Imperial College London

ProfessorPaulAylin

Faculty of MedicineSchool of Public Health

Professor of Epidemiology and Public Health
 
 
 
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Contact

 

p.aylin Website

 
 
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Location

 

Dr. Foster Unit3 Dorset Rise, London EC4Y 8EN

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Summary

 

Publications

Publication Type
Year
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371 results found

Piggin M, Johnson H, Papadimitriou D, Glampson B, Aylin P, Mayer Eet al., 2022, Insight Report: Digital health online public involvement session on using artificial intelligence to improve health and care in North West London, Insight Report: Digital health online public involvement session on using artificial intelligence to improve health and care in North West London

Summary report on the views of members of the public on using Artificial intelligence as part ofbuilding the digital healthcare programme of research in North West London.

Report

Dewa LH, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2022, The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study., JMIR Res Protoc, Vol: 11, ISSN: 1929-0748

BACKGROUND: Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. OBJECTIVE: Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients. METHODS: Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality. RESULTS: South Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022. CONCLUSIONS: This protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational

Journal article

Beaney T, Neves AL, Alboksmaty A, Ashrafian H, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Darzi A, Clarke Jet al., 2022, Trends and associated factors for Covid-19 hospitalisation and fatality risk in 2.3 million adults in England, Nature Communications, Vol: 13, Pages: 1-9, ISSN: 2041-1723

The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital admission and mortality. Of 2,311,282 people included in the study, 164,046 (7.1%) were admitted and 53,156 (2.3%) died within 28 days of a positive Covid-19 test. We found significant variation in the case hospitalisation and mortality risk over time, which remained after accounting for the underlying risk of those infected. Older age groups, males, those resident in areas of greater socioeconomic deprivation, and those with obesity had higher odds of admission and death. People with severe mental illness and learning disability had the highest odds of admission and death. Our findings highlight both the role of external factors in Covid-19 admission and mortality risk and the need for more proactive care in the most vulnerable groups.

Journal article

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2022, SWAY: Associations between sleep disturbance and suicidality in psychiatric inpatients transitioning to the community: an ecological momentary assessment study protocol, JMIR Research Protocols, ISSN: 1929-0748

Background:Patients are at high risk of suicidal behaviour and death by suicide immediately followingdischarge from an inpatient psychiatric hospital. Furthermore, there is a high prevalence ofsleep problems in inpatient settings which is associated with worse outcomes followinghospitalisation. However, it is unknown whether poor sleep is associated with suicidalityfollowing initial hospital discharge.Objective:Our study objective is to describe the ecological momentary assessment (EMA) studyprotocol that aims to examine the relationship between sleep and suicidality in dischargedpatients.Methods:Our study will use EMA design using a wearable device to examine the sleep-suiciderelationship during the transition from acute inpatient care to the community. Prospectivelydischarged inpatients aged 18-35 with a mental disorder (n=50) will be assessed foreligibility and recruited across two sites. Data on suicidal ideation, behaviour and imagery,non-suicidal self-harm and imagery, defeat, entrapment, and hopelessness, affect and sleepwill be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objectivesleep and daytime activity will be measured using the inbuilt MotionWare software.Questionnaires will be administered face-to-face at baseline and follow-up while data willalso be collected on the acceptability and feasibility of using the Pro-Diary V watch tomonitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality.Results:South Birmingham Research Ethics Committee (Ref: 21/WM/0128) approved the study onJune 28th 2021. We expect to see a relationship between poor sleep and post-dischargesuicidality. Results will be available in 2022.DiscussionThis protocol describes the first co-produced EMA study to examine the relationshipbetween sleep and suicidality, and to apply the IMV model in young patients transitioningfrom psychiatric

Journal article

Beaney T, Clarke J, Alboksmaty A, Flott K, Fowler A, Benger J, Aylin P, Elkin S, Neves AL, Darzi Aet al., 2022, Population level impact of a pulse oximetry remote monitoring programme on mortality and healthcare utilisation in the people with COVID-19 in England: a national analysis using a stepped wedge design, Emergency Medicine Journal, ISSN: 1472-0205

