Publications
980 results found
Diaz VA, Mainous AG, Baker R, et al., 2007, How does ethnicity affect the association between obesity and diabetes?, DIABETIC MEDICINE, Vol: 24, Pages: 1199-1204, ISSN: 0742-3071
- Author Web Link
- Cite
- Citations: 57
Patel H, Bell D, Molokhia M, et al., 2007, Trends in hospital admissions for adverse drug reactions in England: analysis of national hospital episode statistics 1998-2005, BMC Clinical Pharmacology, Vol: 7, Pages: 9-9, ISSN: 1472-6904
BACKGROUND: Adverse drug reactions (ADRs) are a frequent cause of mortality and morbidity to patients worldwide, with great associated costs to the healthcare providers including the NHS in England. We examined trends in hospital admissions associated with adverse drug reaction in English hospitals and the accuracy of national reporting. METHODS: Data from the Hospital Episode Statistics database (collected by the Department of Health) was obtained and analysed for all English hospital episodes (1998-2005) using ICD-10 codes with a primary (codes including the words ('drug-induced' or 'due to') or secondary diagnosis of ADR (Y40-59). More detailed analysis was performed for the year 2004-2005 RESULTS: Between 1998 and 2005 there were 447 071 ADRs representing 0.50% of total hospital episodes and over this period the number of ADRs increased by 45%. All ADRs with an external code increased over this period. In 2005 the total number of episodes (all age groups) was 13,706,765 of which 76,692 (0.56%) were drug related. Systemic agents, which include anti-neoplastic drugs, were the most implicated class (15.7%), followed by analgesics (11.7%) and cardiovascular drugs (10.1%). There has been a 6 fold increase in nephropathy secondary to drugs and a 65% decline in drug induced extra-pyramidal side effects. 59% of cases involving adverse drug reactions involved patients above 60 years of age. CONCLUSION: ADRs have major public health and economic implications. Our data suggest that national Hospital Episode Statistics in England have recognised limitations and that consequently, admissions associated with adverse drug reactions continue to be under-recorded. External causes of ADR have increased at a greater rate than the increase in total hospital admissions. Improved and more detailed reporting combined with educational interventions to improve the recording of ADRs are needed to accurately monitor the morbidity caused by ADRs and to meaningfully evaluate national initia
Gray J, Millett C, Saxena S, et al., 2007, Ethnicity and quality of diabetes care in a health system with universal coverage: Population-based cross-sectional survey in primary care, JOURNAL OF GENERAL INTERNAL MEDICINE, Vol: 22, Pages: 1317-1320, ISSN: 0884-8734
- Author Web Link
- Cite
- Citations: 45
Bindman AB, Forrest CB, Britt H, et al., 2007, Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from, three national surveys, BMJ-BRITISH MEDICAL JOURNAL, Vol: 334, Pages: 1261-1264B, ISSN: 1756-1833
- Author Web Link
- Cite
- Citations: 67
Millett C, Gray J, Saxena S, et al., 2007, Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes, CANADIAN MEDICAL ASSOCIATION JOURNAL, Vol: 176, Pages: 1705-1710, ISSN: 0820-3946
- Author Web Link
- Cite
- Citations: 53
Millett C, Gray J, Saxena S, et al., 2007, Ethnic disparities in diabetes management and pay-for-performance in the UK: The Wandsworth prospective diabetes study, PLoS Medicine, Vol: 4, Pages: 1087-1093, ISSN: 1549-1277
BackgroundPay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004.Methods and FindingsWe conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005.ConclusionsPay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.
