract, Age-Related Macular Degeneration, or Glaucoma. JAMA Ophthalmol 2024; 142:96-106. [PMID: 38153708 PMCID: PMC10870181 DOI: 10.1001/jamaophthalmol.2023.5858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/30/2023] [Indexed: 12/29/2023]
Abstract
Importance Three leading disease causes of age-related visual loss are cataract, age-related macular degeneration (AMD), and glaucoma. Although all 3 eye diseases have been implicated with falls and fracture risk, evidence is mixed, with the contribution of different eye diseases being uncertain. Objective To examine whether people with cataract, AMD, or glaucoma have higher risks of falls or fractures than those without. Design, Setting, and Participants This cohort study was a population-based study in England using routinely collected electronic health records from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum primary care databases with linked hospitalization and mortality records from 2007 to 2020. Participants were people with cataract, AMD, or glaucoma matched to comparators (1:5) by age, sex, and general practice. Data were analyzed from May 2021 to June 2023. Exposures For each eye disease, we estimated the risk of falls or fractures using separate multivariable Cox proportional hazards regression models. Main Outcomes Two primary outcomes were incident falls and incident fractures derived from general practice, hospital, and mortality records. Secondary outcomes were incident fractures of specific body sites. Results A total of 410 476 people with cataract, 75 622 with AMD, and 90 177 with glaucoma were matched (1:5) to 2 034 194 (no cataract), 375 548 (no AMD), and 448 179 (no glaucoma) comparators. The mean (SD) age was 73.8 (11.0) years, 79.4 (9.4) years, and 69.8 (13.1) years for participants with cataract, AMD, or glaucoma, respectively. Compared with comparators, there was an increased risk of falls in those with cataract (adjusted hazard ratio [HR], 1.36; 95% CI, 1.35-1.38), AMD (HR, 1.25; 95% CI, 1.23-1.27), and glaucoma (HR, 1.38; 95% CI, 1.35-1.41). Likewise for fractures, there were increased risks in all eye diseases, with an HR of 1.28 (95% CI, 1.27-1.30) in the cataract cohort, an HR of 1.18 (95% CI, 1.15-1.21) for AMD, and an HR of 1.31 (95% CI, 1.27-1.35) for glaucoma. Site-specific fracture analyses revealed increases in almost all body sites (including hip, spine, forearm, skull or facial bones, pelvis, ribs or sternum, and lower leg fractures) compared with matched comparators. Conclusions and Relevance The results of this study support recognition that people with 1 or more of these eye diseases are at increased risk of both falls and fractures. They may benefit from improved advice, access, and referrals to falls prevention services.
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Affiliation(s)
- Jung Yin Tsang
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
| | - Alison Wright
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Matthew J. Carr
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Christine Dickinson
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Robert A. Harper
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- Manchester Royal Eye Hospital and Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tjeerd Van Staa
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Luke Munford
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Applied Research Collaboration Greater Manchester, University of Manchester, Manchester, United Kingdom
| | - Thomas Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, United Kingdom
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
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12
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Bansal N, Campbell SM, Lin CY, Ashcroft DM, Chen LC. Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care-a modified e-Delphi study. BMC Med 2024; 22:5. [PMID: 38167142 PMCID: PMC10763174 DOI: 10.1186/s12916-023-03213-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. METHODS Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1-9 scale from inappropriate to appropriate. The score's median, 30th and 70th percentiles, and disagreement index were calculated. RESULTS The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. CONCLUSIONS The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings.
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Affiliation(s)
- Neetu Bansal
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Stephen M Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Chiu-Yi Lin
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Darren M Ashcroft
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, M13 9PL, UK
| | - Li-Chia Chen
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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13
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Gibson H, Sanders C, Blakeman T, Ashcroft DM, Fudge N, Howells K. Providing care to marginalised communities: a qualitative study of community pharmacy teams. Br J Gen Pract 2024; 74:e49-e55. [PMID: 38154937 PMCID: PMC10755997 DOI: 10.3399/bjgp.2023.0267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/13/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Health inequalities in the UK are widening, particularly since the COVID-19 pandemic. Community pharmacies are the most visited healthcare provider in England and are ideally placed to provide and facilitate access to care for those most disadvantaged. AIM To explore the experiences and needs of community pharmacy teams in providing care for marginalised groups and how this has changed since the COVID-19 pandemic. DESIGN AND SETTING A qualitative study in community pharmacy and across primary care. METHOD Semi-structured interviews were undertaken with members of community pharmacy teams, primary care network (PCN) pharmacists, GPs, and nurses in the North of England. RESULTS In total, 31 individuals participated in an interview (26 pharmacy staff, three GPs, and two nurses). Most participants acknowledged that their pharmacy had become busier since COVID-19 because of increased footfall compounded by patient difficulties in navigating remote digital systems. Few participants had received any formal training on working with marginalised communities; however, organisational barriers (such as lack of access to translation facilities) combined with interorganisational barriers (such as lack of integrated care) made it more difficult to provide care for some marginalised groups. Despite this, the continuity of care provided by many pharmacies was viewed as an important factor in enabling marginalised groups to access and receive care. CONCLUSION There are opportunities to better utilise the skills of community pharmacy teams. Resources, such as access to translation services, and interventions to enable better communication between community pharmacy teams and other primary care services, such as general practice, are essential.
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Affiliation(s)
- Helen Gibson
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Caroline Sanders
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester; Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Nina Fudge
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Kelly Howells
- National Institute for Health and Care Research (NIHR) School for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester; NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
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14
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Heward E, Dempsey J, Molloy J, Isba R, Lunn J, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Outcome measures for use in trials of paediatric otorrhoea: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 176:111820. [PMID: 38103308 DOI: 10.1016/j.ijporl.2023.111820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Paediatric otorrhoea (PO) describes a middle ear infection that results in a perforation of the tympanic membrane and ear discharge, in children and young people (CYP). Prolonged infection may be associated with hearing loss and developmental delay. The current management of paediatric otorrhoea is variable, including non-invasive treatments (conservative, oral antibiotics, topical antibiotics) and surgery, reflecting the lack of a sufficiently strong evidence base. Outcome reporting is fundamental to producing reliable and meaningful evidence to inform best practice. OBJECTIVES Primary objective: to determine which outcome measures are currently used to evaluate treatment success in studies of non-surgical treatments for paediatric otorrhoea. SECONDARY OBJECTIVES to identify outcome measurement instruments used in the literature and assess their applicability for use in clinical trials of PO. METHODS This systematic review was registered with PROSPERO (CRD42023407976). Database searches of EMBASE, MEDLINE and Cochrane was performed on June 6, 2023, covering from Jan 1995 to May 2023. Randomised controlled trials or study protocols involving CYP with PO were included following PRISMA guidelines. Risk of bias was assessed with Cochrane's tool. RESULTS Of the 377 papers identified, six were included in the systematic review. The primary outcome of five of the studies related to otorrhoea cessation; both time to cessation and proportion recovered at various time points were used as measures. Two measurement instruments were identified: Otitis Media-6 Questionnaire and the Institute for Medical Technology Assessment Productivity Cost Questionnaire. Both were shown to be applicable measurement instruments when used in clinical trials of PO. CONCLUSIONS To promote homogeneity and facilitate meaningful comparison and combination of studies, we propose that time to cessation of otorrhoea from onset of otorrhoea should be used as the primary outcome in future studies. Further research is needed to establish if this is the most important outcome to children and their caregivers.
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Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK.
| | - James Dempsey
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - Rachel Isba
- Alder Hey Children's NHS Foundation Trust, UK
| | - Judith Lunn
- Lancaster Medical School, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK; Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, UK
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Sutherland A, Phipps DL, Gill A, Morris S, Ashcroft DM. Medication Safety Gaps in English Pediatric Inpatient Units: An Exploration Using Work Domain Analysis. J Patient Saf 2024; 20:7-15. [PMID: 37921742 DOI: 10.1097/pts.0000000000001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Medication is a common cause of preventable medical harm in pediatric inpatients. This study aimed to examine the sociotechnical system surrounding pediatric medicines management, to identify potential gaps in this system and how these might contribute to adverse drug events (ADEs). METHODS An exploratory prospective qualitative study in pediatric wards in three hospitals in the north of England was conducted between October 2020 and May 2022. Analysis included a documentary analysis of 72 policies and procedures and analysis of field notes from 60 hours of participant observation. The cognitive work analysis prompt framework was used to generate a work domain analysis (WDA) and identify potential contributory factors to ADEs. RESULTS The WDA identified 2 functional purposes, 7 value/priority measures, 6 purpose-related functions, 11 object-related processes and 14 objects. Structured means-ends connections supported identification of 3 potential contributory factors-resource limitations, cognitive demands, and adaptation of processes. The lack of resources (equipment, materials, knowledge, and experience) created an environment where distractions and interruptions were unavoidable. Families helped provide practical support in medicines administration but were largely unacknowledged at an organizational level. There was a lack of teamwork with regards to medication with different professionals responsible for different parts of the system. Mandated safety checks on medicines were frequently omitted because of limited resources and perceived redundancy. Interventions to support adherence to safety policies were also often bypassed because they created more work. CONCLUSIONS The WDA has provided insights into the complex system of medication safety for children in hospital and has facilitated the identification of potential contributory factors to ADEs. We therefore advocate (in priority order) for processes to involve parents in the care of their children in hospital, development of skill-mix interventions to ensure appropriate expertise is available where it is needed, and modified checking procedures to permit staff to use their skills and judgment effectively and efficiently.