BackgroundTo identify the population level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use.MethodsWe conducted a retrospective cohort study using a stepped wedge pre- and post- implementation design, including all 106 Clinical Commissioning Groups (CCGs) in England implementing a local CO@h programme. All symptomatic people with a positive COVID-19 polymerase chain reaction test result from 1st October 2020 to 3rd May 2021, and who were aged ≥65 years or identified as clinically extremely vulnerable were included. Care home residents were excluded. A pre-intervention period before implementation of the CO@h programme in each CCG was compared to a post-intervention period after implementation. Five outcome measures within 28 days of a positive COVID-19 test: i) death from any cause; ii) any ED attendance; iii) any emergency hospital admission; iv) critical care admission; and v) total length of hospital stay.Results217,650 people were eligible and included in the analysis. Total enrolment onto the programme was low, with enrolment data received for only 5,527 (2.5%) of the eligible population. The period of implementation of the programme was not associated with mortality or length of hospital stay. The period of implementation was associated with increased health service utilisation with a 12% increase in the odds of ED attendance (95% CI: 6%-18%) and emergency hospital admission (95% CI: 5%-20%) and a 24% increase in the odds of critical care admission in those admitted (95% CI: 5%-47%). In a secondary analysis of CO@h sites with at least 10% or 20% of eligible people enrolled, there was no significant association with any outcome measure. ConclusionAt a population level, there was no association with mortality before and after the implementation period of the CO@h programme, and small increases in health service utilisation were observed. However, lower than

Journal article

Alboksmaty A, Beaney T, Elkin S, Clarke JM, Darzi A, Aylin P, Neves A-Let al., 2022, Effectiveness and safety of pulse oximetry in remote patient monitoring of patients with COVID-19: a systematic review., Lancet Digit Health, Vol: 4, Pages: e279-e289

The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv, and bioRxiv) from database inception to April 15, 2021, and included feasibility studies, clinical trials, and observational studies, including preprints. We found 561 studies, of which 13 were included in our narrative synthesis. These 13 studies were all observational cohorts and involved a total of 2908 participants. A meta-analysis was not feasible owing to the heterogeneity of the outcomes reported in the included studies. Our systematic review substantiates the safety and potential of pulse oximetry for monitoring patients at home with COVID-19, identifying the risk of deterioration and the need for advanced care. The use of pulse oximetry can potentially save hospital resources for patients who might benefit the most from care escalation; however, we could not identify explicit evidence for the effect of RPM with pulse oximetry on health outcomes compared with other monitoring models such as virtual wards, regular monitoring consultations, and online or paper diaries to monitor changes in symptoms and vital signs. Based on our findings, we make 11 recommendations across the three Donabedian model domains and highlight three specific measurements for setting up an RPM system with pulse oximetry.

Journal article

Nakubulwa M, Junghans C, Novov V, Lyons-Amos C, Lovett D, Majeed A, Aylin P, Woodcock Tet al., 2022, Factors associated with accessing long-term adult social care in people aged 75 and over: a retrospective cohort study., Age Ageing, Vol: 51

BACKGROUND: An ageing population and limited resources have put strain on state provision of adult social care (ASC) in England. With social care needs predicted to double over the next 20 years, there is a need for new approaches to inform service planning and development, including through predictive models of demand. OBJECTIVE: Describe risk factors for long-term ASC in two inner London boroughs and develop a risk prediction model for long-term ASC. METHODS: Pseudonymised person-level data from an integrated care dataset were analysed. We used multivariable logistic regression to model associations of demographic factors, and baseline aspects of health status and health service use, with accessing long-term ASC over 12 months. RESULTS: The cohort comprised 13,394 residents, aged ≥75 years with no prior history of ASC at baseline. Of these, 1.7% became ASC clients over 12 months. Residents were more likely to access ASC if they were older or living in areas with high socioeconomic deprivation. Those with preexisting mental health or neurological conditions, or more intense prior health service use during the baseline period, were also more likely to access ASC. A prognostic model derived from risk factors had limited predictive power. CONCLUSIONS: Our findings reinforce evidence on known risk factors for residents aged 75 or over, yet even with linked routinely collected health and social care data, it was not possible to make accurate predictions of long-term ASC use for individuals. We propose that a paradigm shift towards more relational, personalised approaches, is needed.

