Publications
980 results found
Razai MS, Chaudhry UAR, Doerholt K, et al., 2021, Covid-19 vaccination hesitancy, BMJ: British Medical Journal, Vol: 373, Pages: 1-4, ISSN: 0959-535X
Clarke JM, Majeed A, Beaney T, 2021, Measuring the impact of covid-19, BMJ, Vol: 373, Pages: 1-2, ISSN: 1759-2151
El-Osta A, Alaa A, Webber I, et al., 2021, How is the COVID-19 lockdown impacting the mental health of parents of school-age children in the United Kingdom? A cross-sectional online survey, BMJ Open, Vol: 11, Pages: 1-11, ISSN: 2044-6055
ObjectiveInvestigate the impact of the COVID-19 lockdown on feelings of loneliness and social isolation in parents of school-age childrenDesignCross sectional online survey of parents of primary and secondary school-age childrenSettingCommunity settingParticipants 1214 parents of school-age children in the United KingdomMethodsAn online survey explored the impact of lockdown on the mental health of parents with school-age children, and in particular about feelings of social isolation and loneliness. Associations between the UCLA three-item Loneliness Scale (UCLATILS), the Direct Measure of Loneliness (DMOL) and the characteristics of the study participants were assessed using ordinal logistic regression modelsMain outcome measuresSelf-reported measures of social isolation and loneliness using UCLATILS and DMOL.Results Half of respondents felt they lacked companionship, 45% had feelings of being left out, 58% felt isolated and 46% felt lonely. The factors that were associated with higher levels of loneliness on UCLATILS were female gender, parenting a child with special needs, lack of a dedicated space for distance learning, disruption of sleep patterns and low levels of physical activity during the lockdown. Factors associated with a higher DMOL were female gender, single-parenting, parenting a child with special needs, unemployment, low physical activity, lack of a dedicated study-space and disruption of sleep patterns during the lockdown.ConclusionsThe COVID-19 lockdown has increased feelings of social isolation and loneliness among parents of school-age children. Two modifiable health seeking lifestyle behaviours (increased levels of physical activity and the maintenance of good sleep hygiene practices) were identified as key factors in reducing feelings of social isolation and loneliness during lockdown.
Hodes S, Majeed A, 2021, Using the NHS App as a covid-19 vaccine passport, BMJ: British Medical Journal, Vol: 373, ISSN: 0959-535X
Zhu N, Aylin P, Rawson T, et al., 2021, Investigating the impact of COVID-19 on primary care antibiotic prescribing in North West London across two epidemic waves, Clinical Microbiology and Infection, Vol: 27, Pages: 762-768, ISSN: 1198-743X
ObjectivesWe investigated the impact of COVID-19 and national pandemic response on primary care antibiotic prescribing in London.MethodsIndividual prescribing records between 2015 and 2020 for 2 million residents in north west London were analysed. Prescribing records were linked to SARS-CoV-2 test results. Prescribing volumes, in total, and stratified by patient characteristics, antibiotic class and AWaRe classification, were investigated. Interrupted time series analysis was performed to detect measurable change in the trend of prescribing volume since the national lockdown in March 2020, immediately before the first COVID-19 peak in London.ResultsRecords covering 366 059 patients, 730 001 antibiotic items and 848 201 SARS-CoV-2 tests between January and November 2020 were analysed. Before March 2020, there was a background downward trend (decreasing by 584 items/month) in primary care antibiotic prescribing. This reduction rate accelerated to 3504 items/month from March 2020. This rate of decrease was sustained beyond the initial peak, continuing into winter and the second peak. Despite an overall reduction in prescribing volume, co-amoxiclav, a broad-spectrum “Access” antibiotic, prescribing rose by 70.1% in patients aged 50 and older from February to April. Commonly prescribed antibiotics within 14 days of a positive SARS-CoV-2 test were amoxicillin (863/2474, 34.9%) and doxycycline (678/2474, 27.4%). This aligned with national guidelines on management of community pneumonia of unclear cause. The proportion of “Watch” antibiotics used decreased during the peak in COVID-19.DiscussionA sustained reduction in community antibiotic prescribing has been observed since the first lockdown. Investigation of community-onset infectious diseases and potential unintended consequences of reduced prescribing is urgently needed.