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Affiliation(s)
- Adam Sutherland
- From the NIHR Greater Manchester Patient Safety Translational Research Centre; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Denham L Phipps
- From the NIHR Greater Manchester Patient Safety Translational Research Centre; School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Andrea Gill
- Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool
| | | | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre; School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
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16
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Chen TC, Wang TC, Yiu ZZN, Lee MS, Chen LC, Chan KA, Griffiths CEM, Ashcroft DM. Risk of serious infection and infection mortality in patients with psoriasis: A nationwide cohort study using the Taiwan National Health Insurance claims database. J Eur Acad Dermatol Venereol 2024; 38:136-144. [PMID: 37611288 DOI: 10.1111/jdv.19466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/11/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND The risks of serious infections that lead to hospitalization and mortality in patients with psoriasis in Asia have not been comprehensively studied. OBJECTIVES We examined the incidence of serious infection and infection mortality in patients with psoriasis. METHODS This population-based retrospective cohort study used the Taiwan National Health Insurance claims database from 2000 to 2017. Adult patients with psoriasis were identified by a relevant International Classification of Diseases (ICD) code and matched to six comparators without psoriasis on age and sex. Psoriasis patients were categorized as having moderate-to-severe disease once exposed to systemic therapies, phototherapy or biologic therapies. The incidence of serious infection and infection mortality were identified by ICD codes from inpatient hospitalization and death registration. Cox proportional hazard models were used to compare the risk, and the results were adjusted for covariates and presented as adjusted hazard ratios (aHR) and 95% confidence interval (95% CI). RESULTS Overall, 185,434 psoriasis patients and 1,112,581 comparators were included. A higher rate of serious infection (aHR: 1.21, 95% CI: 1.19-1.22) was found in patients with psoriasis compared to matched comparators without psoriasis, and the risk was enhanced when patients had moderate-to-severe psoriasis (aHR: 1.30, 95% CI: 1.27-1.34). Specifically, there was an increased risk of serious infection due to respiratory infections (aHR: 1.11, 95% CI: 1.09-1.13), skin/soft-tissue infections (aHR: 1.57, 95% CI: 1.52-1.62), sepsis (aHR: 1.23, 95% CI: 1.19-1.27), urinary tract infections (aHR: 1.11, 95% CI: 1.08-1.14), hepatitis B (aHR: 1.18, 95% CI: 1.06-1.30) and hepatitis C (aHR: 1.49, 95% CI: 1.32-1.69). Furthermore, psoriasis patients were associated with a higher risk of infection-related mortality (aHR: 1.15, 95% CI: 1.11-1.18) compared to matched comparators. CONCLUSION Patients with psoriasis had a higher risk of serious infection and infection mortality, which was enhanced by moderate-to-severe psoriasis. Practitioners should be aware of the increased risk in patients with psoriasis, but it should not be a barrier to offering effective treatment.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ting-Chun Wang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Zenas Z N Yiu
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Meng-Sui Lee
- Department of Dermatology, Taipei City Hospital, Taipei, Taiwan
- Department of Dermatology, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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17
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van Staa TP, Pirmohamed M, Sharma A, Ashcroft DM, Buchan I. Adverse drug reactions and hospital admissions: Large case-control study of patients aged 65-100 years using linked English primary care and hospital data. Pharmacoepidemiol Drug Saf 2024; 33:e5681. [PMID: 37609702 DOI: 10.1002/pds.5681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/29/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Adverse drug reactions (ADRs) are common and a leading cause of injury. However, information on ADR risks of individual medicines is often limited. The aim of this hypothesis-generating study was to assess the relative importance of ADR-related and emergency hospital admission for large group of medication classes. METHODS This study was a propensity-matched case-control study in English primary care. Data sources were Clinical Practice Research Databank and Aurum with longitudinal, anonymized, patient level electronic health records (EHRs) from English general practices linked to hospital records. Cases aged 65-100 with ADR-related or emergency hospital admission were matched to up to six controls by age, sex, morbidity and propensity scores for hospital admission risk. Medication groups with systemic administration as listed in the British National Formulary (used by prescribers for medication advice). Prescribing in the 84 days before the index date was assessed. Only medication groups with 50+ cases exposed were analysed. The outcomes of interest were ADR-related and emergency hospital admissions. Conditional logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CI). RESULTS The overall population included 121 546 cases with an ADR-related and 849 769 cases with emergency hospital admission. The percentage of hospitalizations with an ADR-related code for admission diagnosis was 1.83% and 6.58% with an ADR-related code at any time during hospitalization. A total of 137 medication groups was included in the main ADR analyses. Of these, 13 (9.5%) had statistically non-significant adjusted ORs, 58 (42.3%) statistically significant ORs between 1.0 and 1.5, 37 (27.0%) between 1.5-2.0, 18 (13.1%) between 2.0-3.0 and 11 (8.0%) 3.0 or higher. Several classes of antibiotics (including penicillins) were among medicines with largest ORs. Evaluating the 14 medications most often associated with ADRs, a strong association was found between the number of these medicines and the risk of ADR-related hospital admission (adjusted OR of 7.53 (95% CI 7.15-7.93) for those exposed to 6+ of these medicines). CONCLUSIONS AND RELEVANCE There is a need for a regular systematic assessment of the harm-benefit ratio of medicines, harvesting the information in large healthcare databases and combining it with causality assessment of individual case histories.
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Affiliation(s)
- Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology (ISMIB) University of Liverpool Block A: Waterhouse Building, Liverpool, UK
| | | | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Iain Buchan
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
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18
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Heward E, Saeed H, Bate S, Rajai A, Molloy J, Isba R, Ashcroft DM, Hay AD, Nichani JR, Bruce IA. Risk factors associated with the development of chronic suppurative otitis media in children: Systematic review and meta-analysis. Clin Otolaryngol 2024; 49:62-73. [PMID: 37794685 DOI: 10.1111/coa.14102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 08/08/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVES Chronic suppurative otitis media (CSOM) is defined as persistent discharge through a tympanic membrane perforation for greater than 2 weeks. It is associated with a significant disease burden, including hearing loss, and reducing its incidence could significantly improve short- and long-term health. We aimed to identify risk factors associated with the development of CSOM in children. DESIGN AND SETTING Systematic review and meta-analysis of studies set in community, primary and secondary care settings, identified from Medline, Embase and Cochrane databases from 2000 to 2022. PARTICIPANTS Children 16 years old and below. MAIN OUTCOME MEASURES Clinical diagnosis of CSOM. RESULTS In total, 739 papers were screened, with 12 deemed eligible for inclusion in the systematic review, of which, 10 were included in the meta-analysis. Risk factors examined included perinatal, patient, dietary, environmental and parental factors. Meta-analysis results indicate that atopy (RR = 1.18, 95% CI [1.01-1.37], p = .04, 2 studies); and birth weight <2500 g (RR = 1.79 [1.27-2.50], p < .01, 2 studies) are associated with an increased risk of CSOM development. Factors not associated were male sex (RR = 0.96 [0.82-1.13], p = .62, 8 studies); exposure to passive smoking (RR = 1.27 [0.81-2.01], p = .30, 3 studies); and parental history of otitis media (RR = 1.14 [0.59-2.20], p = .69, 2 studies). CONCLUSION Optimal management of risk factors associated with CSOM development will help reduce the burden of disease and prevent disease progression or recurrence. The current quality of evidence in the literature is variable and heterogeneous. Future studies should aim to use standardised classification systems to define risk factors to allow meta-analysis.
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Affiliation(s)
- Elliot Heward
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Haroon Saeed
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
| | - Sebastian Bate
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - Azita Rajai
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Population Health, Health Services Research, and Primary Care, Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Molloy
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Rachel Isba
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Health Innovation One, Lancaster, UK
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
| | - Jaya R Nichani
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Iain A Bruce
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, UK
- Royal Manchester Children's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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19
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Williams SG, Frain S, Guo H, Carr MJ, Ashcroft DM, Keavney BD. Clinical risk associated with COVID-19 among 86000 patients with congenital heart disease. Open Heart 2023; 10:e002415. [PMID: 38097365 PMCID: PMC10729200 DOI: 10.1136/openhrt-2023-002415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To determine the magnitude of any excess risk of mortality and hospitalisation due to COVID-19 infection in patients with congenital heart disease (CHD) in the UK healthcare system. METHODS Matched case-control study within the Clinical Practice Research Datalink study of anonymised general practice records in the National Health Service in England. Patients with CHD were stratified for disease severity according to the European Society of Cardiology guidelines. Presence of a positive COVID-19 test, hospitalisation with a diagnosis of COVID-19 and COVID-19-related mortality were compared in case and control groups. RESULTS 86 441 patients with CHD and 335 839 controls were studied. Of patients with a positive COVID-19 test, patients with CHD were more likely than controls to be hospitalised (22.4% vs 14.5%; OR=1.77 (95% CI 1.60 to 1.96); p=2.11e-28) and suffer COVID-19-related death (6.1% vs 3.8%; OR=1.60 (95% CI 1.35 to 1.89); p=7.00e-08). The excess risk of COVID-19 hospitalisation and death rose with increasing physiological severity of CHD (presence of pulmonary vascular disease and/or cyanosis), rather than anatomical complexity. CONCLUSIONS In this study of the COVID-19 pandemic experience, using population health records in over 86000 patients with CHD in England, patients with CHD with COVID-19 were at around 50-75% higher risk of hospitalisation and mortality compared with matched controls with COVID-19. We provide the first primary care-derived estimates for COVID-19 hospitalisation and case-fatality rates in patients with CHD. Some factors predictive of worse COVID-19 outcome in general populations (such as non-white ethnic group), and other CHD-specific comorbidities (such as pulmonary hypertension), influenced outcomes among patients with CHD.
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Affiliation(s)
- Simon G Williams
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Simon Frain
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Hui Guo
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety and NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety and NIHR Greater Manchester Patient Safety Research Collaboration, The University of Manchester, Manchester, UK
| | - Bernard D Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Manchester Heart Institute, Manchester University NHS Foundation Trust, Manchester, UK
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20
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Patel A, Perrone F, Ashcroft DM, Flaum N, Cook N, Riva S. Cross-cultural adaptation of the PROFFIT Instrument to measure financial toxicity in people living with cancer within a UK population. J Cancer Policy 2023; 38:100440. [PMID: 37633419 DOI: 10.1016/j.jcpo.2023.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 08/17/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND This study aimed to develop a British version of the Patient Reported Outcomes for Fighting Financial Toxicity of Cancer (PROFFIT): originally designed to measure financial toxicity in cancer for an Italian universal healthcare system. The instrument was carefully evaluated for crosscultural equivalence, face validity and practicality. METHODS A systematic approach to cross-cultural adaptation was used, including forward translation, synthesis, backward translation, consolidation of translations with an expert committee, and cognitive interviews. As part of the cognitive interview process, 18 cancer patients completed a structured interview of 60-90 min in length. RESULTS The translated and modified PROFFIT questionnaire demonstrated good psycho-linguistic properties, including high compliance (only one item was revised for clarity), high retrieval from memory, high decision-making processes, and high response processes. CONCLUSION PROFFIT has been found to be functional and adaptable in a new social environment. The tool may be useful for tailoring interventions to address and measure financial hardships within the cancer population, which appear to be a current challenge for public health. POLICY SUMMARY Even in universal healthcare systems, financial toxicity due to the increase in outof-pocket expenses poses a significant problem. The FT phenomenon warrants proper attention in the United Kingdom since it may negatively impact financial well-being, quality of life, psychosocial health, and treatment adherence.
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Affiliation(s)
- Alkesh Patel
- Pharmacy Department, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, United Kingdom
| | - Nicola Flaum
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Natalie Cook
- University of Manchester and the Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Silvia Riva
- The St Mary's University, Twickenham, London, United Kingdom.
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21
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Osam CS, Hope H, Ashcroft DM, Abel KM, Pierce M. Maternal mental illness and child atopy: a UK population-based, primary care cohort study. Br J Gen Pract 2023; 73:e924-e931. [PMID: 37783510 PMCID: PMC10562998 DOI: 10.3399/bjgp.2022.0584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/08/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND The number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy. AIM To investigate the association between maternal mental illness and risk of atopy among offspring. DESIGN AND SETTING Retrospective cohort study using a UK primary care database (674 general practices). METHOD In total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region). RESULTS Children exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93). CONCLUSION The finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier.
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Affiliation(s)
- Cemre Su Osam
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Holly Hope
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Faculty of Biology, Medicine and Health, and National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester; Greater Manchester Mental Health NHS Foundation Trust, Manchester
| | - Matthias Pierce
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester
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22
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Domzaridou E, Carr MJ, Millar T, Webb RT, Ashcroft DM. Non-fatal overdose risk associated with prescribing opioid agonists concurrently with other medication: Cohort study conducted using linked primary care, secondary care and mortality records. Addiction 2023; 118:2374-2383. [PMID: 37536685 DOI: 10.1111/add.16306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/25/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND AND AIMS An apparently protective effect of opioid agonist treatment (OAT) on all-cause and cause-specific mortality risk has been widely reported. Non-fatal overdose (NFO) often precedes subsequent drug-poisoning deaths. We hypothesized that benzodiazepines, gabapentinoids, antipsychotics, antidepressants, Z-drugs or opioids increase the NFO risk when co-prescribed with OAT. DESIGN We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases. The cohort was linked to Hospital Episode Statistics admitted patient care data (HES-APC), neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records from the Office for National Statistics. SETTING Primary care in England. PARTICIPANTS We studied patients with opioid use disorder, aged 18-64 years, who were prescribed OAT (15155 methadone and 5743 buprenorphine recipients) between Jan 1, 1998, and Dec 31, 2017. MEASUREMENTS The main outcome examined was NFO risk during co-prescription of OAT with benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids. Overdose was defined according to International Classification of Diseases codes from the HES-APC data set. Negative binomial regression models were used to estimate weighted rate ratios (wRR) for NFO during co-prescription of OAT and benzodiazepines, antipsychotics, gabapentinoids, antidepressants, Z-drugs or opioids with periods of exclusive OAT usage. FINDINGS Among 20 898 patients observed over 83 856 person-years, we found an elevated overdose risk that resulted in hospital admission during co-prescription of OAT with benzodiazepines [wRR: 1.45; 95% confidence interval (CI) = 1.26-1.67], gabapentinoids (wRR = 2.22; 95% CI = 1.77-2.79), Z-drugs (wRR = 1.60; 95% CI = 1.31-1.96), antipsychotics (wRR = 1.85; 95% CI = 1.53-2.25) and opioids (wRR = 1.28; 95% CI = 1.02-1.60). The risk ratio for antidepressant co-prescriptions was below unity (wRR = 0.90; 95% CI = 0.79-1.02) but this result was not statistically significant. CONCLUSION Elevated risk of non-fatal overdose among opioid agonist treatment recipients is associated with concurrent use of medication prescribed for other reasons.