Journal article

Deputy M, Sahnan K, Worley G, Patel K, Balinskaite V, Bottle A, Aylin P, Burns EM, Hart A, Faiz Oet al., 2022, The use of, and outcomes for, inflammatory bowel disease services during the Covid-19 pandemic: a nationwide observational study, ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Vol: 55, Pages: 836-846, ISSN: 0269-2813

Journal article

Dewa LH, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2021, Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis, JOURNAL OF MEDICAL INTERNET RESEARCH, Vol: 23, ISSN: 1438-8871

Journal article

Alboksmaty A, Beaney T, Elkin S, Clarke J, Darzi A, Aylin P, Neves Aet al., 2021, Effectiveness and safety of pulse oximetry in remote home monitoring of COVID-19 patients: a systematic review, The Lancet Digital Health, ISSN: 2589-7500

The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. This study aims to assess the effectiveness and safety of pulse oximetry in Remote Patient Monitoring (RPM) of COVID-19 patients at home. We conducted a systematic review, searching five databases, Medline, Embase, Global Health, medRxiv, and bioRxiv, from inception to April 15, 2021. We included feasibility studies, clinical trials, observational studies, including preprints. We found 561 studies, of which 13 were included in our synthesis. The final studies were all observational cohorts and involved a total of 2,908 participants. A meta-analysis was not feasible due to the heterogeneity of the outcomes reported in the included studies. Our review confirmed the safety and potential of using pulse oximetry in monitoring COVID-19 patients at home. It can potentially save hospital resources for those who may benefit most from care escalation. However, we could not identify explicit evidence on the impact on health outcomes compared with other monitoring models that have not used pulse oximetry. Based on our findings, we make 11 recommendations and three measures for setting up an RPM system using pulse oximetry.

Journal article

Warner M, Burn S, Stoye G, Aylin PP, Bottle A, Propper Cet al., 2021, Socioeconomic deprivation and ethnicity inequalities in disruption to NHS hospital admissions during the COVID-19 pandemic: a national observational study, BMJ Quality & Safety, Pages: 1-9, ISSN: 2044-5415

Introduction Hospital admissions in many countries fell dramatically at the onset of the COVID-19 pandemic. Less is known about how care patterns differed by patient groups. We sought to determine whether areas with higher levels of socioeconomic deprivation or larger ethnic minority populations saw larger falls in emergency and planned admissions in England.Methods We conducted a national observational study of hospital care in the English National Health Service (NHS) in 2019–2020. Weekly volumes of elective (planned) and emergency admissions in 2020 compared with 2019 were calculated for each census area. Multiple linear regression analysis was used to estimate the reductions in volumes for areas in different quintiles of socioeconomic deprivation and ethnic minority populations after controlling for national time trends and local area composition.Results Between March and December 2020, there were 35.5% (3.0 million) fewer elective admissions and 22.0% (1.2 million) fewer emergency admissions with a non-COVID-19 primary diagnosis than in 2019. Areas with the largest share of ethnic minority populations experienced a 36.7% (95% CI 24.1% to 49.3%) larger reduction in non-primary COVID-19 emergency admissions compared with those with the smallest. The most deprived areas experienced a 10.1% (95% CI 2.6% to 17.7%) smaller reduction in non-COVID-19 emergency admissions compared with the least deprived. These patterns are not explained by differential prevalence of COVID-19 cases by area.Conclusions Even in a healthcare system founded on the principle of equal access for equal need, the impact of COVID-19 on NHS hospital care for non-COVID patients has not been spread evenly by ethnicity and deprivation in England. While we cannot conclusively determine the mechanisms behind these differences, they risk exacerbating prepandemic health inequalities.Data availability statementData may be obtained from a third party and are not publicly available.

Journal article

Balinskaite V, Bottle A, Aylin P, 2021, Capacity planning for acute hospital inpatient care and adult critical care in England: a descriptive study using hospital administrative data, Annual National Conference on Public Health Science dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 22-22, ISSN: 0140-6736

Conference paper

Piggin M, Johnson H, Papadimitriou D, Mayet J, Glampson B, Aylin P, Mayer Eet al., 2021, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London, Insight Report: Digital health online public involvement session on building our digital healthcare programme in North West London

Summary report on the views of members of the public on building the digital healthcare programme of research in North West London.