Fadahunsi P, O'Connor S, Akinlua J, et al., 2021, Information quality frameworks for digital health technologies: systematic review, Journal of Medical Internet Research, Vol: 23, ISSN: 1438-8871
Background: Digital health technologies (DHTs) generate a large volume of information used in health care for administrative, educational, research, and clinical purposes. The clinical use of digital information for diagnostic, therapeutic, and prognostic purposes has multiple patient safety problems, some of which result from poor information quality (IQ).Objective: This systematic review aims to synthesize an IQ framework that could be used to evaluate the extent to which digital health information is fit for clinical purposes.Methods: The review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We searched Embase, MEDLINE, PubMed, CINAHL, Maternity and Infant Care, PsycINFO, Global Health, ProQuest Dissertations and Theses Global, Scopus, and HMIC (the Health Management Information Consortium) from inception until October 2019. Multidimensional IQ frameworks for assessing DHTs used in the clinical context by health care professionals were included. A thematic synthesis approach was used to synthesize the Clinical Information Quality (CLIQ) framework for digital health.Results: We identified 10 existing IQ frameworks from which we developed the CLIQ framework for digital health with 13 unique dimensions: accessibility, completeness, portability, security, timeliness, accuracy, interpretability, plausibility, provenance, relevance, conformance, consistency, and maintainability, which were categorized into 3 meaningful categories: availability, informativeness, and usability.Conclusions: This systematic review highlights the importance of the IQ of DHTs and its relevance to patient safety. The CLIQ framework for digital health will be useful in evaluating and conceptualizing IQ issues associated with digital health, thus forestalling potential patient safety problems.Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42018097142; https://www.crd.york.ac.uk/pros
Ngaosuwan K, Johnston DG, Godsland IF, et al., 2021, Cardiovascular disease in patients with primary and secondary adrenal insufficiency and the role of comorbidities, Journal of Clinical Endocrinology and Metabolism, Vol: 106, Pages: 1284-1293, ISSN: 0021-972X
CONTEXT: Mortality studies have established that cardiovascular disease is the leading cause of death in patients with adrenal insufficiency and the risk is greater than that observed in individually-matched controls. OBJECTIVE: Here we have performed a detailed analysis of cardiovascular morbidity and mortality, taking account of the role of co-morbidities. DESIGN: Retrospective cohort study. SETTING: UK general practitioner database (CPRD). PARTICIPANTS: 6821 patients with adrenal insufficiency (primary, 2052; secondary, 3948) compared with 67564 individually-matched controls, with and without adjustment for comorbidities (diabetes, hypertension, dyslipidaemia, previous cardiovascular disease, and smoking). MAIN OUTCOME MEASURES: Composite cardiovascular events recorded in CPRD and cardiovascular mortality in those participants with linked national mortality data. RESULTS: Hazard ratios (95%CI) for composite cardiovascular events in patients with adrenal insufficiency of any cause were 1.28 (1.20-1.36, unadjusted) and 1.07 (1.01-1.14, adjusted). Increased cerebrovascular events in patients with secondary adrenal insufficiency accounted for most of the increased hazard (1.53 (1.34-1.74, adjusted)) and were associated with cranial irradiation therapy. Cardiovascular mortality data were available for 3547 patients and 34944 controls. The adjusted hazard ratio for ischaemic heart disease mortality was 1.86 (1.25-2.78) for primary adrenal insufficiency and 1.39 (1.02-1.89) for secondary. CONCLUSION: Co-morbidities largely accounted for the increased cardiovascular events but in secondary adrenal insufficiency, cerebrovascular events were independently increased and associated with irradiation treatment. However, the risk of cardiovascular mortality remained increased even following adjustment for co-morbidities in both primary and secondary adrenal insufficiency.