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Affiliation(s)
- Eleni Domzaridou
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Matthew J Carr
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Tim Millar
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Roger T Webb
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Mental Health and Safety, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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23
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Chen TC, Lin CP, Wang TC, Ashcroft DM, Chan KA, Chen LC. Longitudinal Trajectory of Opioid Prescribing and its Associated Serious Adverse Events: A Population-Wide Cohort Study in Taiwan. Clin Pharmacol Ther 2023; 114:1358-1365. [PMID: 37746873 DOI: 10.1002/cpt.3058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Abstract
Chronic opioid prescribing (COP) for noncancer pain is highly restricted in Taiwan, but tramadol is not listed in the regulation on chronic prescribing. This study investigated the trajectories of COP in noncancer pain when considering tramadol in Taiwan and identified the risk of serious adverse events. This population-wide longitudinal cohort study used the Taiwan National Health Insurance claims records from 2001 to 2016. Adults prescribed opioids (including tramadol) and without cancer were selected. Patients who received COP (opioid supply days for 28 days or continuous opioid supply for 14 days) in the first patient quarter were included, and serious adverse events were identified. Group-based trajectory models were applied to identify patients with a similar trajectory of quarterly COP. The Cox proportional hazard model was applied to assess the association between adverse events and patients' trajectories. Of the 2,360,358 noncancer opioid users, 476,934 (20.2%) received COP in the first quarter. Four groups of COP trajectory were identified, and 59,310 (12.8%) patients received COP quarterly over 2 years. Patients categorized into the trajectory of long-term COP had a significantly higher crude incidence rate of cardiovascular death, seizure, and hypoglycemia. Still, there is no newly developed opioid use disorder. There was a substantial underestimate in COP in Taiwan when tramadol was not considered. Notably, 10% of them could receive COP for over 2 years. The result raises concern about unmet pain management needs and the limited accessibility of alternative treatments for noncancer pain.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- Department of Pharmacy, School of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Peng Lin
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Anesthesiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ting-Chun Wang
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - K Arnold Chan
- Health Data Research Center, National Taiwan University, Taipei, Taiwan
| | - Li-Chia Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
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24
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Barron E, Khunti K, Wright AK, Ashcroft DM, Carr MJ, Rutter MK, Valabhji J. Impact of the COVID-19 pandemic on new diagnoses of type 2 diabetes in England. Diabetes Obes Metab 2023; 25:3424-3429. [PMID: 37489091 DOI: 10.1111/dom.15223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Affiliation(s)
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Martin K Rutter
- Manchester Academic Health Science Centre, Manchester, UK
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Diabetes, Endocrinology and Metabolism Centre, NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Jonathan Valabhji
- NHS England, London, UK
- Department of Diabetes and Endocrinology, Imperial College Healthcare NHS Trust, London, UK
- Division of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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25
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Zghebi SS, Rutter MK, Sun LY, Ullah W, Rashid M, Ashcroft DM, Steinke DT, Weng S, Kontopantelis E, Mamas MA. Comorbidity clusters and in-hospital outcomes in patients admitted with acute myocardial infarction in the USA: A national population-based study. PLoS One 2023; 18:e0293314. [PMID: 37883354 PMCID: PMC10602297 DOI: 10.1371/journal.pone.0293314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The prevalence of multimorbidity in patients with acute myocardial infarction (AMI) is increasing. It is unclear whether comorbidities cluster into distinct phenogroups and whether are associated with clinical trajectories. METHODS Survey-weighted analysis of the United States Nationwide Inpatient Sample (NIS) for patients admitted with a primary diagnosis of AMI in 2018. In-hospital outcomes included mortality, stroke, bleeding, and coronary revascularisation. Latent class analysis of 21 chronic conditions was used to identify comorbidity classes. Multivariable logistic and linear regressions were fitted for associations between comorbidity classes and outcomes. RESULTS Among 416,655 AMI admissions included in the analysis, mean (±SD) age was 67 (±13) years, 38% were females, and 76% White ethnicity. Overall, hypertension, coronary heart disease (CHD), dyslipidaemia, and diabetes were common comorbidities, but each of the identified five classes (C) included ≥1 predominant comorbidities defining distinct phenogroups: cancer/coagulopathy/liver disease class (C1); least burdened (C2); CHD/dyslipidaemia (largest/referent group, (C3)); pulmonary/valvular/peripheral vascular disease (C4); diabetes/kidney disease/heart failure class (C5). Odds ratio (95% confidence interval [CI]) for mortality ranged between 2.11 (1.89-2.37) in C2 to 5.57 (4.99-6.21) in C1. For major bleeding, OR for C1 was 4.48 (3.78; 5.31); for acute stroke, ORs ranged between 0.75 (0.60; 0.94) in C2 to 2.76 (2.27; 3.35) in C1; for coronary revascularization, ORs ranged between 0.34 (0.32; 0.36) in C1 to 1.41 (1.30; 1.53) in C4. CONCLUSIONS We identified distinct comorbidity phenogroups that predicted in-hospital outcomes in patients admitted with AMI. Some conditions overlapped across classes, driven by the high comorbidity burden. Our findings demonstrate the predictive value and potential clinical utility of identifying patients with AMI with specific comorbidity clustering.
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Affiliation(s)
- Salwa S. Zghebi
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Department of Pharmaceutics, Faculty of Pharmacy, University of Tripoli, Tripoli, Libya
| | - Martin K. Rutter
- Diabetes, Endocrinology & Metabolism Centre, Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Diabetes, Endocrinology & Gastroenterology, School of Medical Sciences, The University of Manchester, Manchester, United Kingdom
| | - Louise Y. Sun
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, United States of America
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Stoke‐on‐Trent, United Kingdom
- Department of Academic Cardiology, Royal Stoke University Hospital, Stoke‐on‐Trent, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Research Collaboration (PSRC), The University of Manchester, Manchester, United Kingdom
| | - Douglas T. Steinke
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Stephen Weng
- Development Biostatistics, GSK, Stevenage, United Kingdom
| | - Evangelos Kontopantelis
- Centre for Primary Care and Health Services Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, School of Medicine, Keele University, Stoke‐on‐Trent, United Kingdom
- Department of Academic Cardiology, Royal Stoke University Hospital, Stoke‐on‐Trent, United Kingdom
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26
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Ajabnoor AM, Parisi R, Zghebi SS, Ashcroft DM, Faivre‐Finn C, Morris C, Mamas MA, Kontopantelis E. Common Cancer Types and Risk of Stroke and Bleeding in Patients With Nonvalvular Atrial Fibrillation: A Population-Based Study in England. J Am Heart Assoc 2023; 12:e029423. [PMID: 37750567 PMCID: PMC10727261 DOI: 10.1161/jaha.123.029423] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND The association between cancer and stroke or bleeding outcomes in atrial fibrillation is unclear. We sought to examine how certain types of cancer influence the balance between stroke and bleeding risk in patients with nonvalvular atrial fibrillation (NVAF). METHODS AND RESULTS We estimated stroke and bleeding risk among adult patients with NVAF and certain types of cancer (breast, prostate, colorectal, lung, and hematological cancer) from 2009 to 2019 based on data from the UK Clinical Practice Research Datalink GOLD and Aurum databases. The control group included patients with NVAF only. Of 177 065 patients with NVAF, 11379 (6.4%) had cancer (1691 breast, 3955 prostate, 1666 colorectal, 2491 hematological, and 1576 lung). Compared with patients without cancer, stroke risk was higher in patients with breast cancer (adjusted hazard ratio [aHR], 1.20 [95% CI, 1.07-1.35) and with prostate cancer (aHR, 1.11 [95% CI, 1.01-1.12) if diagnosed within 6 months before NVAF. The risk of bleeding was increased in subjects with hematological cancer (aHR, 1.55 [95% CI, 1.40-1.71]), lung cancer (aHR, 1.49 [95% CI, 1.25, 1.77]), prostate cancer (aHR, 1.38 [95% CI, 1.28-1.49]), and colorectal cancer (aHR, 1.36 [95% CI, 1.21-1.53]), but not for subjects with breast cancer. The more recent the cancer diagnosis before NVAF diagnosis (within 6 months), the higher the risk of bleeding. CONCLUSIONS Breast and prostate cancer are associated with increased stroke risk, whereas in some cancer types, the risk of bleeding seemed to exceed stroke risk. In these patients, prescribing of oral anticoagulant should be carefully evaluated to balance bleeding and stroke risk.
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Affiliation(s)
- Alyaa M. Ajabnoor
- Department of Pharmacy Practice, Faculty of PharmacyKing Abdulaziz UniversityJeddahSaudi Arabia
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUnited Kingdom
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUnited Kingdom
| | - Salwa S. Zghebi
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUnited Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUnited Kingdom
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (PSRC)University of ManchesterManchesterUnited Kingdom
| | - Corinne Faivre‐Finn
- The Christie NHS Foundation Trust and The University of ManchesterManchesterUnited Kingdom
| | - Charlotte Morris
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUnited Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health SciencesKeele UniversityKeeleUnited Kingdom
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC)University of ManchesterManchesterUnited Kingdom
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Lophatananon A, Carr M, Mcmillan B, Dobson C, Itzhaki R, Parisi R, Ashcroft DM, Muir KR. The association of herpes zoster and influenza vaccinations with the risk of developing dementia: a population-based cohort study within the UK Clinical Practice Research Datalink. BMC Public Health 2023; 23:1903. [PMID: 37784088 PMCID: PMC10546661 DOI: 10.1186/s12889-023-16768-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/15/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Dementia affects ability to remember, think, or make decisions that interfere with doing everyday activities. There is no cure, therefore any prevention or delay of the onset is of importance. This study aims to investigate the association between zoster and influenza vaccinations and the risk of developing dementia. METHODS We conducted a retrospective population-based cohort study using electronic health records from 1469 general practices contributing to the Clinical Practice Research Datalink (CPRD) Aurum database with linked hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records. We built two 'matched cohorts': zoster vaccine (854,745 exposed individuals) matched with 8.8 million comparators without a history of zoster vaccination, and influenza vaccine (742,487 exposed individuals) matched with 7.12 million comparators without a history of vaccination as another comparator group. The cohorts were then followed to assess the association of exposure (vaccine) with outcome (dementia diagnosis). RESULTS Zoster vaccination was associated with a lower risk of dementia diagnosis (adjusted hazard ratio (HR) 0.78 with 95% CI: 0.77-0.79), Alzheimer's diagnosis (adjusted HR 0.91 with 95% CI: 0.89-0.92 and other types of dementia (adjusted HR 0.71 with 95% CI: 0.69-0.72). Influenza vaccination also was associated with a slightly reduced hazard of dementia risk (adjusted HR 0.96 with 95% CI: 0.94-0.97). CONCLUSION Both zoster vaccine for prevention of shingles / herpes zoster and influenza vaccine to prevent influenza were associated with diminished risk of dementia, with the zoster association appearing more pronounced.