Report

Piggin M, Johnson H, Papadimitriou D, Kaura A, Quint J, Glampson B, Mayer E, Aylin Pet al., 2021, Insight Report: Digital health online public involvement session on using real world evidence to improve health and care in North West London, Insight Report: Digital health online public involvement session on using real world evidence to improve health and care in North West London

Summary report on the views of members of the public on real world evidence studies undertaken aspart of building the digital healthcare programme of research in North West London

Report

Dewa L, Lawrance E, Roberts L, Brooks-Hall E, Ashrafian H, Fontana G, Aylin Pet al., 2021, Quality social connection as an 'active ingredient' in digital interventions for young people with depression and anxiety: a systematic scoping review and meta-analysis, Journal of Medical Internet Research, ISSN: 1438-8871

BackgroundDisrupted social connections may negatively impact youth mental health. In contrast, sustained quality social connections (QSC) can improve mental health outcomes. However, few studies have examined how these quality connections impact depression and anxiety outcomes within digital interventions, and conceptualisation is limited.ObjectiveThe study aim was to conceptualise, appraise and synthesise evidence on quality social connection within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people (14-24).MethodsA systematic scoping review and meta-analysis was conducted using the Johanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Medline, Embase, PsycInfo and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were searched against a comprehensive combination of key concepts on 24th June 2020. Search concepts included young people, digital intervention, depression/anxiety, and social connection. Google was also searched. One reviewer independently screened abstracts/titles and full-text and 10% were screened by a second reviewer. A narrative synthesis was used to structure findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from included studies were synthesised to produce a conceptual framework. Results5715 publications were identified and 42 were included. Of these, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness and feeling ignored indicated D-QSC was not present. In ten applicable studies, a meta-an

Journal article

Dewa L, Pappa S, Greene T, Cooke J, Mitchell L, Hadley M, Di Simplicio M, Woodcock T, Aylin Pet al., 2021, SWAY: Sleep disturbance as an early warning sign of suicidality in psychiatric inpatients transitioning to the community: an ecological momentary assessment study protocol

Working paper

Vollmer MAC, Radhakrishnan S, Kont MD, Flaxman S, Bhatt SJ, Costelloe C, Honeyford K, Aylin P, Cooke G, Redhead J, Sanders A, Mangan H, White PJ, Ferguson N, Hauck K, Perez Guzman PN, Nayagam Set al., 2021, The impact of the COVID-19 pandemic on patterns of attendance at emergency departments in two large London hospitals: an observational study, BMC Health Services Research, Vol: 21, Pages: 1-9, ISSN: 1472-6963

Background Hospitals in England have undergone considerable change to address the surgein demand imposed by the COVID-19 pandemic. The impact of this on emergencydepartment (ED) attendances is unknown, especially for non-COVID-19 related emergencies.Methods This analysis is an observational study of ED attendances at the Imperial CollegeHealthcare NHS Trust (ICHNT). We calibrated auto-regressive integrated moving averagetime-series models of ED attendances using historic (2015-2019) data. Forecasted trendswere compared to present year ICHNT data for the period between March 12, 2020 (whenEngland implemented the first COVID-19 public health measure) and May 31, 2020. Wecompared ICHTN trends with publicly available regional and national data. Lastly, wecompared hospital admissions made via the ED and in-hospital mortality at ICHNT duringthe present year to the historic 5-year average.Results ED attendances at ICHNT decreased by 35% during the period after the firstlockdown was imposed on March 12, 2020 and before May 31, 2020, reflecting broadertrends seen for ED attendances across all England regions, which fell by approximately 50%for the same time frame. For ICHNT, the decrease in attendances was mainly amongst thoseaged <65 years and those arriving by their own means (e.g. personal or public transport) andnot correlated with any of the spatial dependencies analysed such as increasing distance frompostcode of residence to the hospital. Emergency admissions of patients without COVID-19after March 12, 2020 fell by 48%; we did not observe a significant change to the crudemortality risk in patients without COVID-19 (RR 1.13, 95%CI 0.94-1.37, p=0.19).Conclusions Our study findings reflect broader trends seen across England and give anindication how emergency healthcare seeking has drastically changed. At ICHNT, we findthat a larger proportion arrived by ambulance and that hospitalisation outcomes of patientswithout COVID-19 did not differ from previous years. The ext

