234 research outputs found
Timeliness in chronic kidney disease and albuminuria identification: a retrospective cohort study
No full textBackgroundChronic kidney disease (CKD) is predominantly managed in primary care in the UK, but there is evidence of under-identification leading to lack of inclusion on practice chronic disease registers, which are necessary to ensure disease monitoring. Guidelines for CKD patients recommend urinary albumin to creatinine ratio (uACR) testing to identify albuminuria to stratify risk and guide management. This study aimed to describe the pattern and associations of timely CKD registration and uACR testing.MethodsA retrospective cohort of individuals with incident CKD 3–5 (two estimated glomerular filtration rates (eGFR) <60 ml/min/1.73 m2???three months apart) between 2007 and 2013 was identified from a linked database containing primary and secondary care data. Descriptive statistics and Cox proportional hazards models were used to identify associations with patient characteristics of timely CKD registration and uACR testing (within a year of first low eGFR).Results12,988 people with CKD 3–5 were identified from 88 practices and followed for median 3.3 years. During this time period, 3235 (24.9%) were CKD-registered and 4638/12,988 (35.7%) had uACR testing (median time to CKD registration 307 days and to uACR test 379 days). 1829 (14.1%) were CKD-registered and 2229 (17.2%) had uACR testing within one year. Amongst people whose CKD was registered within a year, 676/1829 (37.0%) had uACR testing within a year (vs. 1553/11,159 (13.9%) of those not registered (p?<?0.001)). Timely uACR testing varied by year, with a sharp rise in proportion in 2009 (when uACR policy changed). Timely CKD registration was independently associated with lower eGFR, being female, earlier year of joining the cohort, having diabetes, hypertension, or cardiovascular disease but not with age. Timely uACR testing was associated with timely CKD registration, younger age, having diabetes, higher baseline eGFR and later year of joining the cohort.ConclusionsBetter systems are needed to support timely CKD identification, registration and uACR testing in primary care in order to facilitate risk stratification and appropriate clinical management.<br/
Price versus clinical guidelines in primary care statin prescribing: a retrospective cohort study and cost simulation model
No full textObjectiveTo investigate the relative impact of generic entry and National Institute for Health and Care Excellence clinical guidelines on prescribing using statins as an exemplar.DesignRetrospective analysis of statin prescribing in primary care and cost simulation model.SettingRoyal College of General Practitioners Research and Surveillance Centre (RCGP R&amp;SC) database and Prescription Cost Analysis (PCA) database.ParticipantsNew patients prescribed statins for the first time between July 2003 and September 2018.Main outcome measuresShares of new patients prescribed one of the five statins available in the British National Formulary, and cost of prescribing statins to new and existing patients in primary care in England.ResultsGeneral trends of statin’ prescriptions were largely driven by a decrease in acquisition costs triggered by patent expiration, preceding NICE guidelines which themselves did not seem to affect prescription trends. Significant heterogeneity is observed in the prescription of the most cost-effective statin acrossGPs. A cost simulation shows that, between 2004 and 2018, the NHS could have saved £2.8bn (around 40% of the £6.3bn spent on statins during this time) if all GP practices had prescribed only the most cost-effective treatment.ConclusionsThere is potential for large savings for the NHS if new and, whenever possible, ongoing patients are promptly switched to the first medicine that becomes available as generic within a therapeutic class as long as it has similar efficacy to still-patented medicines.</span
sj-pdf-1-jrs-10.1177_01410768211051713 - Supplemental material for Price versus clinical guidelines in primary care statin prescribing: a retrospective cohort study and cost simulation model
No full textSupplemental material, sj-pdf-1-jrs-10.1177_01410768211051713 for Price versus clinical guidelines in primary care statin prescribing: a retrospective cohort study and cost simulation model by Matias Ortiz De Zarate, Emmanouil Mentzakis, Simon DS Fraser, Paul Roderick, Paul Rutter and Carmine Ornaghi in Journal of the Royal Society of Medicine</p
Influence of health-system change on treatment burden: a systematic review