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Affiliation(s)
- Artitaya Lophatananon
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Matthew Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PT, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Brian Mcmillan
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Curtis Dobson
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PT, Manchester, UK
| | - Ruth Itzhaki
- The Oxford Institute of Population Ageing, University of Oxford, Oxford, OX2 6PR, UK
| | - Rosa Parisi
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PT, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK
| | - Kenneth R Muir
- Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, M13 9PT, UK.
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Alqenae FA, Steinke D, Belither H, Robertson P, Bartlett J, Wilkinson J, Williams SD, Brad L, Jeffries M, Ashcroft DM, Keers RN. A Multi-method Exploratory Evaluation of a Service Designed to Improve Medication Safety for Patients with Monitored Dosage Systems Following Hospital Discharge. Drug Saf 2023; 46:1021-1037. [PMID: 37819463 PMCID: PMC10584716 DOI: 10.1007/s40264-023-01342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND AND OBJECTIVE Medication safety problems are common post-hospital discharge, and an important global healthcare improvement target. The Transfers of Care Around Medicines (TCAM) service was launched by a National Health Service Trust in the North-West of England, initially focusing on patients with new or existing Monitored Dosage Systems (MDS). The TCAM service is designed to enable the prompt transfer of medication information, with referrals made by hospitals at discharge to a named community pharmacy. This study aimed to explore the utilisation and impact of the TCAM service on medication safety. METHODS The evaluation included a descriptive analysis of 3033 anonymised patient referrals to 71 community pharmacies over a 1-year period alongside an assessment of the impact of the TCAM service on unintentional medication discrepancies and adverse drug events using a retrospective before-and-after study design. Impact data were collected across 18 general practices by 16 trained clinical pharmacists. RESULTS Most patient referrals (70%, 2126/3033) were marked as 'completed' by community pharmacies, with 15% of completed referrals delayed beyond 30 days. Screening of 411 patient records by clinical pharmacists yielded no statistically significant difference in unintentional medication discrepancies or adverse drug event rates following TCAM implementation using a multivariable regression analysis (unintentional medication discrepancies adjusted odds ratio = 0.79 [95% confidence interval 0.44-1.44, p = 0.46]; and adverse drug events adjusted odds ratio = 1.19 [95% confidence interval 0.57-2.45, p = 0.63]), although there remained considerable uncertainty. CONCLUSIONS The TCAM service facilitated a number of community pharmacy services offered to patients with monitored dosage systems; but the impact of the intervention on unintentional medication discrepancies and adverse drug event rates post-hospital discharge for this patient group was uncertain. The results of this exploratory study can inform the ongoing implementation of the TCAM service at hospital discharge and highlight the need to understand service implementation in different contexts, which may influence its impact on medication safety.
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Affiliation(s)
- Fatema A Alqenae
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Douglas Steinke
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Hilary Belither
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | | | - Jennifer Bartlett
- Pharmacy Department, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, Greater Manchester, UK
| | - Jack Wilkinson
- Centre for Biostatistics, Division of Population Health, Health Service Research and Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Steven D Williams
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- Westbourne Medical Centre, Bournemouth, UK
| | | | - Mark Jeffries
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Division of Population Health, Health Service Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Richard N Keers
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacoepidemiology and Drug Safety, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
- Suicide, Risk and Safety Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Yang YT, Zhong X, Fahmi A, Watts S, Ashcroft DM, Massey J, Fisher L, MacKenna B, Mehrkar A, Bacon SCJ, Goldacre B, Hand K, van Staa T, Palin V. The impact of the COVID-19 pandemic on the treatment of common infections in primary care and the change to antibiotic prescribing in England. Antimicrob Resist Infect Control 2023; 12:102. [PMID: 37717030 PMCID: PMC10504725 DOI: 10.1186/s13756-023-01280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/22/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND There is concern that the COVID-19 pandemic altered the management of common infections in primary care. This study aimed to evaluate infection-coded consultation rates and antibiotic use during the pandemic and how any change may have affected clinical outcomes. METHODS With the approval of NHS England, a retrospective cohort study using the OpenSAFELY platform analysed routinely collected electronic health data from GP practices in England between January 2019 and December 2021. Infection coded consultations and antibiotic prescriptions were used estimate multiple measures over calendar months, including age-sex adjusted prescribing rates, prescribing by infection and antibiotic type, infection consultation rates, coding quality and rate of same-day antibiotic prescribing for COVID-19 infections. Interrupted time series (ITS) estimated the effect of COVID-19 pandemic on infection-coded consultation rates. The impact of the pandemic on non- COVID-19 infection-related hospitalisations was also estimated. RESULTS Records from 24 million patients were included. The rate of infection-related consultations fell for all infections (mean reduction of 39% in 2020 compared to 2019 mean rate), except for UTI which remained stable. Modelling infection-related consultation rates highlighted this with an incidence rate ratio of 0.44 (95% CI 0.36-0.53) for incident consultations and 0.43 (95% CI 0.33-0.54) for prevalent consultations. Lower respiratory tract infections (LRTI) saw the largest reduction of 0.11 (95% CI 0.07-0.17). Antibiotic prescribing rates fell with a mean reduction of 118.4 items per 1000 patients in 2020, returning to pre-pandemic rates by summer 2021. Prescribing for LRTI decreased 20% and URTI increased 15.9%. Over 60% of antibiotics were issued without an associated same-day infection code, which increased during the pandemic. Infection-related hospitalisations reduced (by 62%), with the largest reduction observed for pneumonia infections (72.9%). Same-day antibiotic prescribing for COVID-19 infection increased from 1 to 10.5% between the second and third national lockdowns and rose again during 2022. CONCLUSIONS Changes to consultations and hospital admissions may be driven by reduced transmission of non-COVID-19 infections due to reduced social mixing and lockdowns. Inconsistencies in coding practice emphasises the need for improvement to inform new antibiotic stewardship policies and prevent resistance to novel infections.
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Affiliation(s)
- Ya-Ting Yang
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Xiaomin Zhong
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Ali Fahmi
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Simon Watts
- Health Education England, Manchester, M1 3BN, UK
| | - Darren M Ashcroft
- Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Faculty of Biology, Medicine and Health, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Sebastian C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX26GG, UK
| | - Kieran Hand
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK
| | - Victoria Palin
- Faculty of Biology, Medicine, and Health, Centre for Health Informatics, School of Health Sciences, The University of Manchester, Manchester, M13 9PL, UK.
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, The University of Manchester, Manchester, M13 9WL, UK.
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Domzaridou E, Van Staa T, Renehan AG, Cook N, Welfare W, Ashcroft DM, Palin V. The Impact of Oral Antibiotics Prior to Cancer Diagnosis on Overall Patient Survival: Findings from an English Population-Based Cohort Study. Curr Oncol 2023; 30:8434-8443. [PMID: 37754529 PMCID: PMC10528751 DOI: 10.3390/curroncol30090614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND There is limited evidence in humans as to whether antibiotics impact the effectiveness of cancer treatments. Rodent studies have shown that disruption in gut microbiota due to antibiotics decreases cancer therapy effectiveness. We evaluated the associations between the antibiotic treatment of different time periods before cancer diagnoses and long-term mortality. METHODS Using the Clinical Practice Research Datalink GOLD, linked to the Cancer Registry's and the Office for National Statistics' mortality records, we delineated a study cohort that involved cancer patients who were prescribed antibiotics 0-3 months; 3-24 months; or more than 24 months before cancer diagnosis. Patients' exposure to antibiotics was compared according to the recency of prescriptions and time-to-event (all-cause mortality) by applying Cox models. RESULTS 111,260 cancer patients from England were included in the analysis. Compared with antibiotic prescriptions that were issued in the past, patients who had been prescribed antibiotics shortly before cancer diagnosis presented an increased hazard ratio (HR) for mortality. For leukaemia, the HR in the Cancer Registry was 1.32 (95% CI 1.16-1.51), for lymphoma it was 1.22 (1.08-1.36), for melanoma it was 1.28 (1.10-1.49), and for myeloma it was 1.19 (1.04-1.36). Increased HRs were observed for cancer of the uterus, bladder, and breast and ovarian and colorectal cancer. CONCLUSIONS Antibiotics that had been issued within the three months prior to cancer diagnosis may reduce the effectiveness of chemotherapy and immunotherapy. Judicious antibiotic prescribing is needed among cancer patients.
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Affiliation(s)
- Eleni Domzaridou
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Tjeerd Van Staa
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (T.V.S.); (V.P.)
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Andrew G. Renehan
- Centre for Health Informatics, Manchester Cancer Research Centre, University of Manchester, Manchester M13 9PL, UK;
| | - Natalie Cook
- Division of Cancer Science, School of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - William Welfare
- Public Health England Northwest, 3 Piccadilly Place, London Road, Manchester M1 3BN, UK;
| | - Darren M. Ashcroft
- National Institute for Health and Care Research Greater Manchester Patient Safety Research Collaboration, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
| | - Victoria Palin
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (T.V.S.); (V.P.)
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, University of Manchester, St Marys Hospital, Oxford Road, Manchester M13 9WL, UK
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Choon SE, Wright AK, Griffiths CEM, Wong KW, Tey KE, Lim YT, Chua KY, Ashcroft DM. Incidence and prevalence of generalized pustular psoriasis in multiethnic Johor Bahru, Malaysia: a population-based cohort study using routinely captured electronic health records in the Teleprimary Care (TPC®) clinical information system from 2010 to 2020. Br J Dermatol 2023; 189:410-418. [PMID: 37162007 DOI: 10.1093/bjd/ljad158] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND There is limited understanding of the epidemiology of generalized pustular psoriasis (GPP) internationally, with no population-based estimates of GPP in South East Asia. OBJECTIVES To determine the incidence and prevalence of GPP in the Malaysian population and characterize its flares and trigger factors. METHODS We conducted a population-based cohort study using the Teleprimary Care database between January 2010 and December 2020. We identified 230 dermatologist-confirmed GPP cases using International Classification of Diseases, 10th revision, diagnostic codes. Annual prevalence and incidence rates were stratified by age, sex and ethnicity. We compared data regarding flares and trigger factors for patients with GPP who had associated psoriasis vulgaris (PV) with those who did not have associated PV. RESULTS The prevalence of GPP was 198 per million (267 women, 127 men) and incidence was 27.2 per million person-years [95% confidence interval (CI) 22.8-31.6]; 35.3 (28.4-42.2) per million person-years for women and 18.3 (13.1-23.5) per million person-years for men. Rates were higher in Chinese individuals [prevalence 271 per million; incidence 41.6 per million person-years (28.9-54.3)] than in the Malay population [prevalence 186; incidence 24.6 (19.4-29.7)] or the Indian ethnic group [prevalence 179; incidence 25.0 (13.8-36.3)]. Annual prevalence was consistently higher in women than in men and highest among the Chinese population, followed by the Indian and Malay populations. Overall, 67% of patients with GPP had associated PV. The prevalence and incidence of GPP without PV were lower than GPP with PV at 66 vs. 132 per million and 19.3 (95% CI 15.6-23.0) vs. 8.0 (95% CI 5.6-10.3) per million person-years, respectively. The mean age at GPP onset was 42.7 years (SD 18.4). A bimodal trend in the age of GPP onset was observed, with first and second peaks at age 20-29 years and age 50-59 years, respectively. Disease onset was significantly earlier in patients with GPP without PV than in those with PV [mean age 37.5 years (SD 20.7) vs. 44.9 years (SD 17.0), P = 0.026]. Flares occurred more frequently in patients without PV than in those with PV [mean number of flares per patient per year was 1.35 (SD 0.77) vs. 1.25 (SD 0.58), P = 0.039]. Common triggers of flares in patients with GPP who did not have PV were infections, pregnancy, menstruation and stress, whereas withdrawal of therapy, particularly systemic corticosteroids, was a more frequent trigger in patients with GPP who also had PV. CONCLUSIONS Our findings contribute to the global mapping of GPP, which will help inform the management of this rare condition.
