Is real world evidence influencing practice? A systematic review of CPRD research in NICE guidances

Oyinlola, Jessie; Campbell, Jennifer; Kousoulis, Antonis A.

doi:10.1186/s12913-016-1562-8

Cited by 69 publications

(59 citation statements)

References 71 publications

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“…Evidence for the accuracy and validity of the data from clinical databases is mixed and varies between clinical areas, the individual databases and the use of data 17 – 19. A recent systematic review exemplified the low usage of EHDs to inform national healthcare guidelines 20. Out of 25 guidelines included in the review, only 43 CPRD/GPRD studies were referenced, highlighting how electronic health records (EHRs) are a relatively untapped resource for informing evidence-based medicine (EBM) 20.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review exemplified the low usage of EHDs to inform national healthcare guidelines 20. Out of 25 guidelines included in the review, only 43 CPRD/GPRD studies were referenced, highlighting how electronic health records (EHRs) are a relatively untapped resource for informing evidence-based medicine (EBM) 20. This may in part be due to the widely accepted status quo that randomised controlled trials (RCTs) are the ‘gold standard’ data source for informing EBM.…”

Section: Discussionmentioning

confidence: 99%

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Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis

Chaudhry¹,

Mannan

Gibson-White

et al. 2017

jhi

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Background Electronic health database (EHD) data are increasingly used by researchers. The major United Kingdom EHDs are the 'Clinical Practice Research Datalink' (CPRD), 'The Health Improvement Network' (THIN) and 'QResearch'. Over time, outputs from these databases have increased but have not been evaluated. Objective This study compares research outputs from CPRD, THIN and QResearch assessing growth and publication outputs over a 10-year period (2004-2013). CPRD was also reviewed separately over 20 years as a case study. Methods Publications from CPRD and QResearch were extracted using the Science Citation Index of the Thomson Scientific Institute for Scientific Information (Web of Science). THIN data were obtained from University College London and validated in the Web of Science. All databases were analysed for growth in publications, the speciality areas and the journals in which their data have been published. Results These databases collectively produced 1,296 publications over a tenyear period, with CPRD representing 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. Over the 9-year period (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013), publications for THIN and QResearch have slowly increased over time, whereas CPRD publications have increased substantially in the last 4 years with almost 75% of CPRD publications published in the past 9 years. Conclusion These databases are enhancing scientific research and are growing yearly, however display variability in their growth. They could become more powerful research tools if the National Health Service and general practitioners can provide accurate and comprehensive data for inclusion in these databases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis

Chaudhry¹,

Mannan

Gibson-White

et al. 2017

jhi

View full text Add to dashboard Cite

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“…There has been an ongoing discussion on involving the patients' voice and preferences during the development of medical products . Regulatory agencies (for example, the US Food and Drug Administration) and health technology assessment bodies (such as the UK's National Institute for Health and Care Excellence [NICE]) have increasingly adopted new policies to assess the value of new products based on real‐world patient‐reported outcomes . For patients suffering from LUTS, previous studies conclude that some HRQoL measures are quite distinct and specific to different symptoms .…”

Section: Introductionmentioning

confidence: 99%

Impact of nocturia on patients' health‐related quality of life and healthcare resource utilisation compared with OAB and BPH: Results from an observational survey in European and American patients

et al. 2019

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Objective To evaluate the impact of nocturia on patients' quality of life and healthcare resource utilisation (HRU) compared with overactive bladder (OAB) and benign prostatic hyperplasia (BPH). Methods Data were drawn from a multinational (France, Germany, Spain, UK and US) survey of physician and patient‐reported outcomes. The patient groups of interests were those diagnosed with only nocturia, with only OAB, and with only BPH. Health‐related quality of life (HRQoL) and productivity measures were derived from the EuroQoL‐5D, OAB‐q and the Work Productivity and Activity Impairment Questionnaire (WPAI). Measures of HRU included lower urinary tract symptoms (LUTS)‐relevant surgeries, hospitalisations, current use of pads and related physician visits. Bivariate and multivariate regression analyses were used to evaluate associations between HRQoL/HRU/Productivity and nocturia status. Multivariate analysis was used to address any potential confounding factors among the groups, ie age, gender, body mass index (BMI), ethnicity and comorbidities. Results A total of 3552 patients were identified including 358 nocturia patients, 1415 OAB patients and 1779 BPH patients. The mean age of the nocturia patients was 61.2 years with a mean BMI of 27.3. About 60.6% were women, 87.2% were Caucasian, and their most common comorbidities included depression, hypertension and diabetes. In terms of impact, nocturia patients were significantly worse off than OAB patients in their HRQoL. There was no significant difference regarding HRU and productivity measurement. Nocturia patients also presented with significantly worse HRQoL and lower productivity compared with BPH patients. Nocturia patients also had more physician visits. Conclusions Nocturia should be emphasised as a standalone LUTS disease with substantial patient impact. Compared with OAB and/or BPH, nocturia patients presented with a significant reduction on patients' quality of life, reduced work productivity and increased utilisation of healthcare resources.