Osama T, Razai MS, Majeed A, 2021, COVID-19 vaccine allocation: addressing the United Kingdom's colour-blind strategy, Journal of the Royal Society of Medicine, Vol: 114, Pages: 240-243, ISSN: 0141-0768
Gunn LH, Vamos EP, Majeed A, et al., 2021, Associations between attainment of incentivised primary care indicators and incident lower limb amputation among those with type 2 diabetes: a population-based historical cohort study, BMJ Open Diabetes Research and Care, Vol: 9, ISSN: 2052-4897
Introduction England has invested considerably in diabetes care through such programs as the Quality and Outcomes Framework (QOF) and National Diabetes Audit (NDA). Associations between program indicators and clinical endpoints, such as amputation, remain unclear. We examined associations between primary care indicators and incident lower limb amputation.Research design and methods This population-based retrospective cohort study, spanning 2010–2017, was comprised of adults in England with type 2 diabetes and no history of lower limb amputation. Exposures at baseline (2010–2011) were attainment of QOF glycated hemoglobin (HbA1c), blood pressure and total cholesterol indicators, and number of NDA processes completed. Propensity score matching was performed and multivariable Cox proportional hazards models, adjusting for disease-related, comorbidity, lifestyle, and sociodemographic factors, were fitted using matched samples for each exposure.Results 83 688 individuals from 330 English primary care practices were included. Mean follow-up was 3.9 (SD 2.0) years, and 521 (0.6%) minor or major amputations were observed (1.62 per 1000 person-years). HbA1c and cholesterol indicator attainment were associated with considerably lower risks of minor or major amputation (adjusted HRs; 95% CIs) 0.61 (0.49 to 0.74; p<0.0001) and 0.67 (0.53 to 0.86; p=0.0017), respectively). No evidence of association between blood pressure indicator attainment and amputation was observed (adjusted HR 0.88 (0.73 to 1.06; p=0.1891)). Substantially lower amputation rates were observed among those completing a greater number of NDA care processes (adjusted HRs 0.45 (0.24 to 0.83; p=0.0106), 0.67 (0.47 to 0.97; p=0.0319), and 0.38 (0.20 to 0.70; p=0.0022) for comparisons of 4–6 vs 0–3, 7–9 vs 0–3, and 7–9 vs 4–6 processes, respectively). Results for major-only amputations were similar for HbA1c and blood pressure, though cholesterol indicator a
McKay AJ, Gunn LH, Sathish T, et al., 2021, Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study, BMC MEDICINE, Vol: 19, ISSN: 1741-7015
BackgroundThe associations between England’s incentivised primary care-based diabetes prevention activities and hard clinical endpoints remain unclear. We aimed to examine the associations between attainment of primary care indicators and incident diabetic retinopathy (DR) among people with type 2 diabetes.MethodsA historical cohort (n = 60,094) of people aged ≥ 18 years with type 2 diabetes and no DR at baseline was obtained from the UK Clinical Practice Research Datalink (CPRD). Exposures included attainment of the Quality and Outcomes Framework (QOF) HbA1c (≤ 7.5% or 59 mmol/mol), blood pressure (≤ 140/80 mmHg), and cholesterol (≤ 5 mmol/L) indicators, and number of National Diabetes Audit (NDA) care processes completed (categorised as 0–3, 4–6, or 7–9), in 2010–2011. Outcomes were time to development of DR and sight-threatening diabetic retinopathy (STDR). Nearest neighbour propensity score matching was undertaken and Cox proportional hazards models then fitted using the matched samples. Concordance statistics were calculated for each model.Results8263 DR and 832 STDR diagnoses were observed over mean follow-up periods of 3.5 (SD 2.1) and 3.8 (SD 2.0) years, respectively. HbA1c and blood pressure (BP) indicator attainment were associated with lower rates of DR (adjusted hazard ratios (aHRs) 0.94 (95% CI 0.89–0.99) and 0.87 (0.83–0.92), respectively), whereas cholesterol indicator attainment was not (aHR 1.03 (0.97–1.10)). All QOF indicators were associated with lower rates of STDR (aHRs 0.74 (0.62–0.87) for HbA1c, 0.78 (0.67–0.91) for BP, and 0.82 (0.67–0.99) for cholesterol). Completion of 7–9 vs. 0–3 NDA processes was associated with fewer STDR diagnoses (aHR 0.72 (0.55–0.94)).ConclusionsAttainment of key primary care indicators is associated with lower incidence of DR and STDR among patients with type 2 diabetes in England.