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Affiliation(s)
- Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Selangor, Malaysia
| | - Alison K Wright
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health
| | - Christopher E M Griffiths
- Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
- Department of Dermatology, King's College Hospital, King's College London, London, UK
| | - Kit Wan Wong
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Selangor, Malaysia
| | - Kwee Eng Tey
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Selangor, Malaysia
| | - Yee Ting Lim
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Selangor, Malaysia
| | - Keow Yin Chua
- Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru, Malaysia
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine & Health Sciences, Monash University, Selangor, Malaysia
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health
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Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. Locum doctors in English general practices: evidence from a national survey. Br J Gen Pract 2023; 73:e667-e676. [PMID: 37604697 PMCID: PMC10471140 DOI: 10.3399/bjgp.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/16/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Locum doctors give practices flexibility to deliver patient services but there are concerns about the impact of locum working on continuity of care, patient safety, team function, and cost. AIM To explore locum working in English general practices, and understand why and where locum doctors were needed and how they were engaged, supported, perceived, and managed. DESIGN AND SETTING An online survey was sent to 3745 practices. METHOD Quantitative responses were analysed using frequency tables, t-tests, and correlations. Free-text responses were analysed using thematic analysis. RESULTS In total, 605 (16.2%) responses were returned between June and December 2021. Practices made frequent use of locums, preferring regular locums familiar with processes and patients. Disadvantages of agency locums included cost, lack of patient familiarity, and impact on continuity of care. Care provided by locums was generally viewed as the same but sometimes worse compared with permanent GPs. Some practices reported that locums did not always perform the full range of duties, resulting in increased workload for other staff. Practices were largely unfamiliar with national guidance for organisations engaging locums, and, although processes such as verifying documentation were conducted, far fewer responders reported providing feedback, support for revalidation, or professional development. CONCLUSION Locum working is an essential part of English general practice, but this research raises some concerns about the robustness of arrangements for locum working and the impact on quality and safety of care. Further research is needed about the clinical practice and performance of locums, and to explore how locum working can be organised in ways that assure safe and high-quality care.
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Affiliation(s)
- Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Jane Ferguson
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, University of Manchester, Manchester, UK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK; Danish Centre for Health Economics, University of Southern Denmark, Denmark
| | - Evangelos Kontopantelis
- National Institute for Health and Care Research School for Primary Care Research, Centre for Primary Care and Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK
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Taxiarchi VP, Senior M, Ashcroft DM, Carr MJ, Hope H, Hotopf M, Kontopantelis E, McManus S, Patalay P, Steeg S, Webb RT, Abel KM, Pierce M. Changes to healthcare utilisation and symptoms for common mental health problems over the first 21 months of the COVID-19 pandemic: parallel analyses of electronic health records and survey data in England. Lancet Reg Health Eur 2023; 32:100697. [PMID: 37671125 PMCID: PMC10477036 DOI: 10.1016/j.lanepe.2023.100697] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 09/07/2023]
Abstract
Background Few studies have investigated the effect of the COVID-19 pandemic on mental health beyond 2020. This study quantifies changes to healthcare utilisation and symptoms for common mental health problems over the pandemic's first 21 months. Methods Parallel cohort studies using primary care database and survey data for adults (≥16 years) in England from January 2015 to December 2021: 16,551,842 from the Clinical Practice Research Datalink (CPRD) and 40,699 from the UK Household Longitudinal Survey (UKHLS). Interrupted time-series models estimated changes in monthly prevalence of presentations and prescribed medications for anxiety and depression (CPRD); and self-reported psychological distress (UKHLS). The pandemic period was divided into five phases: 1st Wave (April-May 2020); post-1st Wave (June-September 2020); 2nd Wave (October 2020-February 2021); post 2nd Wave (March-May 2021); 3rd Wave (June-December 2021). Findings Primary care presentations for depression or anxiety dropped during the first wave (4.6 fewer monthly appointments per 1000 patients, 4.4-4.8) and remained lower than expected throughout follow-up. Self-reported psychological distress exceeded expected levels during the first (Prevalence Ratio = 1.378, 95% CI 1.289-1.459) and second waves (PR = 1.285, 1.189-1.377), returning towards expected levels during the third wave (PR = 1.038, 0.929-1.154). Increases in psychological distress and declines in presentations were greater for women. The decrease in primary care presentations for depression and anxiety exceeded that for physical health conditions (rheumatoid arthritis, diabetes, urinary tract infections). Anxiety and depression prescriptions returned to pre-pandemic levels during the second wave due to increased repeat prescriptions. Interpretation Despite periods of distress during the pandemic, we did not find an enduring effect on common mental health problems. The fall in primary care presentations for anxiety or depression suggests changing healthcare utilisation for mental distress and a potential treatment gap. Funding National Institute for Health and Care Research (NIHR).
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Affiliation(s)
- Vicky P. Taxiarchi
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Morwenna Senior
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Matthew J. Carr
- Faculty of Biology, Medicine and Health, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
| | - Holly Hope
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Evangelos Kontopantelis
- Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - Sally McManus
- Violence and Society Centre, City, University of London, London EC1V 0HB, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sarah Steeg
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, UK
| | - Roger T. Webb
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Research Collaboration (GM PSRC), University of Manchester, UK
- Division of Psychology & Mental Health, Centre for Mental Health and Safety, The University of Manchester, Manchester, UK
| | - Kathryn M. Abel
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
| | - Matthias Pierce
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, Centre for Women’s Mental Health, University of Manchester, Manchester, UK
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Edwards L, Pickett J, Ashcroft DM, Dambha-Miller H, Majeed A, Mallen C, Petersen I, Qureshi N, van Staa T, Abel G, Carvalho C, Denholm R, Kontopantelis E, Macaulay A, Macleod J. UK research data resources based on primary care electronic health records: review and summary for potential users. BJGP Open 2023; 7:BJGPO.2023.0057. [PMID: 37429634 PMCID: PMC10646196 DOI: 10.3399/bjgpo.2023.0057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND The range and scope of electronic health record (EHR) data assets in the UK has recently increased, which has been mainly in response to the COVID-19 pandemic. Summarising and comparing the large primary care resources will help researchers to choose the data resources most suited to their needs. AIM To describe the current landscape of UK EHR databases and considerations of access and use of these resources relevant to researchers. DESIGN & SETTING Narrative review of EHR databases in the UK. METHOD Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data, and from key informants. The eligibility criteria were population-based open-access databases sampling EHRs across the whole population of one or more countries in the UK. Published database characteristics were extracted and summarised, and these were corroborated with resource providers. Results were synthesised narratively. RESULTS Nine large national primary care EHR data resources were identified and summarised. These resources are enhanced by linkage to other administrative data to a varying extent. Resources are mainly intended to support observational research, although some can support experimental studies. There is considerable overlap of populations covered. While all resources are accessible to bona fide researchers, access mechanisms, costs, timescales, and other considerations vary across databases. CONCLUSION Researchers are currently able to access primary care EHR data from several sources. Choice of data resource is likely to be driven by project needs and access considerations. The landscape of data resources based on primary care EHRs in the UK continues to evolve.
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Affiliation(s)
| | | | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | | | - Azeem Majeed
- Primary Care and Public Health, Imperial College London, London, UK
| | | | - Irene Petersen
- Department of Primary Care & Population Health, Institute of Epidemiology & Health, University College London, London, UK
| | - Nadeem Qureshi
- Centre for Academic Primary Care, University of Nottingham, Nottingham, UK
| | - Tjeerd van Staa
- Health eResearch Centre, University of Manchester, Manchester, UK
| | - Gary Abel
- Department of Health and Community Sciences (Medical School), Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Chris Carvalho
- Clinical Effectiveness Group, Queen Mary University of London, London, UK
| | - Rachel Denholm
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, Bristol, UK
- Health Data Research UK South-West, Bristol, UK
- NIHR Applied Research Collaboration (ARC) West, Bristol, UK
| | - Evangelos Kontopantelis
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | | | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration (ARC) West, Bristol, UK
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Stringer G, Ferguson J, Walshe K, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. The use of locum doctors in the NHS - results of a national survey of NHS Trusts in England. BMC Health Serv Res 2023; 23:889. [PMID: 37612669 PMCID: PMC10464080 DOI: 10.1186/s12913-023-09830-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/18/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Locum working in healthcare organisations has benefits for individual doctors and organisations but there are concerns about the impact of locum working on continuity of care, patient safety, team function and cost. We conducted a national survey of NHS Trusts in England to explore locum work, and better understand why and where locum doctors were needed; how locum doctors were engaged, supported, perceived and managed; and any changes being made in the way locums are used. METHODS An online survey was sent to 191 NHS Trusts and 98 were returned (51%) including 66 (67%) acute hospitals, 26 (27%) mental health and six (6%) community health providers. Data was analysed using frequency tables, t-tests and correlations. Free-text responses were analysed using thematic analysis. RESULTS Most NHS Trusts use locums frequently and for varying lengths of time. Trusts prefer to use locums from internal locum banks but frequently rely on locum agencies. The benefits of using locums included maintaining workforce capacity and flexibility. Importantly, care provided by locums was generally viewed as the same or somewhat worse when compared to care provided by permanent doctors. The main disadvantages of using locum agencies included cost, lack of familiarity and impact on organisational development. Some respondents felt that locums could be unreliable and less likely to be invested in quality improvement. NHS Trusts were broadly unfamiliar with the national guidance from NHS England for supporting locums and there was a focus on processes like compliance checks and induction, with less focus on providing feedback and support for appraisal. CONCLUSIONS Locum doctors provide a necessary service within NHS Trusts to maintain workforce capacity and provide patient care. There are potential issues related to the way that locums are perceived, utilised, and supported which might impact the quality of the care that they provide. Future research should consider the arrangements for locum working and the performance of locums and permanent doctors, investigating the organisation of locums in order to achieve safe and high-quality care for patients.
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Affiliation(s)
- Gemma Stringer
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
| | - Jane Ferguson
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kieran Walshe
- Alliance Manchester Business School, Institute for Health Policy and Organisation, The University of Manchester, Booth Street West, Manchester, M15 6PB UK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Darren M. Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Joseph RM, Knaggs RD, Coupland CAC, Taylor A, Vinogradova Y, Butler D, Gerrard L, Waldram D, Iyen B, Akyea RK, Ashcroft DM, Avery AJ, Jack RH. Frequency and impact of medication reviews for people aged 65 years or above in UK primary care: an observational study using electronic health records. BMC Geriatr 2023; 23:435. [PMID: 37442984 PMCID: PMC10347807 DOI: 10.1186/s12877-023-04143-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Medication reviews in primary care provide an opportunity to review and discuss the safety and appropriateness of a person's medicines. However, there is limited evidence about access to and the impact of routine medication reviews for older adults in the general population, particularly in the UK. We aimed to quantify the proportion of people aged 65 years and over with a medication review recorded in 2019 and describe changes in the numbers and types of medicines prescribed following a review. METHODS We used anonymised primary care electronic health records from the UK's Clinical Practice Research Datalink (CPRD GOLD) to define a population of people aged 65 years or over in 2019. We counted people with a medication review record in 2019 and used Cox regression to estimate associations between demographic characteristics, diagnoses, and prescribed medicines and having a medication review. We used linear regression to compare the number of medicines prescribed as repeat prescriptions in the three months before and after a medication review. Specifically, we compared the 'prescription count' - the maximum number of different medicines with overlapping prescriptions people had in each period. RESULTS Of 591,726 people prescribed one or more medicines at baseline, 305,526 (51.6%) had a recorded medication review in 2019. Living in a care home (hazard ratio 1.51, 95% confidence interval 1.40-1.62), medication review in the previous year (1.83, 1.69-1.98), and baseline prescription count (e.g. 5-9 vs 1 medicine 1.41, 1.37-1.46) were strongly associated with having a medication review in 2019. Overall, the prescription count tended to increase after a review (mean change 0.13 medicines, 95% CI 0.12-0.14). CONCLUSIONS Although medication reviews were commonly recorded for people aged 65 years or over, there was little change overall in the numbers and types of medicines prescribed following a review. This study did not examine whether the prescriptions were appropriate or other metrics, such as dose or medicine changes within the same class. However, by examining the impact of medication reviews before the introduction of structured medication review requirements in England in 2020, it provides a useful benchmark which these new reviews can be compared with.