Journal article

Dewa L, Kalniunas A, Orleans-Foli S, Pappa S, Aylin Pet al., 2021, Detecting signs of deterioration in young patients with serious mental illness: a systematic review, Systematic Reviews, Vol: 10, Pages: 1-8, ISSN: 2046-4053

BackgroundSerious mental illnesses (SMI) such as schizophrenia and bipolar disorder first develop between ages 14-25. Once diagnosed, young peoples’ health can deteriorate, and it is therefore vital to detect this early to prevent severe outcomes including hospitalisations and deaths by suicide. The main study aim is to describe and discuss observational studies that examine signs of deterioration in young patients with SMI. MethodsA systematic review guided by the published protocol was conducted. Cumulative Index to Nursing and allied Health Literature (CINAHL), MEDLINE, Embase, PsycINFO, Health Management Information Consortium (HMIC) and Web of Science were searched against pre-defined criteria until March 1st 2021. Observational studies were extracted according to design, country, participant, indicator, outcome and main finding categories. Quality was assessed independently using the Newcastle Ottawa Scale (NOS). ResultsOf the 15788 publications identified, 5 studies were included and subjected to narrative synthesis. Two indicators of mental health deterioration were identified: cognitive functioning (decline, worsening and poor school/academic performance) and expressed emotion status. Indicators revealed mixed views on predicting deterioration. Worsening cognitive functioning and expressed emotion status significantly predicted medication non-adherence and relapse respectively. However, a decline in cognitive functioning (poor academic performance) was not found to significantly correlate to deaths by suicide. Study quality was mostly poor and associations between indicators and varied outcomes were weak. The heterogeneous nature of the data made comparisons difficult and did not allow for further statistical analysis. ConclusionTo our knowledge, this is the first review of observational studies to identify indicators of deterioration in young patients with SMI. Worsening cognitive functioning and expressed emotion status could indicate non-adherence

Journal article

Glampson B, Brittain J, Kaura A, Mulla A, Mercuri L, Brett S, Aylin P, tessa S, goodman I, Redhead J, kavitha S, Mayer Eet al., 2021, North West London Covid-19 Vaccination Programme: Real-world evidence for Vaccine uptake and effectiveness: Retrospective Cohort Study, JMIR Public Health and Surveillance, Vol: 7, Pages: 1-17, ISSN: 2369-2960

Background:On March 11, 2020 the World Health Organisation declared the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing Coronavirus Disease 2019 (COVID-19) syndrome, as a pandemic. The UK mass vaccination programme commenced on December 08, 2020 vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection.Objective:To assess the early vaccine administration coverage and outcome data across an integrated care system in North West London (NWL), leveraging a unique population-level care dataset. Vaccine effectiveness of a single dose of the Oxford/Astrazeneca and Pfizer/BioNtech vaccines were compared.Methods:A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 08, 2020 and February 24, 2021 within a primary, secondary and community care integrated care dataset. These data were used to assess vaccination hesitancy across ethnicity, gender and socio-economic deprivation measures (Pearson Product-Moment Correlations); investigated COVID-19 transmission related to vaccination hubs; and assessed the early effectiveness of COVID-19 vaccination (after a single dose) using time to event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated.Results: In the study 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4,337/26,870). There was a strong negative association between socio-economic deprivation and rate of declining vaccination (r=-0.94, P=.002) with 13.5% (1980/14571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first six days after vaccination 344 of 389587 individuals tested positive for SARS-CoV-2 (0.09%). The rate increased to 0.13% (525/389,243)

Journal article

Cecil E, Dewa L, Ma R, Majeed F, Aylin Pet al., 2021, General practitioner and nurse practitioner attitudes towards electronic reminders in primary care: A qualitative analysis, BMJ Open, Vol: 11, ISSN: 2044-6055

