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  • 1
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    Unscheduled care pathways in patients with myocardial infarction in Scotland
    BMJ ; 2022
    In:  Heart Vol. 108, No. 14 ( 2022-07), p. 1129-1136
    Details
    In: Heart, BMJ, Vol. 108, No. 14 ( 2022-07), p. 1129-1136
    Abstract: Treatment of acute myocardial infarction (MI) requires rapid transfer of people with chest pain to hospital, however, unscheduled care pathways vary in their directness (the minimal number of contacts to hospital admission). The aim was to examine unscheduled care pathways and the associations with mortality in people admitted with MI. Methods Retrospective population study of all people admitted to Scottish hospitals with a diagnosis of MI between 1 January 2015 and 31 December 2017. Linked data for all National Health Service Scotland unscheduled care services (NHS24 telephone triage service, primary care out of hours, ambulance, emergency department (ED)) was used to define continuous unscheduled care pathways (pathways), which were categorised by initial contact, and whether they were ‘direct’ (had minimum number of contacts between first contact and admission). Analysis estimated ORs and 95% CIs in adjusted models in which all covariates were included. Results 26 325 people admitted with MI (63.1% men, 61.6% aged 65+ years), of whom 5.6% died from coronary heart disease within 28 days. For 47.0%, the first unscheduled care contact was ambulance, 23.3% attended ED directly and 18.7% called telephone triage. 92.1% of pathways were direct. Pathways starting with telephone triage were more likely to be indirect compared with other initial contacts (adjusted OR (aOR) 1.97, 95% CI 1.61 to 2.40). Compared to direct pathways, indirect pathways starting with telephone triage were associated with higher mortality (aOR 1.97, 95% CI 1.61 to 2.40) as were indirect pathways starting with another service (aOR 1.55, 95% CI 1.19 to 2.01), but not direct pathways starting with telephone triage (aOR 0.87, 95% CI 0.74 to 1.02). Conclusion Unscheduled care pathways leading to admission with MI in Scotland are usually direct, but those starting with telephone triage were more commonly indirect. Those indirect pathways were associated with higher mortality.
    Type of Medium: Online Resource
    ISSN: 1355-6037 , 1468-201X
    URL: Article
    DOI: 10.1136/heartjnl-2021-320614
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 2
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    Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis
    Oxford University Press (OUP) ; 2021
    In:  Age and Ageing Vol. 50, No. 5 ( 2021-09-11), p. 1482-1492
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 50, No. 5 ( 2021-09-11), p. 1482-1492
    Abstract: understanding care-home outbreaks of COVID-19 is a key public health priority in the ongoing pandemic to help protect vulnerable residents. Objective to describe all outbreaks of COVID-19 infection in Scottish care-homes for older people between 01/03/2020 and 31/05/2020 with follow-up to 30/06/2020. Design and setting National linked data cohort analysis of Scottish care-homes for older people. Methods data linkage was used to identify outbreaks of COVID-19 in care-homes. Care-home characteristics associated with the presence of an outbreak were examined using logistic regression. Size of outbreaks was modelled using negative binomial regression. Results 334 (41%) Scottish care-homes for older people experienced an outbreak, with heterogeneity in outbreak size (1–63 cases; median = 6) and duration (1–94 days, median = 31.5 days). Four distinct patterns of outbreak were identified: ‘typical’ (38% of outbreaks, mean 11.2 cases and 48 days duration), severe (11%, mean 29.7 cases and 60 days), contained (37%, mean 3.5 cases and 13 days) and late-onset (14%, mean 5.4 cases and 17 days). Risk of a COVID-19 outbreak increased with increasing care-home size (for ≥90 beds vs & lt;20, adjusted OR = 55.4, 95% CI 15.0–251.7) and rising community prevalence (OR = 1.2 [1.0–1.4] per 100 cases/100,000 population increase). No routinely available care-home characteristic was associated with outbreak size. Conclusions reducing community prevalence of COVID-19 infection is essential to protect those living in care-homes. More systematic national data collection to understand care-home residents and the homes in which they live is a priority in ensuring we can respond more effectively in future.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afab099
