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Showing posts from October, 2017

Research using primary care databases in the United Kingdom

Data collected in electronic medical records for a patient in primary care can span from birth to death and can have enormous benefits in improving health care and public health, and for research. Several systems exist in the United Kingdom (UK) to facilitate the use of research data generated from consultations between primary care professionals and their patients.

In a study published in the Journal of Innovation in Health Informatics, we carried out a bibliometric review to analyse the research outputs and the longitudinal growth in the number of publications that harness the three main UK primary care databases: CPRD, QResearch and THIN.

These databases collectively produced 1,296 publications over a ten-year period, with CPRD producing 63.6% (n=825 papers), THIN 30.4% (n=394) and QResearch 5.9% (n=77). Pharmacoepidemiology and General Medicine were the most common specialities featured.

The growth in publications from these databases shows that they are making an important contr…

Improving how secondary care and general practice in England work together: the NHS Standard Contract

Due to the increasing pressures on general practices within the National Health Service in England, the interface between primary and secondary care, and the division of labour between these, has become an important issue. This has long been an area prone to difficulties and conflict, the consequences of which can directly impact the quality and safety of patient care, particularly for patients with chronic conditions who regularly transition between these two sectors. In an article published in the Journal of the Royal Society of Medicine, Amy Price and I explore the measures recently implemented in the NHS Standard Contract which aim to target common issues at the primary–secondary care interface, with an aim to reducing inappropriate general practitioner workload in England. We discuss the context behind the implementation of the NHS Standard Contract as well as current concerns and areas for further consideration.

The current crisis in primary care means the NHS Standard Contract…

Routes to the diagnosis of heart failure in primary care

Timely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care where patients can present with a range of symptoms of varying severity. In a paper published in the journal Heart, we describe the journey of people with HF in primary care from presentation through to diagnosis and initial management.

We used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis.

36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March…

The child transgender patient in primary care: practical advice for a 10-minute consultation

Children and adults with gender identity concerns are increasingly presenting for treatment, with referrals to specialist clinics rapidly rising. The percentage of children with gender identity disorder that self-harm or attempt suicide is estimated at 50%, so it is essential that it is recognised early and managed appropriately.

Gender identity disorder of childhood usually manifests before puberty. The child typically experiences distress resulting from an incongruence between their current gender identity (sense of themselves as ‘male’, ‘female’, or otherwise), and their gender assigned at birth. Behaviour and activities of the child may stereotypically be associated with that of the opposite gender and the child may be preoccupied with wanting to change their name and gender pronoun (‘she’, ‘he’). Depending on the age, they may also have a strong desire to acquire secondary sexual characteristics of the opposite gender. This may cause significant distress and can impact their per…

Real World Data and Pharmacoepidemiology in Europe

I was in Vienna on Monday 9 October 2017 for the Annual Meeting of the European Epidemiological Forum, which this year is on the topic of “Real World Data and Pharmacoepidemiology in Europe". It’s been a good opportunity to catch up on biomedical research using ‘Big Data’. There is a lot of work going on in this field that will have a big impact on health. There was also some sadness among European colleagues about Brexit and uncertainty about the future role academics and companies from the UK will play in European research collaborations. At the meeting, I was asked to give one of the keynote presentations on the topic of Brexit and how it might affect the UK contribution to research on areas such as pharmacoepidemiology. In my talk, I outlined some of the current uncertainties for UK researchers and the what the future might look like for the UK’s universities, NHS and life sciences sector, depending on the type of Brexit we negotiate with the other countries of the European …

Meeting with Professor Jonathan Weber, Dean of the Faculty of Medicine

We were very pleased to host the Dean of the Faculty of Medicine, Professor Jonathan Weber, in the Department of Primary Care and Public Health on Wednesday 4 October 2017. Professor Weber met with some of the academic staff in the department to learn more about our research and teaching programmes. We had a good discussion about the more ‘social’ and community-based aspects of our work; such as our collaborations with the NHS, local government and voluntary organisations in the White City area of West London; and our work with medical students on areas such as health coaching and behavioural change. We also discussed how our academic work could support Imperial College’s plans for its Imperial West Campus, and creating opportunities for medical students to get involved in community-based research.

Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s NHS Health Check Programme

Cardiovascular disease (CVD) is a major cause of disability and premature mortality worldwide. In England, it accounts for a third of deaths and costs the National Health Service (NHS) and the UK economy £30 billion annually.

The National Health Service (NHS) Health Check is a CVD risk assessment and management programme in England aiming to increase CVD risk awareness among people at increased risk of CVD. There was previously no tool to assess the effectiveness of the programme in communicating CVD risk to patients. In research published in the journal BMJ Open, we describe how we developed a questionnaire examining patients’ CVD risk awareness for use in health service research evaluations of the NHS Health Check programme.

We developed an 85-item questionnaire to determine patients’ views of their risk of CVD. The questionnaire was based on a review of the relevant literature. After review by an expert panel and focus group discussion, 22 items were dropped and 2 new items were a…