Azeem Majeed

Imperial College London, Londinium, England, United Kingdom

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Publications (340)2049.19 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To identify patient and attendance characteristics that are associated with onwards referral to co-located emergency departments (EDs) or other hospital specialty departments from general practitioner (GP) led urgent care centres (UCCs) in northwest London, England. Methods: We conducted a retrospective analysis of administrative data recorded in the UCCs at Charing Cross and Hammersmith Hospitals, in northwest London, from October 2009 to December 2012. Attendances made by adults resident in England were included. Logistic regression was used to model the associations between the explanatory variables-age; sex; ethnicity; socioeconomic status; area of residence; distance to UCC; GP registration; time, day, quarter, year; and UCC of attendance-and the outcome of onwards referral to the co-located EDs or other hospital specialty departments. Results: Of 243 042 included attendances, 74.1% were managed solely within the UCCs without same day referral to the EDs (16.8%) or other hospital specialty departments (5.7%), or deferred referral to a fracture, hand management or soft tissue injury management clinic (3.3%). The adjusted odds of onwards referral was estimated to increase by 19% (OR 1.19, 95% CI 1.18 to 1.19) for a 10 year increase in a patient's age. Men, patients registered with a GP and residents of less socioeconomically deprived areas were also more likely to be referred onwards from the UCCs. Conclusions: The majority of patients, across each category of all explanatory variables, were managed solely within the UCCs, although a large absolute number of patients were referred onwards each year. Several characteristics of patients and their attendances were associated with the outcome variable.
    Emergency Medicine Journal 09/2015; DOI:10.1136/emermed-2014-204603 · 1.84 Impact Factor
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    Cochrane database of systematic reviews (Online) 09/2015; DOI:10.1002/14651858.CD011861 · 6.03 Impact Factor
  • Azeem Majeed
    BMJ (online) 09/2015; 351. DOI:10.1136/bmj.h4761 · 17.45 Impact Factor
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    ABSTRACT: Introduction: Multidisciplinary group meetings are one of the key drivers of facilitating integrated care. Health care professionals attending such groups have a key role in the success of these discussions and hence, in the forming of multi-professional integrated care. The study aimed to explore the professionals’ experiences and views of participating and implementing the groups in integrated care context. Methods: A qualitative study including 25 semi-structured interviews with professionals participating in the Northwest London Integrated Care Pilot analysed using thematic content analysis. Results: Participants mentioned a number of benefits of participating in the meetings, including shared learning and shared decision-making between different services and specialties. Yet, they perceived barriers that diminish the efficiency of the groups, such as time constraints, group dynamics and technicalities. The participants felt that the quality of discussions and facilitation could be improved, as well as technical arrangements that would make them easier to participate. Most of the participants perceived the groups to be beneficial for providers mostly questioning the benefits for patient care. Conclusion: Findings provide an insight into how health professionals’ views of their participation to the multidisciplinary group meetings can be more effectively translated into more tangible benefits to the patients. To benefit patient care, the multidisciplinary groups need to be more patient-oriented rather than provider-oriented, while overcoming professional boundaries for participating.
    International journal of integrated care 09/2015; 15. · 1.50 Impact Factor
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    ABSTRACT: The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more likely to have been admitted via a GP (vs an A and E department). This furthers evidence suggesting that access to general practice is related to use of emergency hospital services in England. The relative merits of the two admission routes remain unclear. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    BMJ quality & safety 08/2015; DOI:10.1136/bmjqs-2015-004338 · 3.99 Impact Factor
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    ABSTRACT: To determine coverage of NHS Health Check, a national cardiovascular risk assessment programme in England, in the first four years after implementation, and to examine prevalence of high cardiovascular disease (CVD) risk and uptake of statins in high risk patients. Study sample was 95,571 patients in England aged 40-74 years continuously registered with 509 practices in the Clinical Practice Research Datalink between April 2009 and March 2013. Multilevel logistic regression models were used to assess predictors of Health Check attendance; elevated CVD risk factors and statin prescribing among attendees. Programme coverage was 21.4% over four years, with large variations between practices (0%-72.7%) and regions (9.4%-30.7%). Coverage was higher in older patients (adjusted odds ratio 2.88, 95% confidence interval 2.49-3.31 for patients 70-74 years) and in patients with a family history of premature coronary heart disease (2.37, 2.22-2.53), but lower in Black Africans (0.75, 0.61-0.92) and Chinese (0.68, 0.47-0.96) compared with White British. Coverage was similar in patients living in deprived and affluent areas. Prevalence of high CVD risk (QRISK2≥20%) among attendees was 4.6% One third (33.6%) of attendees at high risk were prescribed a statin after Health Checks. Coverage of the programme and statin prescribing in high risk individuals was low. Coverage was similar in deprived and affluent groups but lower in some ethnic minority groups, possibly widening inequalities. These findings raise a question about whether recommendations by WHO to develop CVD risk assessment programmes internationally will deliver anticipated health benefits. Copyright © 2015. Published by Elsevier Inc.