Srishanmuganathan J, Patel H, Car J, et al., 2007, National trends in the use and costs of anti-obesity medications in England 1998-2005, JOURNAL OF PUBLIC HEALTH, Vol: 29, Pages: 199-202, ISSN: 1741-3842
- Author Web Link
- Cite
- Citations: 14
Millett C, Car J, Eldred D, et al., 2007, Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 100, Pages: 275-283, ISSN: 0141-0768
- Author Web Link
- Cite
- Citations: 57
Aylin P, Bottle A, Majeed A, 2007, Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models, BMJ-BRITISH MEDICAL JOURNAL, Vol: 334, Pages: 1044-1047, ISSN: 0959-535X
- Author Web Link
- Cite
- Citations: 221
Mainous AG, Baker R, Koopman RJ, et al., 2007, Impact of the population at risk of diabetes on projections of diabetes burden in the United States: an epidemic on the way, Diabetologia, Vol: 50, Pages: 934-940, ISSN: 0012-186X
Aims/hypothesisThe aim of this study was to make projections of the future diabetes burden for the adult US population based in part on the prevalence of individuals at high risk of developing diabetes.Materials and methodsModels were created from data in the nationally representative National Health and Nutrition Examination Survey (NHANES) II mortality survey (1976–1992), the NHANES III (1988–1994) and the NHANES 1999–2002. Population models for adults (>20 years of age) from NHANES III data were fitted to known diabetes prevalence in the NHANES 1999–2002 before making future projections. We used a multivariable diabetes risk score to estimate the likelihood of diabetes incidence in 10 years. Estimates of future diabetes (diagnosed and undiagnosed) prevalence in 2011, 2021, and 2031 were made under several assumptions.ResultsBased on the multivariable diabetes risk score, the number of adults at high risk of diabetes was 38.4 million in 1991 and 49.9 million in 2001. The total diabetes burden is anticipated to be 11.5% (25.4 million) in 2011, 13.5% (32.6 million) in 2021, and 14.5% (37.7 million) in 2031. Among individuals aged 30 to 39 years old who are not currently targeted for screening according to age, the prevalence of diabetes is expected to rise from 3.7% in 2001 to 5.2% in 2031. By 2031, 20.2% of adult Hispanic individuals are expected to have diabetes.Conclusions/interpretationThe prevalence of diabetes is projected to rise to substantially greater levels than previously estimated. Diabetes prevalence within the Hispanic community is projected to be potentially overwhelming.
Morgan OW, Griffiths C, Majeed A, 2007, Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning, PLoS Medicine, Vol: 4, Pages: 654-659, ISSN: 1549-1277
BackgroundParacetamol (acetaminophen) poisoning is the leading cause of acute liver failure in Great Britain and the United States. Successful interventions to reduced harm from paracetamol poisoning are needed. To achieve this, the government of the United Kingdom introduced legislation in 1998 limiting the pack size of paracetamol sold in shops. Several studies have reported recent decreases in fatal poisonings involving paracetamol. We use interrupted time-series analysis to evaluate whether the recent fall in the number of paracetamol deaths is different to trends in fatal poisoning involving aspirin, paracetamol compounds, antidepressants, or nondrug poisoning suicide.Methods and FindingsWe calculated directly age-standardised mortality rates for paracetamol poisoning in England and Wales from 1993 to 2004. We used an ordinary least-squares regression model divided into pre- and postintervention segments at 1999. The model included a term for autocorrelation within the time series. We tested for changes in the level and slope between the pre- and postintervention segments. To assess whether observed changes in the time series were unique to paracetamol, we compared against poisoning deaths involving compound paracetamol (not covered by the regulations), aspirin, antidepressants, and nonpoisoning suicide deaths. We did this comparison by calculating a ratio of each comparison series with paracetamol and applying a segmented regression model to the ratios. No change in the ratio level or slope indicated no difference compared to the control series. There were about 2,200 deaths involving paracetamol. The age-standardised mortality rate rose from 8.1 per million in 1993 to 8.8 per million in 1997, subsequently falling to about 5.3 per million in 2004. After the regulations were introduced, deaths dropped by 2.69 per million (p = 0.003). Trends in the age-standardised mortality rate for paracetamol compounds, aspirin, and antidepressants were broadly similar to par
Cowan ML, Westlake S, Majeed A, et al., 2007, Haemochromatosis: Rising hospital admission rates but stable mortality 1989/90 to 2002/03, Annual Meeting of the British-Society-of-Gastroenterology, Publisher: B M J PUBLISHING GROUP, Pages: A123-A124, ISSN: 0017-5749
Patel H, Srishanmuganathan J, Car J, et al., 2007, Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991-2004, JOURNAL OF PUBLIC HEALTH, Vol: 29, Pages: 48-52, ISSN: 1741-3842
- Author Web Link
- Cite
- Citations: 15
Bottle A, Xie Y, Majeed A, et al., 2007, Is there an association between quality of primary care and admissions for diabetes?, DIABETIC MEDICINE, Vol: 24, Pages: 68-68, ISSN: 0742-3071