Objectives Reminders in primary care administrative systems aim to help clinicians provide evidence-based care, prescribe safely and save money. However, increased use of reminders can lead to alert fatigue. Our study aimed to assess general practitioners’ (GPs) and nurse practitioners’ (NPs) views on electronic reminders in primary care.Design A qualitative analysis using semistructured interviews.Setting and participants Fifteen GPs and NP based in general practices located in North-West London and Yorkshire, England.Methods We collected data on participants’ views on: (1) perceptions of the value of information provided; (2) reminder-related behaviours and (3) how to improve reminders. We carried out a thematic analysis.Results Participants were familiar with reminders in their clinical systems and felt many were important to support their clinical work. However, participants reported, on average, 70% of reminders were ignored. Four major themes emerged: (1) reaction to a reminder, which was mixed and varied by situation. (2) Factors influencing the decision to act on reminders, often related to experience, consultation styles and interests of participants. Time constraints, alert design, inappropriate presentation and litigation were also factors. (3) Negative consequences of using reminders were increased workload or costs and compromising GP and NPs behaviour. (4) Factors relating to improving users’ engagement with reminders were prevention of unnecessary reminders through data linkage across healthcare administrative systems or the development of more intelligent algorithms. Participants felt training was vital to effectively manage reminders.Conclusions GPs and NPs believe reminders are useful in supporting the provision of good quality patient care. Improving GPs and NPs’ engagement with reminders centres on further developing their relevance to their clinical practice, which is personalised, considers cognitive workflow and s

Journal article

Glampson B, Brittain J, Kaura A, Mulla A, Mercuri L, Brett SJ, Aylin P, Sandall T, Goodman I, Redhead J, Saravanakumar K, Mayer EKet al., 2021, Assessing COVID-19 vaccine uptake and effectiveness through the north west London vaccination program: retrospective cohort study, Publisher: JMIR Publications

Background:Real world data supporting the effectiveness of the COVID-19 vaccination strategy in the UK population is needed to guide health policy. This real-word data-driven evidence study of the UK COVID-19 Vaccination Programme in the Northwest London (NWL) population used a unique dataset established as part of the Gold Command Covid-19 response in NWL (iCARE https://imperialbrc.nihr.ac.uk/facilities/icare/), which included the pre-established Whole System Integrated Care (WSIC) data collated for the purposes of population health in the sector.Objective:To assess the early vaccine administration coverage and vaccine effectiveness and outcome data across an integrated care system of eight CCGs leveraging a unique population-level care datasetMethods:Design - Retrospective cohort study. Setting - Individuals eligible for COVID 19 vaccination in North West London based on linked primary and secondary care data. Participants - 2,183,939 individuals eligible for COVID 19 vaccinationResults:During the NWL vaccine programme study time period 5.88% of individuals declined and did not receive a vaccination. Black or black British individuals had the highest rate of declining a vaccine at 16.14% (4,337). There was a strong negative association between deprivation and rate of declining vaccination (r=-0.94, p<0.01) with 13.5% of individuals declining vaccination in the most deprived postcodes compared to 0.98% in the least deprived postcodes. In the first six days after vaccination 344 of 389587 individuals tested positive for COVID-19 (0.09%). The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination there was a 74% (HR 0.26 (0.19-0.35)) and 78% (HR 0.22 (0.18-0.27)) reduction in risk of testing positive for COVID -19 for individuals that received the Oxford/Astrazeneca and Pfizer/BioNTech vaccines respectively, when compared with unvaccinated individuals. After vaccination very low rates of

Working paper

Cecil E, Bottle A, Majeed A, Aylin Pet al., 2021, Factors associated with potentially missed acute deterioration in primary care, British Journal of General Practice, Vol: 24/6/21, Pages: e547-e554, ISSN: 0960-1643