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Affiliation(s)
- Rebecca M Joseph
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Roger D Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Carol A C Coupland
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Amelia Taylor
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Yana Vinogradova
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Debbie Butler
- National Institute for Health and Care Research MindTech MedTech Co-operative, The Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Louisa Gerrard
- National Institute for Health and Care Research MindTech MedTech Co-operative, The Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - David Waldram
- National Institute for Health and Care Research MindTech MedTech Co-operative, The Institute of Mental Health, Mental Health and Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - Barbara Iyen
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Ralph K Akyea
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anthony J Avery
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Ruth H Jack
- Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK.
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Yang YT, Wong D, Ashcroft DM, Massey J, MacKenna B, Fisher L, Mehrkar A, Bacon SCJ, Hand K, Zhong X, Fahmi A, Goldacre B, van Staa T, Palin V. Repeated antibiotic exposure and risk of hospitalisation and death following COVID-19 infection (OpenSAFELY): a matched case-control study. EClinicalMedicine 2023; 61:102064. [PMID: 37528841 PMCID: PMC10388579 DOI: 10.1016/j.eclinm.2023.102064] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
Background Identifying potential risk factors related to severe COVID-19 outcomes is important. Repeated intermittent antibiotic use is known be associated with adverse outcomes. This study aims to examine whether prior frequent antibiotic exposure is associated with severe COVID-19 outcomes. Methods With the approval of NHS England, we used the OpenSAFELY platform, which integrated primary and secondary care, COVID-19 test, and death registration data. This matched case-control study included 0.67 million patients (aged 18-110 years) from an eligible 2.47 million patients with incident COVID-19 by matching with replacement. Inclusion criteria included registration within one general practice for at least 3 years and infection with incident COVID-19. Cases were identified according to different severity of COVID-19 outcomes. Cases and eligible controls were 1:6 matched on age, sex, region of GP practice, and index year and month of COVID-19 infection. Five quintile groups, based on the number of previous 3-year antibiotic prescriptions, were created to indicate the frequency of prior antibiotic exposure. Conditional logistic regression used to compare the differences between case and control groups, adjusting for ethnicity, body mass index, comorbidities, vaccination history, deprivation, and care home status. Sensitivity analyses were done to explore potential confounding and the effects of missing data. Findings Based on our inclusion criteria, between February 1, 2020 and December 31, 2021, 98,420 patients were admitted to hospitals and 22,660 died. 55 unique antibiotics were prescribed. A dose-response relationship between number of antibiotic prescriptions and risk of severe COVID-19 outcome was observed. Patients in the highest quintile with history of prior antibiotic exposure had 1.80 times greater odds of hospitalisation compared to patients without antibiotic exposure (adjusted odds ratio [OR] 1.80, 95% Confidence Interval [CI] 1.75-1.84). Similarly, the adjusted OR for hospitalised patients with death outcomes was 1.34 (95% CI 1.28-1.41). Larger number of prior antibiotic type was also associated with more severe COVID-19 related hospital admission. The adjusted OR of quintile 5 exposure (the most frequent) with more than 3 antibiotic types was around 2 times larger than quintile 1 (only 1 type; OR 1.80, 95% CI 1.75-1.84 vs. OR 1.03, 95% CI 1.01-1.05). Interpretation Our observational study has provided evidence that antibiotic exposure frequency and diversity may be associated with COVID-19 severity, potentially suggesting adverse effects of repeated intermittent antibiotic use. Future work could work to elucidate causal links and potential mechanisms. Antibiotic stewardship should put more emphasis on long-term antibiotic exposure and its adverse outcome to increase the awareness of appropriate antibiotics use. Funding Health Data Research UK and National Institute for Health Research.
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Affiliation(s)
- Ya-Ting Yang
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - David Wong
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sebastian CJ. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - the OpenSAFELY collaborative
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Ali Fahmi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, University of Manchester, Manchester, UK
- Division of Developmental Biology and Medicine, Maternal and Fetal Research Centre, University of Manchester, St Marys Hospital, Manchester, UK
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Zhong X, Pate A, Yang YT, Fahmi A, Ashcroft DM, Goldacre B, MacKenna B, Mehrkar A, Bacon SCJ, Massey J, Fisher L, Inglesby P, Hand K, van Staa T, Palin V. The impact of COVID-19 on antibiotic prescribing in primary care in England: Evaluation and risk prediction of appropriateness of type and repeat prescribing. J Infect 2023; 87:1-11. [PMID: 37182748 PMCID: PMC10176893 DOI: 10.1016/j.jinf.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/14/2023] [Accepted: 05/09/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. METHODS With the approval of NHS England, we used OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted patient's probability of receiving inappropriate antibiotic type or repeat antibiotic course for each common infection. RESULTS The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%) and 8.6% had potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the 10 risk prediction models, good levels of calibration and moderate levels of discrimination were found. CONCLUSIONS Our study found no evidence of changes in level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.
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Affiliation(s)
- Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Ya-Ting Yang
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Ali Fahmi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK; NHS England, Wellington House, Waterloo Road, London SE1 8UG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Sebastian C J Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX26GG, UK
| | - Kieran Hand
- Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK; NHS England, Wellington House, Waterloo Road, London SE1 8UG, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK.
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK; Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, the University of Manchester, St Marys Hospital, Oxford Road, Manchester M13 9WL, UK
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Trafford AM, Carr MJ, Ashcroft DM, Chew-Graham CA, Cockcroft E, Cybulski L, Garavini E, Garg S, Kabir T, Kapur N, Temple RK, Webb RT, Mok PLH. Temporal trends in eating disorder and self-harm incidence rates among adolescents and young adults in the UK in the 2 years since onset of the COVID-19 pandemic: a population-based study. Lancet Child Adolesc Health 2023:S2352-4642(23)00126-8. [PMID: 37352883 DOI: 10.1016/s2352-4642(23)00126-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/19/2023] [Accepted: 04/28/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Self-harm and eating disorders share multiple risk factors, with onset typically during adolescence or early adulthood. We aimed to examine the incidence rates of these psychopathologies among young people in the UK in the 2 years following onset of the COVID-19 pandemic. METHODS We conducted a population-based study using the primary care electronic health records of patients aged 10-24 years in the UK Clinical Practice Research Datalink (CPRD). The observation period was from Jan 1, 2010, to March 31, 2022. We calculated the monthly incidence rates of eating disorders and self-harm according to the first record of each outcome. On the basis of antecedent trends between January, 2010, and February, 2020, negative binomial regression models were fitted to predict monthly incidence rates after the pandemic began in March, 2020. Percentage differences between observed and expected incidence were calculated to indicate changes since the onset of the pandemic, with stratification by sex, age, and deprivation quintile. FINDINGS The primary care health records of 9 184 712 patients aged 10-24 years (4 836 226 [52·7%] female patients and 4 348 486 [47·3%] male patients; n=1881 general practices) were included for analysis. The incidence rates of eating disorders and self-harm among girls were higher than expected between March 1, 2020, and March 31, 2022. The observed incidence of eating disorders was 42·4% (95% CI 25·7-61·3) higher than expected for girls aged 13-16 years, and 32·0% (13·3-53·8) higher than expected for girls aged 17-19 years, whereas other age groups showed little difference between observed and expected incidence. Similarly, the increase in self-harm incidence was driven by girls aged 13-16 years, for whom the observed incidence was 38·4% (20·7-58·5) higher than expected. By contrast, among boys in all age groups, the incidence rates of eating disorders and self-harm were lower than, or close to, the expected rates. Among boys, the observed incidence of eating disorders was 22·8% (9·2-34·4) lower than expected, and the observed incidence of self-harm was 11·5% (3·6-18·7) lower than expected. The estimated increases in eating disorder and self-harm incidence among girls aged 13-16 years were largely attributable to increases within less deprived communities. INTERPRETATION Although causes are uncertain, increased incidence of eating disorder diagnoses and self-harm among teenage girls in the UK during the first 2 years of the COVID-19 pandemic highlight an urgent need for intervention. Early identification of mental health difficulties by primary care clinicians is necessary. Timely access to treatments and sufficient support from general practitioners and mental health services needs to be available to manage presenting problems and to prevent exacerbations of conditions. FUNDING National Institute for Health and Care Research.
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Affiliation(s)
- Alex M Trafford
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Matthew J Carr
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Carolyn A Chew-Graham
- School of Medicine, Faculty of Medicine and Health Sciences, Keele University, Keele, UK
| | - Emma Cockcroft
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Lukasz Cybulski
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | | | - Shruti Garg
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Nav Kapur
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Roger T Webb
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Pearl L H Mok
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.
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Chen TC, Iskandar IYK, Parisi R, Pierce M, Tower C, Kleyn CE, Griffiths CEM, Ashcroft DM. Fertility Trends and Adverse Pregnancy Outcomes in Female Patients With Psoriasis in the UK. JAMA Dermatol 2023:2805521. [PMID: 37285130 PMCID: PMC10248813 DOI: 10.1001/jamadermatol.2023.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Importance Evidence regarding fertility trends and obstetric outcomes among patients with psoriasis is limited by studies of small sample sizes, noninclusion of comparators, and the lack of accurate pregnancy records. Objective To investigate fertility rates and obstetric outcomes of pregnancies in female patients with psoriasis compared with age- and general practice-matched comparators without psoriasis. Design, Setting, and Participants This population-based cohort study used data from 887 primary care practices that contributed to the UK Clinical Practice Research Datalink GOLD database between 1998 and 2019, linked to a pregnancy register and Hospital Episode Statistics. There were 6 223 298 patients of common childbearing ages (15-44 years), and 63 681 patients with psoriasis had at least 1 year of follow-up data prior to the diagnosis of psoriasis. For each patient with psoriasis, 5 patients were matched by age from the same general practice. The median follow-up duration was 4.1 years. Data analysis was performed in 2021. Exposures Patients with psoriasis were identified using clinical diagnostic codes from consultations. Main Outcomes and Measures Fertility rates were calculated as the number of pregnancies per 100 patient-years. The outcomes of each pregnancy recorded in the pregnancy register or Hospital Episode Statistics were screened to identify obstetric outcomes. A negative binomial model was used to examine the association between psoriasis and the fertility rate. Logistic regression was applied to compare the association between psoriasis and obstetric outcomes. Results A total of 63 681 patients with psoriasis and 318 405 matched comparators were included in the analysis (median [IQR] age, 30 [22-37] years). Lower fertility rates (rate ratio, 0.75; 95% CI, 0.69-0.83) were found in patients with moderate to severe psoriasis. Compared with matched comparators without psoriasis, pregnancies in patients with psoriasis had a higher risk of loss (odds ratio, 1.06; 95% CI, 1.03-1.10); however, there was no increase in the risks of antenatal hemorrhage, preeclampsia, or gestational diabetes. Conclusion and Relevance In this cohort study, patients with moderate to severe psoriasis had a lower fertility rate, and the risk of pregnancy loss was higher than in matched comparators without psoriasis. Future research should identify the mechanism of increased risk of pregnancy loss among patients with psoriasis.
