Publications by authors named "Alex J Walker"
Article Synopsis
- The COVID-19 pandemic negatively impacted cardiovascular disease management in England, particularly affecting blood pressure screening and hypertension management.
- A study analyzed data from 25.2 million NHS patients, showing a decline in blood pressure screening from 90% in March 2019 to 85% in March 2023, while hypertension prevalence remained stable at about 15%.
- Treatment percentages for hypertension also dropped significantly during the pandemic, with patients aged ≤79 years treated to target falling from 71% to 47% and those aged ≥80 years from 85% to 58% before showing signs of recovery.
Objectives: In the UK, guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. In 2023, we published a national audit of PERT which showed suboptimal prescribing and wide regional variation in England. The aim of this manuscript was to describe how we used the PERT audit to drive improvements in healthcare.
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- * In the OpenSAFELY-TPP database, 78.2% of patients had their ethnicity recorded in primary care as of January 2022, with higher rates in women and those with serious health conditions.
- * The primary care ethnicity data closely matched the 2021 UK census data, with a high consistency found among patients with multiple ethnicity records, particularly indicating issues with classification for those recorded as "Other."
Background: The COVID-19 pandemic disrupted health-care delivery, including difficulty accessing in-person care, which could have increased the need for strong pharmacological pain relief. Due to the risks associated with overprescribing of opioids, especially to vulnerable populations, we aimed to quantify changes to measures during the COVID-19 pandemic, overall, and by key subgroups.
Methods: For this interrupted time-series analysis study conducted in England, with National Health Service England approval, we used routine clinical data from more than 20 million general practice adult patients in OpenSAFELY-TPP, which is a a secure software platform for analysis of electronic health records.
Background: The UK delivered its first "booster" COVID-19 vaccine doses in September 2021, initially to individuals at high risk of severe disease, then to all adults. The BNT162b2 Pfizer-BioNTech vaccine was used initially, then also Moderna mRNA-1273.
Methods: With the approval of the National Health Service England, we used routine clinical data to estimate the effectiveness of boosting with BNT162b2 or mRNA-1273 compared with no boosting in eligible adults who had received two primary course vaccine doses.
Background: We have previously demonstrated that opioid prescribing increased by 127% between 1998 and 2016. New policies aimed at tackling this increasing trend have been recommended by public health bodies, and there is some evidence that progress is being made.
Objective: We sought to extend our previous work and develop a data-driven approach to identify general practices and clinical commissioning groups (CCGs) whose prescribing data suggest that interventions to reduce the prescribing of opioids may have been successfully implemented.
Background: Long COVID is the patient-coined term for the persistent symptoms of COVID-19 illness for weeks, months or years following the acute infection. There is a large burden of long COVID globally from self-reported data, but the epidemiology, causes and treatments remain poorly understood. Primary care is used to help identify and treat patients with long COVID and therefore Electronic Health Records (EHRs) of past COVID-19 patients could be used to help fill these knowledge gaps.
View Article and Find Full Text PDFBackground: Long COVID is a major problem affecting patient health, the health service, and the workforce. To optimise the design of future interventions against COVID-19, and to better plan and allocate health resources, it is critical to quantify the health and economic burden of this novel condition. We aimed to evaluate and estimate the differences in health impacts of long COVID across sociodemographic categories and quantify this in Quality-Adjusted Life-Years (QALYs), widely used measures across health systems.
View Article and Find Full Text PDFAims: The COVID-19 pandemic created unprecedented pressure on healthcare services. This study investigates whether disease-modifying antirheumatic drug (DMARD) safety monitoring was affected during the COVID-19 pandemic.
Methods: A population-based cohort study was conducted using the OpenSAFELY platform to access electronic health record data from 24.
Aims: The COVID-19 pandemic caused significant disruption to routine activity in primary care. Medication reviews are an important primary care activity ensuring safety and appropriateness of prescribing. A disruption could have significant negative implications for patient care.
View Article and Find Full Text PDFInfection with SARS-CoV-2 is associated with an increased risk of arterial and venous thrombotic events, but the implications of vaccination for this increased risk are uncertain. With the approval of NHS England, we quantified associations between COVID-19 diagnosis and cardiovascular diseases in different vaccination and variant eras using linked electronic health records for ~40% of the English population. We defined a 'pre-vaccination' cohort (18,210,937 people) in the wild-type/Alpha variant eras (January 2020-June 2021), and 'vaccinated' and 'unvaccinated' cohorts (13,572,399 and 3,161,485 people respectively) in the Delta variant era (June-December 2021).
View Article and Find Full Text PDFObjectives: To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England.
Patients And Methods: With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023.