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2065766-3
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  • 3
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    Corrigendum to: Care-home outbreaks of COVID-19 in Scotland March to May 2020: National linked data cohort analysis
    Oxford University Press (OUP) ; 2022
    In:  Age and Ageing Vol. 51, No. 3 ( 2022-03-01)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 51, No. 3 ( 2022-03-01)
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afac041
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 4
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    The impact of varying the number and selection of conditions on estimated multimorbidity prevalence: A cross-sectional study using a large, primary care population dataset
    Public Library of Science (PLoS) ; 2023
    In:  PLOS Medicine Vol. 20, No. 4 ( 2023-4-4), p. e1004208-
    Details
    In: PLOS Medicine, Public Library of Science (PLoS), Vol. 20, No. 4 ( 2023-4-4), p. e1004208-
    Abstract: Multimorbidity prevalence rates vary considerably depending on the conditions considered in the morbidity count, but there is no standardised approach to the number or selection of conditions to include. Methods and findings We conducted a cross-sectional study using English primary care data for 1,168,260 participants who were all people alive and permanently registered with 149 included general practices. Outcome measures of the study were prevalence estimates of multimorbidity (defined as ≥2 conditions) when varying the number and selection of conditions considered for 80 conditions. Included conditions featured in ≥1 of the 9 published lists of conditions examined in the study and/or phenotyping algorithms in the Health Data Research UK (HDR-UK) Phenotype Library. First, multimorbidity prevalence was calculated when considering the individually most common 2 conditions, 3 conditions, etc., up to 80 conditions. Second, prevalence was calculated using 9 condition-lists from published studies. Analyses were stratified by dependent variables age, socioeconomic position, and sex. Prevalence when only the 2 commonest conditions were considered was 4.6% (95% CI [4.6, 4.6] p 〈 0.001), rising to 29.5% (95% CI [29.5, 29.6] p 〈 0.001) considering the 10 commonest, 35.2% (95% CI [35.1, 35.3] p 〈 0.001) considering the 20 commonest, and 40.5% (95% CI [40.4, 40.6] p 〈 0.001) when considering all 80 conditions. The threshold number of conditions at which multimorbidity prevalence was 〉 99% of that measured when considering all 80 conditions was 52 for the whole population but was lower in older people (29 in 〉 80 years) and higher in younger people (71 in 0- to 9-year-olds). Nine published condition-lists were examined; these were either recommended for measuring multimorbidity, used in previous highly cited studies of multimorbidity prevalence, or widely applied measures of “comorbidity.” Multimorbidity prevalence using these lists varied from 11.1% to 36.4%. A limitation of the study is that conditions were not always replicated using the same ascertainment rules as previous studies to improve comparability across condition-lists, but this highlights further variability in prevalence estimates across studies. Conclusions In this study, we observed that varying the number and selection of conditions results in very large differences in multimorbidity prevalence, and different numbers of conditions are needed to reach ceiling rates of multimorbidity prevalence in certain groups of people. These findings imply that there is a need for a standardised approach to defining multimorbidity, and to facilitate this, researchers can use existing condition-lists associated with highest multimorbidity prevalence.