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“…Often prescribers question the real‐world validity of clinical trials, and therefore use real‐world evidence (including claims database studies) to help weigh the benefits (stroke reduction) and risks (bleeding) of OAC use in routine practice settings . There have been a substantial number of published claims database studies of OAC users with NVAF that have evaluated major bleeding risk, with significant heterogeneity ( I 2 = 93.4%) in reported rates observed across studies.…”

Section: Introductionmentioning

confidence: 99%

Agreement between coding schemas used to identify bleeding‐related hospitalizations in claims analyses of nonvalvular atrial fibrillation patients

Coleman

Vaitsiakhovich

Nguyen

et al. 2018

Clinical Cardiology

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Background Schemas to identify bleeding‐related hospitalizations in claims data differ in billing codes used and coding positions allowed. We assessed agreement across bleeding‐related hospitalization coding schemas for claims analyses of nonvalvular atrial fibrillation (NVAF) patients on oral anticoagulation (OAC). Hypothesis We hypothesized that prior coding schemas used to identify bleeding‐related hospitalizations in claim database studies would provide varying levels of agreement in incidence rates. Methods Within MarketScan data, we identified adults, newly started on OAC for NVAF from January 2012 to June 2015. Billing code schemas developed by Cunningham et al., the US Food and Drug Administration (FDA) Mini‐Sentinel program, and Yao et al. were used to identify bleeding‐related hospitalizations as a surrogate for major bleeding. Bleeds were subcategorized as intracranial hemorrhage (ICH), gastrointestinal (GI), or other. Schema agreement was assessed by comparing incidence, rates of events/100 person‐years (PYs), and Cohen's kappa statistic. Results We identified 151 738 new‐users of OAC with NVAF (CHA2DS2‐VASc score = 3, [interquartile range = 2–4] and median HAS‐BLED score = 3 [interquartile range = 2–3]). The Cunningham, FDA Mini‐Sentinel, and Yao schemas identified any bleeding‐related hospitalizations in 1.87% (95% confidence interval [CI]: 1.81‐1.94), 2.65% (95% CI: 2.57‐2.74), and 4.66% (95% CI: 4.55‐4.76) of patients (corresponding rates = 3.45, 4.90, and 8.65 events/100 PYs). Kappa agreement across schemas was weak‐to‐moderate (κ = 0.47–0.66) for any bleeding hospitalization. Near‐perfect agreement (κ = 0.99) was observed with the FDA Mini‐Sentinel and Yao schemas for ICH‐related hospitalizations, but agreement was weak when comparing Cunningham to FDA Mini‐Sentinel or Yao (κ = 0.52–0.53). FDA Mini‐Sentinel and Yao agreement was moderate (κ = 0.62) for GI bleeding, but agreement was weak when comparing Cunningham to FDA Mini‐Sentinel or Yao (κ = 0.44–0.56). For other bleeds, agreement across schemas was minimal (κ = 0.14–0.38). Conclusions We observed varying levels of agreement among 3 bleeding‐related hospitalizations schemas in NVAF patients.

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Is real world evidence influencing practice? A systematic review of CPRD research in NICE guidances

Cited by 69 publications

References 71 publications

Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis

Outputs and Growth of Primary Care Databases in the United Kingdom: Bibliometric Analysis

Impact of nocturia on patients' health‐related quality of life and healthcare resource utilisation compared with OAB and BPH: Results from an observational survey in European and American patients

Agreement between coding schemas used to identify bleeding‐related hospitalizations in claims analyses of nonvalvular atrial fibrillation patients

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