Car J, Patel H, Srishanmuganathan J, et al., 2007, Diabetes care in developing countries, CANADIAN MEDICAL ASSOCIATION JOURNAL, Vol: 176, Pages: 209-212, ISSN: 0820-3946
- Author Web Link
- Cite
- Citations: 2
Patel H, Srishanmuganathan J, Car J, et al., 2007, Trends in the prescription and cost of diabetic medications and monitoring equipment in England 1991-2004, Journal of Public Health, Vol: 29, Pages: 48-52, ISSN: 1741-3842
Background: To report the trend in prescriptions and cost of antidiabetic drugs and glucose monitoring equipment in England from 1991 to 2004. Methods: We analysed data on all community antidiabetic drug prescriptions in England collated from the Prescription Cost Analysis system. Results: The total number of diabetes prescriptions (medicines and monitoring) rose from 7613000 (1991) to 24325640 (2004) (>300% increase). Meanwhile, total costs increased by 650%. Insulins are the biggest contributor to cost followed by monitoring equipment and then oral medications. Three times as many items of oral tablets are prescribed than insulins. Metformin accounts for 40% of all diabetic drug dispensations but only 7% of the costs. More is spent on glitazones now than on either metformin or sulphonylureas. Conclusions: There has been a substantial increase in the cost of managing diabetes in the community. Costs are likely to continue to rise in the future, as the prevalence of diabetes increases and through more aggressive identification and management of patients with diabetes in the hope of reducing the even more costly complications. The cost implications of glucose monitoring merits further study. © The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Soljak M, Majeed A, Eliahoo J, et al., 2007, Ethnic inequalities in the treatment and outcome of diabetes in three English Primary Care Trusts, Vol: 6, ISSN: 1475-9276
BACKGROUND:Although the prevalence of diabetes is three to five times higher in UK South Asians than Whites, there are no reports of the extent of ethnicity recording in routine general practice, and few population-based published studies of the association between ethnicity and quality of diabetes care and outcomes. We aimed to determine the association between ethnicity and healthcare factors in an English population.METHODS:Data was obtained in 2002 on all 21,343 diabetic patients registered in 99% of all computerised general practitioner (GP) practices in three NW London Primary Care Trusts (PCTs), covering a total registered population of 720,000. Previously practices had been provided with training, data entry support and feedback. Treatment and outcome measures included drug treatment and blood pressure (BP), total cholesterol and haemoglobin A1c (HbA1c) levels.RESULTS:Seventy per cent of diabetic patients had a valid ethnicity code. In the relatively older White population, we expected a smaller proportion with a normal BP, but BP differences between the groups were small and suggested poorer control in non-White ethnic groups. There were also significant differences between ethnic groups in the proportions of insulin-treated patients, with a smaller proportion of South Asians - 4.7% compared to 7.1% of Whites - receiving insulin, although the proportion with a satisfactory HbA1c was smaller- 25.6% compared to 37.9%.CONCLUSION:Recording the ethnicity of existing primary care patients is feasible, beginning with patients with established diseases such as diabetes. We have shown that the lower proportion of South Asian patients with good diabetes control, and who are receiving insulin, is at least partly due to poorer standards of care in South Asians, although biological and cultural factors could also contribute. This study highlights the need to capture ethnicity data in clinical trials and in routine care, to specifically investigate the reasons for these
Saxena S, Car J, Eldred D, et al., 2007, Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study, Vol: 7
BACKGROUND: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We examined the association between quality of primary care for cardiovascular disease achieved by general practices in England and Scotland by general practice caseload, practice size and area based deprivation measures, using data from the New General Practitioner (GP) Contract. METHODS: We analyzed data from 8,970 general practices with a total registered population of 55,522,778 patients in England and Scotland. We measured practice performance against 26 cardiovascular disease (coronary heart disease, left ventricular disease, and stroke) Quality and Outcomes Framework (QOF) indicators for patients on cardiovascular disease registers and linked this with data on practice characteristics and census data. RESULTS: Despite wide variations in practice list sizes and deprivation, the prevalence of was remarkably consistent, (coronary heart disease, left ventricular dysfunction, hypertension and cerebrovascular disease was 3.7%; 0.45%; 11.4% and 1.5% respectively). Achievement in quality of care for cardiovascular disease, as measured by QOF, was consistently high regardless of caseload or size with a few notable exceptions: practices with larger list sizes, higher cardiovascular disease caseloads and those in affluent areas had higher achievement of indicators requiring referral for further investigation. For example, small practices achieved lower scores 71.4% than large practices 88.6% (P < 0.0001) for referral for exercise testing and specialist assessment of patients with newly diagnosed angina. CONCLUSION: The volume-outcome relationship found in hospital settings is not