No full textBackground: Treatment burden is a patient-centred concept describing the effort required of people to look after their health and the impact this has on their functioning and wellbeing. High treatment burden is more likely for people with multiple long-term conditions (LTCs). Validated treatment burden measures exist, but have not been widely used in practice or as research outcomes. Aim: To establish whether changes in organisation and delivery of health systems and services improve aspects contributing to treatment burden for people with multiple LTCs. Design and setting: Systematic review of randomised controlled trials (RCTs) investigating the impact of system-level interventions on at least one outcome relevant to previously defined treatment burden domains among adults with ≥2 LTCs. Method The Embase, Ovid MEDLINE, and Web of Science electronic databases were searched for terms related to multimorbidity, system-level change, and treatment burden published between January 2010 and July 2021. Treatment burden domains were derived from validated measures and qualitative literature. Synthesis without meta-analysis (SWiM) methodology was used to synthesise results and study quality was assessed using the Cochrane risk-of-bias (version 2) tool. Results: The searches identified 1881 articles, 18 of which met the review inclusion criteria. Outcomes were grouped into seven domains. There was some evidence for the effect of system-level interventions on some domains, but the studies exhibited substantial heterogeneity, limiting the synthesis of results. Some concern over bias gave low confidence in study results. Conclusion: System-level interventions may affect some treatment burden domains. However, adoption of a standardised outcome set, incorporating validated treatment burden measures, and the development of standard definitions for care processes in future research would aid study comparability
A reduced complexity-centralized power control scheme for DS/CDMA cellular communication
No full textMolecular Characterization of Double-Stranded (DS) RNAS in Chalara Elegans and Biological Effects on the Fungus
No full textCycling for transport and public health: a systematic review of the effect of the environment on cycling.
No full textBACKGROUND: Active transport policies are being developed across Europe designed to have health and environmental benefits. There is little evidence of impact on physical activity of active transport strategies which modify the built environment. Cycling represents one virtually carbon-neutral form of transport that can help to address declining levels of exercise. METHODS: A systematic literature review of experimental or observational studies that objectively evaluated the effect of the built environment on cycling. RESULTS: A total of 21 studies met the inclusion criteria, all of which were observational studies. Eleven studies identified objectively measured environmental factors with a significant positive association with cycling. The environmental factors identified as being positively associated with cycling included presence of dedicated cycle routes or paths, separation of cycling from other traffic, high population density, short trip distance, proximity of a cycle path or green space and for children projects promoting 'safe routes to school'. Negative environmental factors were perceived and objective traffic danger, long trip distance, steep inclines and distance from cycle paths. Of the seven studies which focused primarily on the impact of cycle routes, four demonstrated a statistically significant positive association. CONCLUSION: Although the study identified environmental factors with positive and negative associations with cycling behaviour, many other types of environmental policies and interventions have yet to be rigorously evaluated. Policies promoting cycle lane construction appear promising but the socio-demographic distribution of their effects on physical activity is unclear. The wider impact of active transport policies on health and inequalities across Europe must be explored
Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006-2017
No full textIntroduction: frailty is common in older adults and is associated with increased health and social care use. Longitudinal information is needed on population-level incidence, prevalence and frailty progression to plan services to meet future population needs. Methods: retrospective open cohort study using electronic health records of adults aged ≥50 from primary care in England, 2006–2017. Frailty was calculated annually using the electronic Frailty Index (eFI). Multistate models estimated transition rates between each frailty category, adjusting for sociodemographic characteristics. Prevalence overall for each eFI category (fit, mild, moderate and severe) was calculated. Results: the cohort included 2,171,497 patients and 15,514,734 person-years. Frailty prevalence increased from 26.5 (2006) to 38.9% (2017). The average age of frailty onset was 69; however, 10.8% of people aged 50–64 were already frail in 2006. Estimated transitions from fit to any level of frailty were 48/1,000 person-years aged 50–64, 130/1,000 person-years aged 65–74, 214/1,000 person-years aged 75–84 and 380/1,000 person-years aged ≥ 85. Transitions were independently associated with older age, higher deprivation, female sex, Asian ethnicity and urban dwelling. Mean time spent in each frailty category decreased with age, with the longest period spent in severe frailty at all ages. Conclusions: frailty is prevalent in adults aged ≥50 and time spent in successive frailty states is longer as frailty progresses, resulting in extended healthcare burden. Larger population numbers and fewer transitions in adults aged 50–64 present an opportunity for earlier identification and intervention. A large increase in frailty over 12 years highlights the urgency of informed service planning in ageing populations.</p
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