Razai MS, Majeed A, Esmail A, 2021, Structural racism is a fundamental cause and driver of ethnic disparities in health, BMJ, Vol: 373, Pages: 1-2, ISSN: 1759-2151
Gunn LH, McKay AJ, Molokhia M, et al., 2021, Associations between attainment of incentivised primary care indicators and emergency hospital admissions among type 2 diabetes patients: a population-based historical cohort study., Journal of the Royal Society of Medicine, Pages: 1-14, ISSN: 0141-0768
OBJECTIVES: England has invested considerably in diabetes care over recent years through programmes such as the Quality and Outcomes Framework and National Diabetes Audit. However, associations between specific programme indicators and key clinical endpoints, such as emergency hospital admissions, remain unclear. We aimed to examine whether attainment of Quality and Outcomes Framework and National Diabetes Audit primary care diabetes indicators is associated with diabetes-related, cardiovascular, and all-cause emergency hospital admissions. DESIGN: Historical cohort study. SETTING: A total of 330 English primary care practices, 2010-2017, using UK Clinical Practice Research Datalink. PARTICIPANTS: A total of 84,441 adults with type 2 diabetes. MAIN OUTCOME MEASURES: The primary outcome was emergency hospital admission for any cause. Secondary outcomes were (1) diabetes-related and (2) cardiovascular-related emergency admission. RESULTS: There were 130,709 all-cause emergency admissions, 115,425 diabetes-related admissions and 105,191 cardiovascular admissions, corresponding to unplanned admission rates of 402, 355 and 323 per 1000 patient-years, respectively. All-cause hospital admission rates were lower among those who met HbA1c and cholesterol indicators (incidence rate ratio = 0.91; 95% CI 0.89-0.92; p < 0.001 and 0.87; 95% CI 0.86-0.89; p < 0.001), respectively), with similar findings for diabetes and cardiovascular admissions. Patients who achieved the Quality and Outcomes Framework blood pressure target had lower cardiovascular admission rates (incidence rate ratio = 0.98; 95% CI 0.96-0.99; p = 0.001). Strong associations were found between completing 7-9 (vs. either 4-6 or 0-3) National Diabetes Audit processes and lower rates of all admission outcomes (p-values < 0.001), and meeting all nine National Diabetes Audit processes had significant associations with reductio
McKay AJ, Gunn LH, Vamos EP, et al., 2021, Associations between attainment of incentivised primary care diabetes indicators and mortality in an English cohort, Diabetes Research and Clinical Practice, Vol: 174, Pages: 1-9, ISSN: 0168-8227
AIMS: To describe associations between incentivised primary care clinical and process indicators and mortality, among patients with type 2 diabetes in England. METHODS: A historical 2010-2017 cohort (n = 84,441 adults) was derived from the UK CPRD. Exposures included English Quality and Outcomes Framework glycated haemoglobin (HbA1c; 7.5%, 59 mmol/mol), blood pressure (140/80 mmHg), and cholesterol (5 mmol/L) indicator attainment; and number of National Diabetes Audit care processes completed, in 2010-11. The primary outcome was all-cause mortality. RESULTS: Over median 3.9 (SD 2.0) years follow-up, 10,711 deaths occurred. Adjusted hazard ratios (aHR) indicated 12% (95% CI 8-16%; p < 0.0001) and 16% (11-20%; p < 0.0001) lower mortality rates among those who attained the HbA1c and cholesterol indicators, respectively. Rates were also lower among those who completed 7-9 vs. 0-3 or 4-6 care processes (aHRs 0.76 (0.71-0.82), p < 0.0001 and 0.61 (0.53-0.71), p < 0.0001, respectively), but did not obviously vary by blood pressure indicator attainment (aHR 1.04, 1.00-1.08; p = 0.0811). CONCLUSIONS: Cholesterol, HbA1c and comprehensive process indicator attainment, was associated with enhanced survival. Review of community-based care provision could help reduce the gap between indicator standards and current outcomes, and in turn enhance life expectancy.