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Affiliation(s)
- Teng-Chou Chen
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
| | - Ireny Y K Iskandar
- Centre for Occupational and Environmental Health, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Sciences, Manchester Academic Health Sciences Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
| | - Matthias Pierce
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
| | - Clare Tower
- Division of Obstetrics, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, England, United Kingdom
| | - C Elise Kleyn
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre, Manchester, England, United Kingdom
| | - Christopher E M Griffiths
- Centre for Dermatology Research, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health and Care Research (NIHR) Manchester Biomedical Research Centre, Manchester, England, United Kingdom
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, England, United Kingdom
- National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, England, United Kingdom
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McFadzean IJ, Davies K, Purchase T, Edwards A, Hellard S, Ashcroft DM, Avery AJ, Flynn S, Hewson T, Jordan M, Keers R, Panagioti M, Wainwright V, Walter F, Shaw J, Carson-Stevens A. Patient safety in prisons: a multi-method analysis of reported incidents in England. J R Soc Med 2023:1410768231166138. [PMID: 37196674 PMCID: PMC10387805 DOI: 10.1177/01410768231166138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVES Prisoners use healthcare services three times more frequently than the general population with poorer health outcomes. Their distinct healthcare needs often pose challenges to safe healthcare provision. This study aimed to characterise patient safety incidents reported in prisons to guide practice improvement and identify health policy priorities.Design: We carried out an exploratory multi-method analysis of anonymised safety incidents from prisons. SETTING Safety incidents had been reported to the National Reporting and Learning System by prisons in England between April 2018 and March 2019. PARTICIPANTS Reports were reviewed to identify any unintended or unexpected incident(s) which could have, or did, lead to harm for prisoners receiving healthcare. MAIN OUTCOME MEASURES Free-text descriptions were examined to identify the type and nature of safety incidents, their outcomes and harm severity. Analysis was contextualised with subject experts through structured workshops to explain relationships between the most common incidents and contributory factors. RESULTS Of 4112 reports, the most frequently observed incidents were medication-related (n = 1167, 33%), specifically whilst administering medications (n = 626, 54%). Next, were access-related (n = 559,15%), inclusive of delays in patients accessing healthcare professionals (n = 236, 42%) and managing medical appointments (n = 171, 31%). The workshops contextualised incidents involving contributing factors (n = 1529, 28%) into three key themes, namely healthcare access, continuity of care and the balance between prison and healthcare priorities. CONCLUSIONS This study highlights the importance of improving medication safety and access to healthcare services for prisoners. We recommend staffing level reviews to ensure healthcare appointments are attended, and to review procedures for handling missed appointments, communication during patient transfers and medication prescribing.
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Affiliation(s)
- Isobel J McFadzean
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Kate Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Thomas Purchase
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Adrian Edwards
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Stuart Hellard
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
| | - Anthony J Avery
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Sandra Flynn
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Tom Hewson
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Melanie Jordan
- School of Sociology & Social Policy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Richard Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre (PSTRC), University of Manchester, Manchester, M13 9PL, UK
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9NT, UK
| | - Verity Wainwright
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Florian Walter
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
| | - Jenny Shaw
- Faculty of Biology, Medicine and Health, Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust (GMMH), Manchester, M25 3BL, UK
- Independent Advisory Panel on Deaths in Custody, London, SW1H 9AJ, UK
| | - Andrew Carson-Stevens
- PRIME Centre Wales, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, CF14 4YU, UK
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Zhong X, Pate A, Yang YT, Fahmi A, Ashcroft DM, Goldacre B, MacKenna B, Mehrkar A, Bacon SCJ, Massey J, Fisher L, Inglesby P, Hand K, van Staa T, Palin V. Impact of COVID-19 on broad-spectrum antibiotic prescribing for common infections in primary care in England: a time-series analyses using OpenSAFELY and effects of predictors including deprivation. Lancet Reg Health Eur 2023; 30:100653. [PMID: 37363797 PMCID: PMC10186397 DOI: 10.1016/j.lanepe.2023.100653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/28/2023]
Abstract
Background The COVID-19 pandemic impacted the healthcare systems, adding extra pressure to reduce antimicrobial resistance. Therefore, we aimed to evaluate changes in antibiotic prescription patterns after COVID-19 started. Methods With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system in primary care and selected patients prescribed antibiotics from 2019 to 2021. To evaluate the impact of COVID-19 on broad-spectrum antibiotic prescribing, we evaluated prescribing rates and its predictors and used interrupted time series analysis by fitting binomial logistic regression models. Findings Over 32 million antibiotic prescriptions were extracted over the study period; 8.7% were broad-spectrum. The study showed increases in broad-spectrum antibiotic prescribing (odds ratio [OR] 1.37; 95% confidence interval [CI] 1.36-1.38) as an immediate impact of the pandemic, followed by a gradual recovery with a 1.1-1.2% decrease in odds of broad-spectrum prescription per month. The same pattern was found within subgroups defined by age, sex, region, ethnicity, and socioeconomic deprivation quintiles. More deprived patients were more likely to receive broad-spectrum antibiotics, which differences remained stable over time. The most significant increase in broad-spectrum prescribing was observed for lower respiratory tract infection (OR 2.33; 95% CI 2.1-2.50) and otitis media (OR 1.96; 95% CI 1.80-2.13). Interpretation An immediate reduction in antibiotic prescribing and an increase in the proportion of broad-spectrum antibiotic prescribing in primary care was observed. The trends recovered to pre-pandemic levels, but the consequence of the COVID-19 pandemic on AMR needs further investigation. Funding This work was supported by Health Data Research UK and by National Institute for Health Research.
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Affiliation(s)
- Xiaomin Zhong
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Alexander Pate
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Ya-Ting Yang
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Ali Fahmi
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Sebastian CJ. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Jon Massey
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Louis Fisher
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Peter Inglesby
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - the OpenSAFELY collaborative
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Kieran Hand
- Pharmacy Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- NHS England, Wellington House, Waterloo Road, London, SE1 8UG, UK
| | - Tjeerd van Staa
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
| | - Victoria Palin
- Centre for Health Informatics, School of Health Sciences, Faculty of Biology, Medicine, and Health, the University of Manchester, M13 9PL, UK
- Maternal and Fetal Research Centre, Division of Developmental Biology and Medicine, the University of Manchester, St Marys Hospital, Oxford Road, Manchester, M13 9WL, UK
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Bourne RS, Jeffries M, Phipps DL, Jennings JK, Boxall E, Wilson F, March H, Ashcroft DM. Understanding medication safety involving patient transfer from intensive care to hospital ward: a qualitative sociotechnical factor study. BMJ Open 2023; 13:e066757. [PMID: 37130684 PMCID: PMC10163459 DOI: 10.1136/bmjopen-2022-066757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVE To understand the sociotechnical factors affecting medication safety when intensive care patients are transferred to a hospital ward. Consideration of these medication safety factors would provide a theoretical basis, on which future interventions can be developed and evaluated to improve patient care. DESIGN Qualitative study using semistructured interviews of intensive care and hospital ward-based healthcare professionals. Transcripts were anonymised prior to thematic analysis using the London Protocol and Systems Engineering in Patient Safety V.3.0 model frameworks. SETTING Four north of England National Health Service hospitals. All hospitals used electronic prescribing in intensive care and hospital ward settings. PARTICIPANTS Intensive care and hospital ward healthcare professionals (intensive care medical staff, advanced practitioners, pharmacists and outreach team members; ward-based medical staff and clinical pharmacists). RESULTS Twenty-two healthcare professionals were interviewed. We identified 13 factors within five broad themes, describing the interactions that most strongly influenced the performance of the intensive care to hospital ward system interface. The themes were: Complexity of process performance and interactions; Time pressures and considerations; Communication processes and challenges; Technology and systems and Beliefs about consequences for the patient and organisation. CONCLUSIONS The complexity of the interactions on the system performance and time dependency was clear. We make several recommendations for policy change and further research based on improving: availability of hospital-wide integrated and functional electronic prescribing systems, patient flow systems, sufficient multiprofessional critical care staffing, knowledge and skills of staff, team performance, communication and collaboration and patient and family engagement.
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Affiliation(s)
- Richard S Bourne
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Mark Jeffries
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
| | - Denham L Phipps
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jennifer K Jennings
- Department of Pharmacy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Emma Boxall
- Department of Pharmacy, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Franki Wilson
- Department of Pharmacy, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Helen March
- Department of Pharmacy, Royal Oldham Hospital, Northern Care Alliance NHS Foundation Trust, Oldham, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester, UK
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Nowakowska M, Zghebi SS, Chen LC, Ashcroft DM, Kontopantelis E. Examining non-linearity in the association between age and reported opioid use in different socioeconomic strata: cohort study using Health Survey for England waves from 1997 to 2014. BMJ Open 2023; 13:e057428. [PMID: 36858476 PMCID: PMC9980331 DOI: 10.1136/bmjopen-2021-057428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Age and socioeconomic status (SES) predict several health-related outcomes, including prescription opioid use. Contrasting findings from previous literature found higher prevalence of opioid use in both people over 65 years old and the working-age population of 35-55 years old. This study aimed to analyse if the association between age and opioid use is non-linear and differs in adults with different SES levels. METHODS This cohort study used the Health Survey for England waves 1997-2014 data to investigate the shape of the correlation between reported opioid use and income decile, employment status and educational level. A semiparametric Generalised Additive Model was employed, so that linearity of correlation was not assumed. The shape of the relationship was assessed using the effective degrees of freedom (EDF). RESULTS Positive correlation between age and reported opioid use, more linear in people in the highest income decile (EDF: 1.01, p<0.001) and higher education (EDF: 2.03, p<0.001) was observed. In people on lower income and with lower levels of education, the highes probability of reported opioid use was at around 40-60 years old and slowly decreased after that. Higher income decile and higher levels of education were predictors of a lower probability of reported opioid use (OR: 0.27, 95% CI: 0.21 to 0.36 and OR: 0.48, 95% CI: 0.41 to 0.57, respectively). There was no statistically significant difference in opioid use between employed and unemployed people. CONCLUSION The relationship between age and the probability of prescribed opioid use varies greatly across different income and educations strata, highlighting different drivers in opioid prescribing across population groups. More research is needed into exploring patterns in opioid use in older people, particularly from disadvantaged socioeconomic backgrounds.
