Publications by authors named "Chris Bates"
Background: Use of electronic health records (EHR) to provide real-world data for research is established, but using EHR to deliver randomised controlled trials (RCTs) more efficiently is less developed. The Allergy AntiBiotics And Microbial resistAnce (ALABAMA) RCT evaluated a penicillin allergy assessment pathway versus usual clinical care in a UK primary care setting. The aim of this paper is to describe how EHRs were used to facilitate efficient delivery of a large-scale randomised trial of a complex intervention embracing efficient participant identification, supporting minimising GP workload, providing accurate post-intervention EHR updates of allergy status, and facilitating participant follow up and outcome data collection.
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- 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.
Article Synopsis
- * 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.
Article Synopsis
- Long COVID is associated with increased healthcare utilization and costs, indicating its potential impact on the NHS.
- The study analyzed healthcare usage data from nearly 53,000 individuals with long COVID, comparing it with over 264,000 individuals without the condition from Nov 2020 to Jan 2023.
- Results show that those with long COVID had 49% more healthcare utilization, averaging 30 visits per year, and incurred healthcare costs around £2500 annually, compared to £1500 for the comparators.
Article Synopsis
- - The study examines how the Covid-19 pandemic influenced the rates of group A streptococcal infections and related antibiotic prescriptions in primary care practices across England from January 2018 to March 2023.
- - Significant findings show that infections and antibiotic prescriptions peaked in December 2022, surpassing levels seen during the 2017-18 season, with notable increases in rates for sore throat, scarlet fever, and invasive infections.
- - The research highlights a concerning trend, reporting that the rate ratios for infections and prescriptions in the 2022-23 season were considerably higher compared to the pre-pandemic period, suggesting lasting impacts from the pandemic on public health.
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.
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- Electronic health records (EHRs) are essential for researching medical products and informing public health, but reproducibility in EHR research is a significant challenge.
- OpenSAFELY is an open-source software platform created during the COVID-19 pandemic to improve the reproducibility of research using EHRs by standardizing workflows and ensuring consistent computational environments.
- The platform promotes transparency by enforcing code-sharing, providing an audit trail for data usage, and integrating tools that support reproducible research practices.
Background: 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 PDFBackground: Germ Defence ( www.germdefence.org ) is an evidence-based interactive website that promotes behaviour change for infection control within households.
View Article and Find Full Text PDFChickenpox is a common childhood disease caused by varicella-zoster virus (VZV). VZV vaccination is not part of the UK childhood immunisation programme, but its potential inclusion is regularly assessed. It is therefore important to understand the ongoing burden of VZV in the community to inform vaccine policy decisions.
View Article and Find Full Text PDFBackground: The COVID-19 pandemic affected how care was delivered to vulnerable patients, such as those with dementia or learning disability.
Objective: To explore whether this affected antipsychotic prescribing in at-risk populations.
Methods: With the approval of NHS England, we completed a retrospective cohort study, using the OpenSAFELY platform to explore primary care data of 59 million patients.
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.
Strengthening cancer control in the South Pacific through coalition-building: a co-design framework.
Lancet Reg Health West Pac
April 2023
Background: Cancer is a significant problem for the South Pacific region due to a range of complex health challenges. Currently gaps in diagnosis, treatment and palliative care are significant, and while governmental commitment is strong, economic constrains limit health system strengthening. Alliances have been successful in strengthening non-communicable disease and cancer control policy and services in resource constrained settings.
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.
Objective: Atrial fibrillation (AF) screening by age achieves a low yield and misses younger individuals. We aimed to develop an algorithm in nationwide routinely collected primary care data to predict the risk of incident AF within 6 months (Future Innovations in Novel Detection of Atrial Fibrillation (FIND-AF)).
Methods: We used primary care electronic health record data from individuals aged ≥30 years without known AF in the UK Clinical Practice Research Datalink-GOLD dataset between 2 January 1998 and 30 November 2018, randomly divided into training (80%) and testing (20%) datasets.
The richness of linked population data provides exciting opportunities to understand local health needs, identify and predict those in most need of support and evaluate health interventions. There has been extensive investment to unlock the potential of clinical data for health research in the UK. However, most of the determinants of our health are social, economic, education, environmental, housing, food systems and are influenced by local authorities.
View Article and Find Full Text PDFObjective: To compare the effectiveness of the BNT162b2 mRNA (Pfizer-BioNTech) and the ChAdOx1 (Oxford-AstraZeneca) covid-19 vaccines against infection and covid-19 disease in health and social care workers.
Design: Cohort study, emulating a comparative effectiveness trial, on behalf of NHS England.
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 Alpha variant was dominant.
Background: While the vaccines against COVID-19 are highly effective, COVID-19 vaccine breakthrough is possible despite being fully vaccinated. With SARS-CoV-2 variants still circulating, describing the characteristics of individuals who have experienced COVID-19 vaccine breakthroughs could be hugely important in helping to determine who may be at greatest risk.
Methods: With the approval of NHS England, we conducted a retrospective cohort study using routine clinical data from the OpenSAFELY-TPP database of fully vaccinated individuals, linked to secondary care and death registry data and described the characteristics of those experiencing COVID-19 vaccine breakthroughs.
Background: The risk of severe COVID-19 outcomes in people with immune-mediated inflammatory diseases and on immune-modifying drugs might not be fully mediated by comorbidities and might vary by factors such as ethnicity. We aimed to assess the risk of severe COVID-19 in adults with immune-mediated inflammatory diseases and in those on immune-modifying therapies.
Methods: We did a cohort study, using OpenSAFELY (an analytics platform for electronic health records) and TPP (a software provider for general practitioners), analysing routinely collected primary care data linked to hospital admission, death, and previously unavailable hospital prescription data.
At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, "high-cost drugs" (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients.
View Article and Find Full Text PDFPatients surviving hospitalisation for COVID-19 are thought to be at high risk of cardiometabolic and pulmonary complications, but quantification of that risk is limited. We aimed to describe the overall burden of these complications in people after discharge from hospital with COVID-19. Working on behalf of NHS England, we used linked primary care records, death certificate and hospital data from the OpenSAFELY platform.
View Article and Find Full Text PDFBackground: Early evidence has shown that anticoagulant reduces the risk of thrombotic events in those infected with COVID-19. However, evidence of the role of routinely prescribed oral anticoagulants (OACs) in COVID-19 outcomes is limited.
Aim: To investigate the association between OACs and COVID-19 outcomes in those with atrial fibrillation and a CHADS-VASc score of 2.