Osama T, Razai MS, Majeed A, 2021, Covid-19 vaccine passports: access, equity, and ethics., BMJ, Vol: 373, Pages: n861-n861, ISSN: 1759-2151
Asanati K, Voden L, Majeed A, 2021, Healthier schools during the COVID-19 pandemic: ventilation, testing and vaccination, Journal of the Royal Society of Medicine, Vol: 114, Pages: 160-163, ISSN: 0141-0768
Khunti K, Griffiths A, Majeed A, et al., 2021, Assessing risk for healthcare workers during the covid-19 pandemic, BMJ: British Medical Journal, Vol: 372, ISSN: 0959-535X
Razai MS, Osama T, McKechnie DGJ, et al., 2021, Covid-19 vaccine hesitancy among ethnic minority groups, BMJ: British Medical Journal, Vol: 372, ISSN: 0959-535X
Borek AJ, Campbell A, Dent E, et al., 2021, Implementing interventions to reduce antibiotic use: a qualitative study in high-prescribing practices, BMC Family Practice, Vol: 22, ISSN: 1471-2296
BackgroundTrials have shown that delayed antibiotic prescriptions (DPs) and point-of-care C-Reactive Protein testing (POC-CRPT) are effective in reducing antibiotic use in general practice, but these were not typically implemented in high-prescribing practices. We aimed to explore views of professionals from high-prescribing practices about uptake and implementation of DPs and POC-CRPT to reduce antibiotic use.MethodsThis was a qualitative focus group study in English general practices. The highest antibiotic prescribing practices in the West Midlands were invited to participate. Clinical and non-clinical professionals attended focus groups co-facilitated by two researchers. Focus groups were audio-recorded, transcribed verbatim and analysed thematically.ResultsNine practices (50 professionals) participated. Four main themes were identified. Compatibility of strategies with clinical roles and experience – participants viewed the strategies as having limited value as ‘clinical tools’, perceiving them as useful only in ‘rare’ instances of clinical uncertainty and/or for those less experienced. Strategies as ‘social tools’ – participants perceived the strategies as helpful for negotiating treatment decisions and educating patients, particularly those expecting antibiotics. Ambiguities – participants perceived ambiguities around when they should be used, and about their impact on antibiotic use. Influence of context – various other situational and practical issues were raised with implementing the strategies.ConclusionsHigh-prescribing practices do not view DPs and POC-CRPT as sufficiently useful ‘clinical tools’ in a way which corresponds to the current policy approach advocating their use to reduce clinical uncertainty and improve antimicrobial stewardship. Instead, policy attention should focus on how these strategies may instead be used as ‘social tools’ to reduce unnecessary antibio
Greenfield G, Blair M, Aylin P, et al., 2021, Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data, Emergency Medicine Journal, Vol: 38, Pages: 146-150, ISSN: 1472-0205
BACKGROUND:Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM:To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD:We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS:One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION:One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
Razai MS, Kankam HKN, Majeed A, et al., 2021, Mitigating ethnic disparities in covid-19 and beyond, BMJ: British Medical Journal, Vol: 372, ISSN: 0959-535X
Graetz N, Woyczynski L, Wilson KF, et al., 2021, Mapping subnational HIV mortality in six Latin American countries with incomplete vital registration systems, BMC Medicine, Vol: 19, Pages: 1-25, ISSN: 1741-7015