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Affiliation(s)
- Magdalena Nowakowska
- NIHR School for Primary Care Research, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
| | - Salwa S Zghebi
- NIHR School for Primary Care Research, The University of Manchester, Manchester, UK
- Division of Population Health, Health Services Research and Primary Care; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Li-Chia Chen
- Division of Pharmacy and Optometry; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Division of Pharmacy and Optometry; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Khan SS, Ashcroft DM, Dlova N, Kini LC, Mavura D, Philemon RN, Sabushmike D, Swan R, Trialonis-Suthakharan N, Tian T, Varma A, Griffiths CEM. A skin disease survey of the Maasai in North Eastern Tanzania. Br J Dermatol 2023; 188:303-304. [PMID: 36763867 DOI: 10.1093/bjd/ljac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/13/2022] [Accepted: 10/24/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Sidra S Khan
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK.,NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.,Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ncoza Dlova
- Department of Dermatology, King Edward VII Hospital and University of Natal, Durban, South Africa
| | - Luly C Kini
- The Regional Dermatology Training Centre, Moshi, Tanzania
| | - Daudi Mavura
- The Regional Dermatology Training Centre, Moshi, Tanzania
| | | | | | - Rebekah Swan
- NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Nirohshah Trialonis-Suthakharan
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Tina Tian
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK
| | - Aakash Varma
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher E M Griffiths
- Dermatology Centre, Salford Royal NHS Foundation Trust, Manchester, UK.,NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK.,Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Fahmi A, Wong D, Walker L, Buchan I, Pirmohamed M, Sharma A, Cant H, Ashcroft DM, van Staa TP. Combinations of medicines in patients with polypharmacy aged 65-100 in primary care: Large variability in risks of adverse drug related and emergency hospital admissions. PLoS One 2023; 18:e0281466. [PMID: 36753492 PMCID: PMC9907844 DOI: 10.1371/journal.pone.0281466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Polypharmacy can be a consequence of overprescribing that is prevalent in older adults with multimorbidity. Polypharmacy can cause adverse reactions and result in hospital admission. This study predicted risks of adverse drug reaction (ADR)-related and emergency hospital admissions by medicine classes. METHODS We used electronic health record data from general practices of Clinical Practice Research Datalink (CPRD GOLD) and Aurum. Older patients who received at least five medicines were included. Medicines were classified using the British National Formulary sections. Hospital admission cases were propensity-matched to controls by age, sex, and propensity for specific diseases. The matched data were used to develop and validate random forest (RF) models to predict the risk of ADR-related and emergency hospital admissions. Shapley Additive eXplanation (SHAP) values were calculated to explain the predictions. RESULTS In total, 89,235 cases with polypharmacy and hospitalised with an ADR-related admission were matched to 443,497 controls. There were over 112,000 different combinations of the 50 medicine classes most implicated in ADR-related hospital admission in the RF models, with the most important medicine classes being loop diuretics, domperidone and/or metoclopramide, medicines for iron-deficiency anaemias and for hypoplastic/haemolytic/renal anaemias, and sulfonamides and/or trimethoprim. The RF models strongly predicted risks of ADR-related and emergency hospital admission. The observed Odds Ratio in the highest RF decile was 7.16 (95% CI 6.65-7.72) in the validation dataset. The C-statistics for ADR-related hospital admissions were 0.58 for age and sex and 0.66 for RF probabilities. CONCLUSIONS Polypharmacy involves a very large number of different combinations of medicines, with substantial differences in risks of ADR-related and emergency hospital admissions. Although the medicines may not be causally related to increased risks, RF model predictions may be useful in prioritising medication reviews. Simple tools based on few medicine classes may not be effective in identifying high risk patients.
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Affiliation(s)
- Ali Fahmi
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
- * E-mail:
| | - David Wong
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Lauren Walker
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, United Kingdom
| | - Iain Buchan
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, United Kingdom
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology (ISMIB) University of Liverpool, Liverpool, United Kingdom
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, United Kingdom
| | - Harriet Cant
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom
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van Staa TP, Pirmohamed M, Sharma A, Buchan I, Ashcroft DM. Clinical Relevance of Drug-Drug Interactions With Antibiotics as Listed in a National Medication Formulary: Results From Two Large Population-Based Case-Control Studies in Patients Aged 65-100 Years Using Linked English Primary Care and Hospital Data. Clin Pharmacol Ther 2023; 113:423-434. [PMID: 36448824 PMCID: PMC10107602 DOI: 10.1002/cpt.2807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/23/2022] [Indexed: 12/05/2022]
Abstract
This study evaluated drug-drug interactions (DDIs) between antibiotic and nonantibiotic drugs listed with warnings of severe outcomes in the British National Formulary based on adverse drug reaction (ADR) detectable with routine International Classification of Diseases, Tenth Revision coding. Data sources were Clinical Practice Research Databank GOLD and Aurum anonymized electronic health records from English general practices linked to hospital admission records. In propensity-matched case-control study, outcomes were ADR or emergency admissions. Analyzed were 121,546 ADR-related admission cases matched to 638,238 controls. For most antibiotics, adjusted odds ratios (aORs) for ADR-related hospital admission were large (aOR for trimethoprim 4.13; 95% confidence interval (CI), 3.97-4.30). Of the 51 DDIs evaluated for ADR-related admissions, 38 DDIs (74.5%) had statistically increased aORs of concomitant exposure compared with nonexposure (mean aOR 3.96; range 1.59-11.42); for the 89 DDIs for emergency hospital admission, the results were 75 (84.3%) and mean aOR 2.40; range 1.43-4.17. Changing reference group to single antibiotic exposure reduced aORs for concomitant exposure by 76.5% and 83.0%, respectively. Medicines listed to cause nephrotoxicity substantially increased risks that were related to number of medicines (aOR was 2.55 (95% CI, 2.46-2.64) for current use of 1 and 10.44 (95% CI, 7.36-14.81) for 3 or more medicines). In conclusion, no evidence of substantial risk was found for multiple DDIs with antibiotics despite warnings of severe outcomes in a national formulary and flagging in electronic health record software. It is proposed that the evidence base for inclusion of DDIs in national formularies be strengthened and made publicly accessible and indiscriminate flagging, which compounds alert fatigue, be reduced.
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Affiliation(s)
- Tjeerd Pieter van Staa
- Centre for Health Informatics & Health Data Research UK North, Division of Informatics, Imaging and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Munir Pirmohamed
- Centre for Drug Safety Science, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anita Sharma
- Chadderton South Health Centre, Eaves Lane, Chadderton, Oldham, UK
| | - Iain Buchan
- Institute of Population Health, NIHR Applied Research Collaboration North West Coast, University of Liverpool, Liverpool, UK
| | - Darren M Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, National Institute for Health Research Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Prinz JC, Choon SE, Griffiths CEM, Merola JF, Morita A, Ashcroft DM, Viguier M. Prevalence, comorbidities and mortality of generalized pustular psoriasis: A literature review. J Eur Acad Dermatol Venereol 2023; 37:256-273. [PMID: 36331364 DOI: 10.1111/jdv.18720] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
Generalized pustular psoriasis (GPP) is a rare auto-inflammatory skin disease characterised by acute episodes of sterile pustule formation. Diagnosis and treatment of the disease have historically been complicated by a lack of awareness, and no consistent global definition or clinical coding standards. Now acknowledged as a distinct clinical entity with a recognised genetic component, GPP can take a serious and life-threatening course due to systemic inflammatory complications and its association with various comorbidities. As with other rare diseases, there are significant challenges to understanding the epidemiology of GPP, notably a small patient population, non-standardised study methodologies and ethnic differences in its presentation. A clearer understanding of GPP is therefore required for clinicians to better manage patients with this rare condition. In this review article, we present an overview of the available data on GPP prevalence estimates in key demographics and report the frequency of genetic mutations associated with the disease. We detail the incidence of known comorbidities and summarise the data on mortality and assigned causes of death. Lastly, we discuss the various factors that impact the collection, interpretation and comparison of these data.
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Affiliation(s)
- Jörg C Prinz
- Department of Dermatology and Allergy, University Hospital, Ludwig-Maximilian University, Munich, Germany
| | - Siew Eng Choon
- Department of Dermatology, Hospital Sultanah Aminah, Clinical School Johor Bahru, Monash University Malaysia, Johor Bahru, Malaysia
| | - Christopher E M Griffiths
- Dermatology Centre, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Joseph F Merola
- Department of Dermatology and Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Darren M Ashcroft
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Manuelle Viguier
- Department of Dermatology-Venereology, Hôpital Robert Debré, Université Reims-Champagne Ardenne, Reims, France
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Wang SV, Pottegård A, Crown W, Arlett P, Ashcroft DM, Benchimol EI, Berger ML, Crane G, Goettsch W, Hua W, Kabadi S, Kern DM, Kurz X, Langan S, Nonaka T, Orsini L, Perez-Gutthann S, Pinheiro S, Pratt N, Schneeweiss S, Toussi M, Williams RJ. HARmonized Protocol Template to Enhance Reproducibility of hypothesis evaluating real-world evidence studies on treatment effects: A good practices report of a joint ISPE/ISPOR task force. Pharmacoepidemiol Drug Saf 2023; 32:44-55. [PMID: 36215113 PMCID: PMC9771861 DOI: 10.1002/pds.5507] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/17/2022] [Accepted: 06/28/2022] [Indexed: 02/06/2023]
Abstract
PROBLEM Ambiguity in communication of key study parameters limits the utility of real-world evidence (RWE) studies in healthcare decision-making. Clear communication about data provenance, design, analysis, and implementation is needed. This would facilitate reproducibility, replication in independent data, and assessment of potential sources of bias. WHAT WE DID The International Society for Pharmacoepidemiology (ISPE) and ISPOR-The Professional Society for Health Economics and Outcomes Research (ISPOR) convened a joint task force, including representation from key international stakeholders, to create a harmonized protocol template for RWE studies that evaluate a treatment effect and are intended to inform decision-making. The template builds on existing efforts to improve transparency and incorporates recent insights regarding the level of detail needed to enable RWE study reproducibility. The overarching principle was to reach for sufficient clarity regarding data, design, analysis, and implementation to achieve 3 main goals. One, to help investigators thoroughly consider, then document their choices and rationale for key study parameters that define the causal question (e.g., target estimand), two, to facilitate decision-making by enabling reviewers to readily assess potential for biases related to these choices, and three, to facilitate reproducibility. STRATEGIES TO DISSEMINATE AND FACILITATE USE Recognizing that the impact of this harmonized template relies on uptake, we have outlined a plan to introduce and pilot the template with key international stakeholders over the next 2 years. CONCLUSION The HARmonized Protocol Template to Enhance Reproducibility (HARPER) helps to create a shared understanding of intended scientific decisions through a common text, tabular and visual structure. The template provides a set of core recommendations for clear and reproducible RWE study protocols and is intended to be used as a backbone throughout the research process from developing a valid study protocol, to registration, through implementation and reporting on those implementation decisions.
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Affiliation(s)
| | | | | | | | | | - Eric I Benchimol
- 1. Department of Paediatrics and Institute of Health Policy, Management and Evaluation, The Hospital for Sick Children, University of Toronto, Toronto, Canada,2. Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada,3. ICES, Toronto, Canada
| | | | | | - Wim Goettsch
- The National Health Care Institute, Diemen, and Utrecht University, Utrecht, the Netherlands
| | - Wei Hua
- US Food and Drug Administration
| | | | | | | | | | | | | | | | | | - Nicole Pratt
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia
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50
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Cook MJ, Lunt M, Ashcroft DM, Board T, O'Neill TW. The Impact of Frailty and Deprivation on the Likelihood of Receiving Primary Total Hip and Knee Arthroplasty among People with Hip and Knee Osteoarthritis. J Frailty Aging 2023; 12:298-304. [PMID: 38008980 DOI: 10.14283/jfa.2023.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
BACKGROUND Among people with hip and knee osteoarthritis (OA), increasing deprivation is associated with reduced likelihood of receiving hip and knee arthroplasty (THA, TKA). OBJECTIVES To assess whether higher levels of frailty in the most deprived neighbourhoods explains the association between greater neighbourhood deprivation and reduced likelihood of receiving THA and TKA among people with hip and knee OA. DESIGN Longitudinal cohort study. SETTING Linked primary and secondary care electronic medical records and national mortality data. PARTICIPANTS 104,913 individuals with incident hip OA and 216,420 with incident knee OA. MEASUREMENTS Frailty was assessed using a frailty index and categorised as fit, mild, moderate, and severe frailty. Neighbourhood deprivation was assessed using the index of multiple deprivation (IMD). RESULTS Compared to those in neighbourhoods in the least deprived quintile of IMD, those in neighbourhoods in the fourth and fifth quintile of IMD (most deprived), respectively, were less likely to receive THA, adjusted subhazard ratio (95% CI), 0.90 (0.87, 0.93) and 0.77 (0.74, 0.80), over a mean follow up of 4.4 years, with similar results for TKA. Higher levels of frailty at OA diagnosis were associated also with reduced likelihood of receiving THA and TKA. The association, however, between deprivation and likelihood of receiving THA and TKA could not be explained by increased levels of frailty among those living in the most deprived areas. CONCLUSIONS Further work is needed to understand why those in the most deprived areas are less likely to receive THA and TKA.
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Affiliation(s)
- M J Cook
- Professor Terence O'Neill, Centre for Epidemiology Versus Arthritis, The Stopford Building, University of Manchester, Oxford Road, Manchester, United Kingdom, M13 9PT, Telephone (+44) 0161 3060547, Email terence.o'
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