Background: Healthcare across all sectors, in the UK and globally, was negatively affected by the COVID-19 pandemic. We analysed healthcare services delivered to people with pancreatic cancer from January 2015 to March 2023 to investigate the effect of the COVID-19 pandemic.
Methods: With the approval of NHS England, and drawing from a nationally representative OpenSAFELY-TPP dataset of 24 million patients (over 40% of the English population), we undertook a cohort study of people diagnosed with pancreatic cancer.
Article Synopsis
- - The COVID-19 pandemic significantly disrupted NHS primary care services, leading to the creation of the OpenSAFELY Service Restoration Observatory (SRO) to track clinical activity trends throughout this period.
- - An open-source data management framework was developed to analyze electronic health records from 48 million adults, focusing on key measures like blood pressure monitoring and asthma reviews from January 2019 to December 2021.
- - While most clinical activities showed signs of recovery by April 2021, some measures like medication and blood pressure reviews continued to experience notable reductions, indicating lasting impacts from the pandemic.
The coronavirus disease 2019 (COVID-19) vaccination programme in England was extended to include all adolescents and children by April 2022. The aim of this paper is to describe trends and variation in vaccine coverage in different clinical and demographic groups amongst adolescents and children in England by August 2022. With the approval of NHS England, a cohort study was conducted of 3.
View Article and Find Full Text PDFObjective: To implement complex, PINCER (pharmacist led information technology intervention) prescribing indicators, on a national scale with general practice data to describe the impact of the covid-19 pandemic on safe prescribing.
Design: Population based, retrospective cohort study using federated analytics.
Setting: Electronic general practice health record data from 56.
Objectives: Cancer treatments were variably disrupted during the coronavirus disease 2019 (COVID-19) pandemic. UK guidelines recommend pancreatic enzyme replacement therapy (PERT) to all people with unresectable pancreatic cancer. The aim was to investigate the impact of the COVID-19 pandemic on PERT prescribing to people with unresectable pancreatic cancer and to investigate the national and regional rates from January 2015 to January 2023.
View Article and Find Full Text PDFThe COVID-19 vaccines were developed and rigorously evaluated in randomized trials during 2020. However, important questions, such as the magnitude and duration of protection, their effectiveness against new virus variants, and the effectiveness of booster vaccination, could not be answered by randomized trials and have therefore been addressed in observational studies. Analyses of observational data can be biased because of confounding and because of inadequate design that does not consider the evolution of the pandemic over time and the rapid uptake of vaccination.
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- The study investigated how different demographic and clinical groups experienced varying mortality risks related to COVID-19 across five pandemic waves in England, using data from the OpenSAFELY platform.
- A total of nearly 19 million adults were analyzed across each wave, with significant trends showing a decrease in crude COVID-19-related death rates from the first wave to the fifth.
- The highest standardized death rates were found among older adults and those with certain health conditions, such as advanced kidney disease or dementia, especially in the first wave of the pandemic.
Background: Approaches to addressing unwarranted variation in health care service delivery have traditionally relied on the prospective identification of activities and outcomes, based on a hypothesis, with subsequent reporting against defined measures. Practice-level prescribing data in England are made publicly available by the National Health Service (NHS) Business Services Authority for all general practices. There is an opportunity to adopt a more data-driven approach to capture variability and identify outliers by applying hypothesis-free, data-driven algorithms to national data sets.
View Article and Find Full Text PDFBackground: The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible.
Aim: To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication.
Article Synopsis
- The study aimed to determine patient eligibility and describe the coverage of antiviral drugs and neutralising monoclonal antibodies (nMAB) as treatments for COVID-19 in community settings in England.
- A retrospective analysis was conducted on data from 23.4 million people, focusing on outpatients with COVID-19 who were at high risk for severe outcomes between December 2021 and April 2022.
- Out of 93,870 high-risk patients identified, only 19,040 (20%) received treatment, with variations in treatment rates based on factors like age, ethnic background, risk group, and NHS region.
Objective: To compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and mRNA-1273 (Moderna) covid-19 vaccines during the booster programme in England.
Design: Matched cohort study, emulating a comparative effectiveness trial.
Setting: Linked primary care, hospital, and covid-19 surveillance records available within the OpenSAFELY-TPP research platform, covering a period when the SARS-CoV-2 delta and omicron variants were dominant.
Objective: To characterise factors associated with COVID-19 vaccine uptake among people with kidney disease in England.
Design: Retrospective cohort study using the OpenSAFELY-TPP platform, performed with the approval of NHS England.
Setting: Individual-level routine clinical data from 24 million people across GPs in England using TPP software.
Background: Data analysis is used to identify signals suggestive of variation in treatment choice or clinical outcome. Analyses to date have generally focused on a hypothesis-driven approach.
Objective: This study aimed to develop a hypothesis-free approach to identify unusual prescribing behavior in primary care data.