BackgroundHuman immunodeficiency virus (HIV) remains a public health priority in Latin America. While the burden of HIV is historically concentrated in urban areas and high-risk groups, subnational estimates that cover multiple countries and years are missing. This paucity is partially due to incomplete vital registration (VR) systems and statistical challenges related to estimating mortality rates in areas with low numbers of HIV deaths. In this analysis, we address this gap and provide novel estimates of the HIV mortality rate and the number of HIV deaths by age group, sex, and municipality in Brazil, Colombia, Costa Rica, Ecuador, Guatemala, and Mexico.MethodsWe performed an ecological study using VR data ranging from 2000 to 2017, dependent on individual country data availability. We modeled HIV mortality using a Bayesian spatially explicit mixed-effects regression model that incorporates prior information on VR completeness. We calibrated our results to the Global Burden of Disease Study 2017.ResultsAll countries displayed over a 40-fold difference in HIV mortality between municipalities with the highest and lowest age-standardized HIV mortality rate in the last year of study for men, and over a 20-fold difference for women. Despite decreases in national HIV mortality in all countries—apart from Ecuador—across the period of study, we found broad variation in relative changes in HIV mortality at the municipality level and increasing relative inequality over time in all countries. In all six countries included in this analysis, 50% or more HIV deaths were concentrated in fewer than 10% of municipalities in the latest year of study. In addition, national age patterns reflected shifts in mortality to older age groups—the median age group among decedents ranged from 30 to 45 years of age at the municipality level in Brazil, Colombia, and Mexico in 2017.ConclusionsOur subnational estimates of HIV mortality revealed significant spatial variati
Salman D, Vishnubala D, Le Feuvre P, et al., 2021, Returning to physical activity after covid-19, BMJ: British Medical Journal, Vol: 372, Pages: 372-m4721, ISSN: 0959-535X
Osama T, Chowdhury M, Majeed A, 2021, Prioritising the global response to curb the spread of COVID-19 in the fragile settings of the Global South., Journal of the Royal Society of Medicine, Vol: 114, Pages: 15-18, ISSN: 0141-0768
Roth GA, Mensah GA, Johnson CO, et al., 2020, Global burden of cardiovascular diseases and risk factors, 1990-2019: update from the GBD 2019 study., Journal of the American College of Cardiology, Vol: 76, Pages: 2982-3021, ISSN: 0735-1097
Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost al
Woods J-B, Greenfield G, Majeed A, et al., 2020, Clinical effectiveness and cost effectiveness of individual mental health workers colocated within primary care practices: a systematic literature review, BMJ Open, Vol: 10, ISSN: 2044-6055
Objectives Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.Design Systematic literature review.Data sources We searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.Eligibility criteria All quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.Data extraction and synthesis Data were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration’s tool for assessing risk of bias in randomised trials.Results Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.Conclusions While there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with u
Sum G, Koh GC-H, Mercer SW, et al., 2020, Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries, BMC Public Health, Vol: 20, Pages: 1-26, ISSN: 1471-2458
BackgroundThe burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs.MethodsCross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007–10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557).ResultsA higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina.ConclusionPatients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.