BACKGROUND: In the UK, the majority of primary care contacts are uncomplicated. However, safety incidents resulting in patient harm occur, such as failure to recognise a patient's deterioration in health. AIM: We aimed to determine patient and healthcare factors associated with potentially missed deterioration. DESIGN AND SETTING: A cohort of patients registered with English CPRD general practices between 01-04-2014 and 31-12-2017 with linked hospital data. METHODS: We defined a potentially missed deterioration as a patient, seen in primary care by a GP in the three days before hospitalisation, having a self-referred admission. We used generalised estimating equations to investigate factors associated with odds of a self-referred admission. We investigated all diagnoses and subsets of commonly reported missed conditions. RESULTS: There were 116,097 patients who contacted a GP three days prior to an emergency admission. Patients with sepsis or urinary tract infections were more likely to self-refer, adjusted odds ratio 1.10 95%CI(1.02-1.19) and 1.09 (1.04-1.14) respectively. GP appointment durations were associated with self-referral. On average, a 5-minute increase resulted in 10% decrease in odds of self-referred admissions, 0.90 (0.89-0.91). Patients having a telephone (compared with face-to-face) consultation 1.13 (1.09-1.16), previous health service use and health status were also associated with self-referred admission. CONCLUSIONS: Differentiating deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, UTI or with long-term conditions. Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; however, research is needed to understand the underlying mechanisms.

Journal article

Balinskaite V, Aylin P, Bottle R, 2021, Assessing the impact of a shadowing programme on in-hospital mortality following trainee doctors’ changeover, BMC Health Services Research, Vol: 21, Pages: 1-7, ISSN: 1472-6963

BackgroundTo assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work.MethodsData on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality.ResultsThere were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme.ConclusionThere was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.

Journal article

Bottle R, Faitna P, Aylin P, Cowie Met al., 2021, Five-year outcomes following left ventricular assist device implantation in England, Open Heart, Vol: 8, Pages: 1-6, ISSN: 2053-3624

Objective Implant rates of mechanical circulatory supports such as left ventricular assist devices (LVAD) have steadily increased in the last decade. We assessed the utility of administrative data to provide information on hospital use and outcomes.Methods Using 2 years of national hospital administrative data for England linked to the death register, we identified all patients with an LVAD and extracted hospital activity for 5 years before and after the LVAD implantation date.Results In the two index years April 2011 to March 2013, 157 patients had an LVAD implanted. The mean age was 50.9 (SD 15.4), and 78.3% were men. After 5 years, 92 (58.6%) had died; the recorded cause of death was noncardiovascular in 67.4%. 42 (26.8%) patients received a heart±lung transplantation. Compared with the 12 months before implantation, the 12 months after but not including the month of implantation saw falls in total inpatient and day case admissions, a fall in admissions for heart failure (HF), a rise in non-HF admissions, a fall in emergency department visits not ending in admission and a rise in outpatient appointments (all per patient at risk). Postimplantation complications were common in the subsequent 5 years: 26.1% had a stroke, 23.6% had a device infection and 13.4% had a new LVAD implanted.Conclusions Despite patients’ young age, their mortality is high and their hospital use and complications are common in the 5 years following LVAD implantation. Administrative data provide important information on resource use in this patient group.

Journal article

Bottle A, Faitna P, Aylin P, Cowie MRet al., 2021, Five-year survival and use of hospital services following ICD and CRT implantation: comparing real-world data with RCTs, ESC Heart Failure, Vol: 8, Pages: 2438-2447, ISSN: 2055-5822

AimsGuidelines recommend the use of an implantable cardioverter-defibrillator (ICD) and/or cardiac resynchronization therapy (CRT) device based on the results of randomized controlled trials (RCTs), typically with selected patients and short follow-up.Methods and resultsWe describe the 5 year survival rate and use of hospital services following ICD and CRT implantation in England from April 2011 to March 2013 using the national hospital administrative database covering emergency department visits, inpatient admissions, and clinic appointments, linked to the national death register. Five-year survival was 64% after ICD implantation and 58% after CRT implantation, with median survival times of 6.8 and 6.2 years, respectively. Hospital use was high in both device groups, for the 5 years prior and after implantation, peaking around the implantation date. Most hospital activity was not primarily related to heart failure. Healthcare costs were dominated by admissions, but emergency department and clinic activity were both high. Only the CRT group saw total per-patient costs fall after the index month (implantation), driven by a slight fall in the heart failure admission rate. Patients were typically older than in the trials, but with similar co-morbidity except for substantially more atrial fibrillation and less dementia. Survival and device complications were similar to the RCTs.ConclusionsClinical and cost-effectiveness assessments of ICD and CRT implantation are supported by real-world data, although the prevalence of atrial fibrillation remains substantially higher than in the RCTs.