    Type of Medium: Online Resource
    ISSN: 1549-1676
    URL: Article
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    DOI: 10.1371/journal.pmed.1004208
    DOI: 10.1371/journal.pmed.1004208.g001
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    DOI: 10.1371/journal.pmed.1004208.t001
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    DOI: 10.1371/journal.pmed.1004208.s001
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    DOI: 10.1371/journal.pmed.1004208.s007
    DOI: 10.1371/journal.pmed.1004208.r001
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    DOI: 10.1371/journal.pmed.1004208.r005
    DOI: 10.1371/journal.pmed.1004208.r006
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2023
    detail.hit.zdb_id: 2164823-2
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  • 5
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    Effect of competing mortality risks on predictive performance of the QFracture-2012 risk prediction tool for major osteoporotic fracture and hip fracture: external validation cohort study in a UK primary care population
    BMJ ; 2022
    In:  BMJ Medicine Vol. 1, No. 1 ( 2022-10), p. e000316-
    Details
    In: BMJ Medicine, BMJ, Vol. 1, No. 1 ( 2022-10), p. e000316-
    Abstract: To externally evaluate the QFracture-2012 risk prediction tool for predicting the risk of major osteoporotic fracture and hip fracture. Design External validation cohort study. Setting UK primary care population. Linked general practice (Clinical Practice Research Datalink (CPRD) Gold), mortality registration (Office of National Statistics), and hospital inpatient (Hospital Episode Statistics) data, from 1 January 2004 to 31 March 2016. Participants 2 747 409 women and 2 684 730 men, aged 30-99 years, with up-to-standard linked data that had passed CPRD checks for at least one year. Main outcome measures Two outcomes were modelled based on those predicted by QFracture: major osteoporotic fracture and hip fracture. Major osteoporotic fracture was defined as any hip, distal forearm, proximal humerus, or vertebral crush fracture, from general practice, hospital discharge, and mortality data. The QFracture-2012 10 year predicted risk of major osteoporotic fracture and hip fracture was calculated, and performance evaluated versus observed 10 year risk of fracture in the whole population, and in subgroups based on age and comorbidity. QFracture-2012 calibration was examined accounting for, and not accounting for, competing risk of mortality from causes other than the major osteoporotic fracture. Results 2 747 409 women with 95 598 major osteoporotic fractures and 36 400 hip fractures, and 2 684 730 men with 34 321 major osteoporotic fractures and 13 379 hip fractures were included in the analysis. The incidence of all fractures was higher than in the QFracture-2012 internal derivation. Competing risk of mortality was more common than fracture from middle age onwards. QFracture-2012 discrimination in the whole population was excellent or good for major osteoporotic fracture and hip fracture (Harrell’s C statistic in women 0.813 and 0.918, and 0.738 and 0.888 in men, respectively), but was poor to moderate in age subgroups (eg, Harrell’s C statistic in women and men aged 85-99 years was 0.576 and 0.624 for major osteoporotic fractures, and 0.601 and 0.637 for hip fractures, respectively). Without accounting for competing risks, QFracture-2012 systematically under-predicted the risk of fracture in all models, and more so for major osteoporotic fracture than for hip fracture, and more so in older people. Accounting for competing risks, QFracture-2012 still under-predicted the risk of fracture in the whole population, but over-prediction was considerable in older age groups and in people with high comorbidities at high risk of fracture. Conclusions The QFracture-2012 risk prediction tool systematically under-predicted the risk of fracture (because of incomplete determination of fracture rates) and over-predicted the risk in older people and in those with more comorbidities (because of competing mortality). The current version of QFracture-2016 that is used by the UK's health service needs to be externally validated, particularly in people at high risk of death from other causes.
    Type of Medium: Online Resource
    ISSN: 2754-0413
    URL: Article
    DOI: 10.1136/bmjmed-2022-000316
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 6
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    Analysis of the impact of COVID-19 on Scotland’s care-homes from March 2020 to October 2021: national linked data cohort analysis
    Oxford University Press (OUP) ; 2024
    In:  Age and Ageing Vol. 53, No. 2 ( 2024-02-01)
    Details
    In: Age and Ageing, Oxford University Press (OUP), Vol. 53, No. 2 ( 2024-02-01)
    Abstract: The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections. Objective To examine change over time in: (i) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality and (ii) characteristics associated with an outbreak. Design Retrospective observational cohort study using routinely-collected data. Setting All adult care-homes in Scotland (1,092 homes, 41,299 places). Methods Analysis was undertaken at care-home level, over three periods. Period (P)1 01/03/2020-31/08/2020; P2 01/09/2020-31/05/2021 and P3 01/06/2021–31/10/2021. Outcomes were the presence and characteristics of outbreaks and mortality within the care-home. Cluster analysis was used to compare the pattern of outbreaks. Logistic regression examined care-home characteristics associated with outbreaks. Results In total 296 (27.1%) care-homes had one outbreak, 220 (20.1%) had two, 91 (8.3%) had three, and 68 (6.2%) had four or more. There were 1,313 outbreaks involving residents: 431 outbreaks in P1, 559 in P2 and 323 in P3. The COVID-19 mortality rate per 1,000 beds fell from 45.8 in P1, to 29.3 in P2, and 3.5 in P3. Larger care-homes were much more likely to have an outbreak, but associations between size and outbreaks were weaker in later periods. Conclusions COVID-19 mitigation measures appear to have been beneficial, although the impact on residents remained severe until early 2021. Care-home residents, staff, relatives and providers are critical groups for consideration and involvement in future pandemic planning.