Majeed A, Molokhia M, 2020, Vaccinating the UK against covid-19 Primary care can do it but needs extra support to do it fast, safely, and effectively, BMJ: British Medical Journal, Vol: 371, Pages: 1-2, ISSN: 0959-535X
Rao A, Dhahri AA, Razzaq H, et al., 2020, Algorithm-based online software for patients' self-referral to breast clinic as an alternative to general practitioner referral pathway., Cureus, Vol: 12, Pages: 1-8, ISSN: 2168-8184
Introduction The study aimed to assess the accuracy of online software in the use of self-referral to breast surgery clinics for patients with new signs and symptoms. The study also evaluated the appropriateness of GP referrals to breast clinics and evaluated patients' perceptions of an online self-referral portal to the breast clinic for the assessment of breast signs and symptoms. Design and methods The pilot study was divided into two phases. In the first phase, prospective questionnaire-based data was collected from patients who were referred by a GP and presented to the regional breast unit with new signs and symptoms for breast conditions, Princess Alexandra Hospital NHS Trust (May - October 2018). The questionnaire assessed the time at each stage required by the patient to have a visit at the breast unit. It also asked the patient's opinion about an online self-referral portal to the surgical clinic. They were given hypothetical scenarios to evaluate their understanding of breast conditions. In the second phase, the patients presenting to symptomatic breast clinics were provided with the iPad to fill in their medical information in the online software. The data was collected between July and October 2019. The software algorithm was based on the National Institute of Clinical Health and Excellence (NICE) guidelines for breast conditions (2015). Breast surgeons' recommendations acted as a standard to evaluate the accuracy of GPs' referrals and software outcome for each patient. Results There were 80 patients (mean age 49.1 [SD: 17.7], all females) included in the first phase of the study. The most common clinical presentation was a breast lump (47.6%), followed by breast pain (26.9%) and nipple changes (7.9%). Breast surgeons considered appropriate 75.6% of the referrals made by the GP. Seventy-two percent of the patients got an urgent appointment to see their GP, and 94.8% of the patients were urgently referred by their GP to see the breast su
Islam N, Khunti K, Majeed A, 2020, COVID-19, seasonal influenza and measles: potential triple burden and the role of flu and MMR vaccines, Journal of the Royal Society of Medicine, Vol: 113, Pages: 141076820972668-141076820972668, ISSN: 0141-0768
Han SM, Greenfield G, Majeed F, et al., 2020, Impact of Remote Consultations on Antibiotic Prescribing in Primary Healthcare: Systematic Review, Journal of Medical Internet Research, Vol: 22, ISSN: 1438-8871
Background: There has been growing international interest in performing remote consultations in primary care, particularly amidst the current COVID-19 pandemic. Despite this, the evidence surrounding the safety of remote consultations is inconclusive. The appropriateness of antibiotic prescribing in remote consultations is an important aspect of patient safety that needs to be addressed.Objective: This study aimed to summarize evidence on the impact of remote consultation in primary care with regard to antibiotic prescribing.Methods: Searches were conducted in MEDLINE, Embase, HMIC, PsycINFO, and CINAHL for literature published since the databases’ inception to February 2020. Peer-reviewed studies conducted in primary health care settings were included. All remote consultation types were considered, and studies were required to report any quantitative measure of antibiotic prescribing to be included in this systematic review. Studies were excluded if there were no comparison groups (face-to-face consultations).Results: In total, 12 studies were identified. Of these, 4 studies reported higher antibiotic-prescribing rates, 5 studies reported lower antibiotic-prescribing rates, and 3 studies reported similar antibiotic-prescribing rates in remote consultations compared with face-to-face consultations. Guideline-concordant prescribing was not significantly different between remote and face-to-face consultations for patients with sinusitis, but conflicting results were found for patients with acute respiratory infections. Mixed evidence was found for follow-up visit rates after remote and face-to-face consultations.Conclusions: There is insufficient evidence to confidently conclude that remote consulting has a significant impact on antibiotic prescribing in primary care. However, studies indicating higher prescribing rates in remote consultations than in face-to-face consultations are a concern. Further, well-conducted studies are needed to inform safe and appropri
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.