Journal article

Dewa L, Lawrence-Jones A, Kalorkoti C, Jaques J, Pickles K, Lavelle M, Pappa S, Aylin Pet al., 2021, Reflections, impact and recommendations of a co-produced qualitative study with young people who have experience of mental health difficulties, Health Expectations, Vol: 24, Pages: 134-146, ISSN: 1369-6513

BackgroundThere is limited evidence of genuine equal partnership where power is shared with young people with mental health difficulties throughout all research stages, particularly in data collection and analysis.ObjectiveTo describe how our qualitative study, exploring young peoples’ perceptions on the feasibility of using technology to detect mental health deterioration, was co-produced using principles of co-production, whilst reflecting on impact, challenges and recommendations.MethodsYoung people with experience of mental health difficulties were appointed and then worked with researchers throughout all research stages. The study was evaluated against the five principles of co-production. Reflections from researchers and young people were collected throughout.ResultsSeven young people formed an initial Young People's Advisory Group (YPAG); three became co-researchers. Reflection was key throughout the process. Sharing power became easier and more evident as trust, confidence and mutual respect grew over time, particularly after a safe space was established. The safe space was crucial for open discussions, and our WhatsApp group enabled continual communication, support and shared decision-making. The resulting co-produced topic guide, coding framework, thematic map, papers and presentations demonstrated significant impact.ConclusionsTo our knowledge, this is the first qualitative mental health study to be co-produced using the principles of co-production. Our rigorous assessment can be utilized as an informative document to help others to produce meaningful co-produced future research. Although co-production takes time, it makes significant impact to the research, researchers and co-researchers. Flexible funding for spontaneous suggestions from co-researchers and more time for interview training is recommended.

Journal article

Zhu N, Aylin P, Rawson T, Gilchrist M, Majeed A, Holmes Aet 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.

Journal article

Christen P, D'Aeth J, Lochen A, McCabe R, Rizmie D, Schmit N, Nayagam S, Miraldo M, Aylin P, Bottle A, Perez Guzman P, Donnelly C, Ghani A, Ferguson N, White P, Hauck Ket al., 2021, The J-IDEA pandemic planner: a framework for implementing hospital provision interventions during the COVID-19 pandemic, Medical Care, Vol: 59, Pages: 371-378, ISSN: 0025-7079

Background : Planning for extreme surges in demand for hospital care of patientsrequiring urgent life-saving treatment for COVID-19, whilst retaining capacity for otheremergency conditions, is one of the most challenging tasks faced by healthcareproviders and policymakers during the pandemic. Health systems must be wellpreparedto cope with large and sudden changes in demand by implementinginterventions to ensure adequate access to care. We developed the first planning toolfor the COVID-19 pandemic to account for how hospital provision interventions (suchas cancelling elective surgery, setting up field hospitals, or hiring retired staff) will affectthe capacity of hospitals to provide life-saving care.Methods : We conducted a review of interventions implemented or considered in 12 European countries in March-April 2020, an evaluation of their impact on capacity, anda review of key parameters in the care of COVID-19 patients. This information wasused to develop a planner capable of estimating the impact of specific interventions ondoctors, nurses, beds and respiratory support equipment. We applied this to ascenario-based case study of one intervention, the set-up of field hospitals in England,under varying levels of COVID-19 patients.Results : The J-IDEA pandemic planner is a hospital planning tool that allows hospitaladministrators, policymakers and other decision-makers to calculate the amount ofcapacity in terms of beds, staff and crucial medical equipment obtained byimplementing the interventions. Flexible assumptions on baseline capacity, the numberof hospitalisations, staff-to-beds ratios, and staff absences due to COVID-19 make theplanner adaptable to multiple settings. The results of the case study show that whilefield hospitals alleviate the burden on the number of beds available, this intervention isfutile unless the deficit of critical care nurses is addressed first.Discussion : The tool supports decision-makers in delivering a fast and effectiveresponse to

Journal article

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