    Type of Medium: Online Resource
    ISSN: 0002-0729 , 1468-2834
    URL: Article
    DOI: 10.1093/ageing/afae015
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2024
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  • 7
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    Telephone triage of young adults with chest pain: population analysis of NHS24 calls in Scottish unscheduled care
    BMJ ; 2022
    In:  Emergency Medicine Journal Vol. 39, No. 7 ( 2022-07), p. 508-514
    Details
    In: Emergency Medicine Journal, BMJ, Vol. 39, No. 7 ( 2022-07), p. 508-514
    Abstract: Telephone triage is increasingly used to manage unscheduled care demand. Younger adults are frequent users, and commonly call with chest pain. We compared pathways of care in younger adults calling with chest pain, and associations of patient characteristics and telephone triage recommendation with hospital admission. Methods A retrospective study of all triage calls with chest pain to NHS24 advice line by people aged 15–34 years between 1 January 2015 and 31 December 2017 where chest pain was recorded as the call reason. Recommended outcome and subsequent use of services were determined using the continuous urgent care pathways (CUPs) database which records single episodes of care spanning multiple services. We determined the number of services involved, the proportion of patients with inpatient admission, those with an admission for an ‘acute-and-serious’ diagnosis, and the association between the triage call recommendation and these outcomes. Results There were 102 822 CUPs identified, with 1251 different combinations of services. The most common pathway was an NHS24 call then attendance at a primary care out-of-hours (PCOOH) centre, accounting for 38 643 (37.6%) CUPs. 9060 (8.8%) CUPs ended with hospital admission, 3030 (3.0%) the result of an ‘acute-and-serious’ diagnosis. 8453 (8.2%) were given ‘self-care’ advice and not referred further, while 46.9% ended at PCOOH and 15.2% at ED. ‘Asthma, unspecified’ was the most frequent ‘acute-and-serious’ diagnosis. Compared with people given self-care advice, referral to other services had increased odds of inpatient admission (adjusted OR (aOR) for ambulance called 28.7, 95% CI 22.6 to 36.3; for 1-hour in-home general practitioner (GP) visit arranged aOR 36.8, 95% CI 23.2 to 58.5) and for admission with an ‘acute-and-serious’ diagnosis (aOR ambulance called 23.9, 95% CI 16.2 to 35.4; aOR 1-hour GP visit 48.3, 95% CI 25.5 to 91.6). Conclusion Chest pain triage by NHS24 appears safe, but care pathways can involve multiple service contacts. While acuity assigned to the call is strongly related to the odds of hospital admission and odds of an ‘acute-and-serious’ diagnosis, ‘overtriage’ means few patients are directed to self-care advice.
    Type of Medium: Online Resource
    ISSN: 1472-0205 , 1472-0213
    URL: Article
    DOI: 10.1136/emermed-2020-210594
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 8
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    Age, sex, and socioeconomic differences in multimorbidity measured in four ways: UK primary care cross-sectional analysis
    Royal College of General Practitioners ; 2023
    In:  British Journal of General Practice Vol. 73, No. 729 ( 2023-04), p. e249-e256
    Details
    In: British Journal of General Practice, Royal College of General Practitioners, Vol. 73, No. 729 ( 2023-04), p. e249-e256
    Abstract: Multimorbidity poses major challenges to healthcare systems worldwide. Definitions with cut-offs in excess of ≥2 long-term conditions (LTCs) might better capture populations with complexity but are not standardised. Aim To examine variation in prevalence using different definitions of multimorbidity. Design and setting Cross-sectional study of 1 168 620 people in England. Method Comparison of multimorbidity (MM) prevalence using four definitions: MM2+ (≥2 LTCs), MM3+ (≥3 LTCs), MM3+ from 3+ (≥3 LTCs from ≥3 International Classification of Diseases, 10th revision chapters), and mental–physical MM (≥2 LTCs where ≥1 mental health LTC and ≥1 physical health LTC are recorded). Logistic regression was used to examine patient characteristics associated with multimorbidity under all four definitions. Results MM2+ was most common (40.4%) followed by MM3+ (27.5%), MM3+ from 3+ (22.6%), and mental–physical MM (18.9%). MM2+, MM3+, and MM3+ from 3+ were strongly associated with oldest age (adjusted odds ratio [aOR] 58.09, 95% confidence interval [CI] = 56.13 to 60.14; aOR 77.69, 95% CI = 75.33 to 80.12; and aOR 102.06, 95% CI = 98.61 to 105.65; respectively), but mental–physical MM was much less strongly associated (aOR 4.32, 95% CI = 4.21 to 4.43). People in the most deprived decile had equivalent rates of multimorbidity at a younger age than those in the least deprived decile. This was most marked in mental–physical MM at 40–45 years younger, followed by MM2+ at 15–20 years younger, and MM3+ and MM3+ from 3+ at 10–15 years younger. Females had higher prevalence of multimorbidity under all definitions, which was most marked for mental–physical MM. Conclusion Estimated prevalence of multimorbidity depends on the definition used, and associations with age, sex, and socioeconomic position vary between definitions. Applicable multimorbidity research requires consistency of definitions across studies.
