Suchergebnisse

ABSTRACTObjectiveNear real-time vaccine safety surveillance (NRTVSS) using electronic health records (EHR) is an option for post-licensure vaccine safety assessment. NRTVSS requires timely recording of outcomes in the database used. Our study aimed to examine recording delays in the Clinical Practice Research Datalink (CPRD) to inform the feasibility of implementing NRTVSS in England using these data.
ApproachTo examine delays we selected 4 outcomes of interest for NRTVSS: Guillain-Barre syndrome (GBS), Bell's palsy (BP), optic neuritis (ON), and seizures for the period January 2005 to July 2015. Timeliness of CPRD records was assessed in two ways: 1) Using linked CPRD-hospital episode (HES) data to compare the hospital diagnosis date with the date the record was entered in CPRD (system date), 2) Looking at delays in recording (e.g. due to feedback from specialist referral) in stand-alone CPRD. For the latter the event date was compared with the system date. However, system dates can be changed when practice software is updated or there is mass transfer of a patient's records. After investigation, we excluded these uninformative system dates by excluding records from patients who had more than 100 records with the system date on the same day.
Results67813 patients were identified in CPRD (GBS:n=1081, BP:n=15835, ON:n=2236, seizures:n=48866), 64527 in HES (GBS:n=1680, BP:n=8468, ON:n=1746, seizures:n=53080) and 14104 in both databases (GBS:n=356, BP:n=1511, ON:n=226, seizures:n=12036). For the CPRD-HES comparison, 11843 patients with a diagnosis of interest both in CPRD and HES were included (GBS:n=321, BP:n=1374, ON:n=190, seizures:n=9976). Of these, the majority had a record in CPRD before or within 1 month of the HES record (GBS:49.5%, BP:83.8%, ON:66.8%, seizures:69.8%). For 6 months the corresponding percentage was more than 85% for all conditions examined (GBS:85.4%, BP:92.9%, ON:90.0%, seizures:86.6%). For stand-alone CPRD 57317 patients were included (GBS:n=972, BP:n=14275, ON:n=1958, seizures:n=40327). The majority had a record within one month of the event date (GBS:67.9%, BP:89.3%, ON:71.8%, seizures:83%). More than 87% of records occurred within 6 months of the event date (GBS:87.9%, BP:94.4%, ON:91.6%, seizures:94.9%).
ConclusionThis work shows that most diagnoses examined were recorded with a delay of ≤30 days, making NRTVSS possible. The distribution of the delays was condition-specific and the weekly delay distribution could be used to adjust for delays in the NRTVSS analysis. CPRD can be a viable data source to use in this kind of analysis; next steps will include trial implementation of the system using these data.

IntroductionThe Inverse Care Law (ICL) programme in Wales was setup to tackle health inequalities. Eligible populations from deprived communities, at higher risk of cardiovascular disease (CVD) were invited to a health-check and offered appropriate lifestyle and clinical interventions.
Objectives and ApproachEvaluation of this programme is vital to ensure that targeted interventions have been received by those most in need, including referrals to lifestyle services and support. The use of longitudinal population-scale routine-data required the development of an approach which was both efficient and cost effective. To achieve this, the Welsh Longitudinal General Practice (WLGP) data held in SAIL Databank was utilised. A programme-specific methodology was agreed by the programme-board and developed so that data collected from GP records prior, during and post health-check accurately identified the eligible population and allowed the effective assessment of lifestyle and clinical risk factors for CVD; poor diet, physical inactivity, smoking and high alcohol intake, so appropriate interventions could be offered.
ResultsWe evaluated the programme from 2015 to 2019 in 70 GP's across the participating Health-Boards, and identified 175,671 individuals eligible by the programme criteria. Substantial preliminary work has been carried out to ensure the specification of outcome measures are both clinically and epidemiologically accurate and relevant. The final report scheduled for release in August-2020, which will evaluate the impact of the programme.
Conclusion / ImplicationsThis ambitious evaluation of a large-scale programme set in the community involving disparate systems and a range of stakeholders, has been both complex and challenging, requiring substantial effort to design and implement. We hope the outcomes and lessons learned from our experience will improve the design, implementation and evaluation of the programme and lead to improvements in services and the quality of life for people in Wales, and provide an exemplar for health care providers worldwide wishing to conduct similar programmes in the future.

Abstract Background Wales faces serious public health challenges, with relatively low life expectancies and wide inequalities in life expectancy with associated pressures on the National Health Service (NHS) at a time of financial recession. This has led to growing recognition of the need to better understand the range of health improvement and prevention programmes across Welsh Government, NHS, local government and voluntary sector agencies. Methods The Minister for Health and Social Care commissioned Public Health Wales, the single national public health organisation, to establish a Health Improvement Advisory Group, to oversee a Programme Budgeting and Marginal Analysis (PBMA) expert panel. The panel drew on evidence from a range of sources to explore potential alternative modes of health improvement initiative delivery across Wales. Electronic voting was used to agree an appropriate time horizon for health improvement programme outcomes, main objective of the health improvement review and criteria for evaluating candidate services for disinvestment and investment. The panel also used electronic voting to state whether they wished to disinvest or invest in a candidate service. Results The review identified a budget of £15.1 million, spanning 10 Welsh Government priority areas, and 6 life course stages. Due to lack of evidence the panel recommended total disinvestment in 7 out of 25 initiatives releasing £1.5 million of resources, and partial disinvestment in a further 3 interventions releasing £7.3 million of resources. The panel did not recommend increasing investment in any of the 25 initiatives under review. Marginal analyses prioritised child health, mental health and wellbeing and tobacco control as key areas for investment. Conclusions Wales is championing a concept of "prudent healthcare". The PBMA exercise undertaken here was a transparent evidence-based tool to reach decisions about potential for disinvestment and reinvestment in health improvement strategies. It also demonstrates the potential wider application at a national level across government public health functions, to ensure resources are most cost-effectively deployed, with due consideration for equity.