Saxena S, Misra T, Car J, et al., 2007, Systematic review of primary healthcare interventions to improve diabetes outcomes in minority ethnic groups., J Ambul Care Manage, Vol: 30, Pages: 218-230, ISSN: 0148-9917
OBJECTIVES: To systematically review the effectiveness of primary care interventions on glycaemic control and cardiovascular risk factors in minority ethnic groups with diabetes. RESEARCH DESIGN AND METHODS: We searched electronic databases, the Cochrane Library, and research registers to December 2006, using multiple search terms related to ethnicity and diabetes. We examined bibliographies of retrieved articles and corresponded with authors. We included randomized controlled trials, controlled clinical trials, and cohort studies. Two reviewers independently assessed study eligibility and quality. RESULTS: Nine studies including 2565 patients met our inclusion criteria. Two main models of care were identified: (1) case management, with specialist diabetes nurses and community health workers and (2) the use of the services of link workers from minority ethnic groups to guide people with diabetes. Heterogeneity of the studies prevented us from carrying out a meta-analysis. Case management improved glycaemic control (reduction in HbA1c range -0.5% to -1.75%). Small but statistically significant reductions in other cardiovascular risk factors were reported with both models. CONCLUSIONS: In minority ethnic groups with diabetes, case management improves glycaemic control and cardiovascular risk factors and link workers improve cardiovascular risk factor control. However, their relative effectiveness, cost, and sustainability of changes over time warrant further evaluation.
Khunti K, Car J, Majeed A, 2006, Quality of diebetes care in England: results of the Quality and Outcomes Framework for primary care, Practical Diabetes International, Vol: 23, Pages: 379-380
Gray J, Millett C, O'Sullivan C, et al., 2006, Association of age, sex and deprivation with quality indicators for diabetes: population-based cross sectional survey in primary care, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 99, Pages: 576-581, ISSN: 0141-0768
- Author Web Link
- Cite
- Citations: 17
Mainous AG, Diaz VA, Saxena S, et al., 2006, Diabetes management in the USA and England: comparative analysis of national surveys, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 99, Pages: 463-469, ISSN: 0141-0768
- Author Web Link
- Cite
- Citations: 31
Bottle A, Aylin P, Majeed A, 2006, Identifying patients at high risk of emergency hospital admissions: a logistic regression analysis, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 99, Pages: 406-414, ISSN: 0141-0768
- Author Web Link
- Cite
- Citations: 97
Kang JY, Elders A, Majeed A, et al., 2006, Recent trends in hospital admissions and mortality rates for peptic ulcer in Scotland 1982-2002, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 24, Pages: 65-79, ISSN: 0269-2813
- Author Web Link
- Cite
- Citations: 88
Mainous AG, Saxena S, Hueston WJ, et al., 2006, Ambulatory antibiotic prescribing for acute bronchitis and cough and hospital admissions for respiratory infections: time trends analysis, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE, Vol: 99, Pages: 358-362, ISSN: 0141-0768
- Author Web Link
- Cite
- Citations: 17
Petri A, de Lusignan S, Williams J, et al., 2006, Management of cardiovascular risk factors in people with diabetes in primary care: Cross-sectional study, PUBLIC HEALTH, Vol: 120, Pages: 654-663, ISSN: 0033-3506
- Author Web Link
- Cite
- Citations: 12
Shack LG, Wood HE, Kang JY, et al., 2006, Small intestinal cancer in England & Wales and Scotland: time trends in incidence, mortality and survival, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 23, Pages: 1297-1306, ISSN: 0269-2813
- Author Web Link
- Cite
- Citations: 23
Wood HE, Gupta S, Kang JY, et al., 2006, Pancreatic cancer in England and Wales 1975-2000: patterns and trends in incidence, survival and mortality, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 23, Pages: 1205-1214, ISSN: 0269-2813
- Author Web Link
- Cite
- Citations: 39
Misra T, Dattani N, Majeed A, 2006, Congenital anomaly surveillance in England and Wales, PUBLIC HEALTH, Vol: 120, Pages: 256-264, ISSN: 0033-3506
- Author Web Link
- Cite
- Citations: 6
Cassell JA, Mercer CH, Sutcliffe L, et al., 2006, Trends in sexually transmitted infections in general practice 1990-2000: population based study using data from the UK general practice research database, BMJ-BRITISH MEDICAL JOURNAL, Vol: 332, Pages: 332-334, ISSN: 1756-1833
- Author Web Link
- Cite
- Citations: 56
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.