    Type of Medium: Online Resource
    ISSN: 0960-1643 , 1478-5242
    URL: Article
    DOI: 10.3399/BJGP.2022.0405
    RVK:
    XA 34050
    Language: English
    Publisher: Royal College of General Practitioners
    Publication Date: 2023
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  • 9
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    120 NHS 24 triage of the young adult with chest pain: an analysis of patient contacts in unscheduled care
    BMJ ; 2020
    In:  Emergency Medicine Journal Vol. 37, No. 12 ( 2020-12), p. 833.2-834
    Details
    In: Emergency Medicine Journal, BMJ, Vol. 37, No. 12 ( 2020-12), p. 833.2-834
    Abstract: Use of unscheduled care is increasing worldwide. In the UK access to services for symptoms not thought to be life-threatening is through a single telephone advice and triage service (NHS 24 in Scotland). Adults under 35 account for the largest cohort contacting this service. This study aimed to examine pathways of care in this population to inform areas for improvement to the triage process. Methods/Design A retrospective, population study using the Scotland-wide Urgent Care Data Mart (UCD) 2015 to 2017. The UCD links data between unscheduled care services to form Continuous Urgent Care Pathways (CUPs). CUPs for those aged 15–34 years, whose initial contact was with NHS 24 and with ‘chest pain’ recorded as the call reason. Two outcomes were examined: admission to hospital, and admission to hospital with a ‘time-critical diagnosis’ defined as an admission with a discharge diagnosis of a condition that required urgent treatment. Abstract 120 Figure 1 Results/Conclusions A total of 102,822 CUPs initiated by a call to NHS24 with chest pain as the call reason in the period studied. 35.1% of calls were made by people living in the most deprived 20% of postcodes. The most common CUP pathway accounted for 37.6% and was an NHS 24 call followed by an attendance at Primary Care Out of Hours. 25.4% of calls were considered not to represent an urgent care need. The most frequent ICD-10 code was ‘chest pain, unspecified’, representing 7.2% of cases with an ICD-10 code, followed by ‘asthma, unspecified’ at 7.1%. All NHS24 dispositions were strongly associated with increased odds of admission compared to self-care advice. Home-visits were associated with the greatest odds of time-critical diagnosis. Chest pain is a symptom of concern for young people. Use of telephone triage is effective. 9060 CUPs result in a hospital admission, although many end with a non-specific diagnosis.
    Type of Medium: Online Resource
    ISSN: 1472-0205 , 1472-0213
    URL: Article
    DOI: 10.1136/emj-2020-rcemabstracts.16
    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 10
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    Derivation and validation of the CFracture competing risk fracture prediction tool compared with QFracture in older people and people with comorbidity: a population cohort study
    Elsevier BV ; 2023
    In:  The Lancet Healthy Longevity Vol. 4, No. 1 ( 2023-01), p. e43-e53
    Details
    In: The Lancet Healthy Longevity, Elsevier BV, Vol. 4, No. 1 ( 2023-01), p. e43-e53
    Type of Medium: Online Resource
    ISSN: 2666-7568
    URL: Article
    DOI: 10.1016/S2666-7568(22)00290-2
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 3049841-7
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