    Preventive Medicine 06/2015; 78. DOI:10.1016/j.ypmed.2015.05.022 · 3.09 Impact Factor
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    British Journal of General Practice 06/2015; 65(635):314-6. DOI:10.3399/bjgp15X685441 · 2.29 Impact Factor
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    ABSTRACT: Rheumatoid arthritis (RA) is an autoimmune disorder that affects the small joints of the body. It is one of the leading causes of chronic morbidity in high-income countries, but little is known about the burden of this disease in low- and middle-income countries (LMIC). The aim of this study was to estimate the prevalence of RA in six of the World Health Organization's (WHO) regions that harbour LMIC by identifying all relevant studies in those regions. To accomplish this aim various bibliographic databases were searched: PubMed, EMBASE, Global Health, LILACS and the Chinese databases CNKI and WanFang. Studies were selected based on pre-defined inclusion criteria, including a definition of RA based on the 1987 revision of the American College of Rheumatology (ACR) definition. Meta-estimates of regional RA prevalence rates for countries of low or middle income were 0.40% (95% CI: 0.23-0.57%) for Southeast Asian, 0.37% (95% CI: 0.23-0.51%) for Eastern Mediterranean, 0.62% (95% CI: 0.47-0.77%) for European, 1.25% (95% CI: 0.64-1.86%) for American and 0.42% (95% CI: 0.30-0.53%) for Western Pacific regions. A formal meta-analysis could not be performed for the sub-Saharan African region due to limited data. Male prevalence of RA in LMIC was 0.16% (95% CI: 0.11-0.20%) while the prevalence in women reached 0.75% (95% CI: 0.60-0.90%). This difference between males and females was statistically significant (P < 0.0001). The prevalence of RA did not differ significantly between urban and rural settings (P = 0.353). These prevalence estimates represent 2.60 (95% CI: 1.85-3.34%) million male sufferers and 12.21 (95% CI: 9.78-14.67%) million female sufferers in LMIC in the year 2000, and 3.16 (95% CI: 2.25-4.05%) million affected males and 14.87 (95% CI: 11.91-17.86%) million affected females in LMIC in the year 2010. Given that majority of the world's population resides in LMIC, the number of affected people is substantial, with a projection to increase in the coming years. Therefore, policy makers and health-care providers need to plan to address a significant disease burden both socially and economically.
    Global journal of health science 06/2015; 5(1). DOI:10.7189/jogh.05.010409
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    ABSTRACT: Data mining of electronic health records (eHRs) allows us to identify patterns of patient data that characterize diseases and their progress and learn best practices for treatment and diagnosis. Clinical Prediction Rules (CPRs) are a form of clinical evidence that quantifies the contribution of different clinical data to a particular clinical outcome and help clinicians to decide the diagnosis, prognosis or therapeutic conduct for any given patient. The TRANSFoRm diagnostic support system (DSS) is based on the construction of an ontological repository of CPRs for diagnosis prediction in which clinical evidence is expressed using a unified vocabulary. This paper explains the proposed methodology for constructing this CPR repository, addressing algorithms and quality measures for filtering relevant rules. Some preliminary application results are also presented.
    Studies in health technology and informatics 05/2015; 210:85-9.
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    ABSTRACT: Introduction The Quality and Outcomes Framework (QOF) is a financial incentive scheme that rewards UK general practices for providing evidence-based care, including smoking cessation advice mainly as a secondary prevention intervention. We examined the effects on smoking outcomes and inequalities of a local version of QOF (QOF+), which ran from 2008 to 2011 and extended financial incentives to the provision of cessation advice as a primary prevention intervention. Methods Before-and-after study using data from 28 general practices in Hammersmith & Fulham, London, UK. We used logistic regression to examine changes in smoking outcomes associated with QOF+ within and between socio-demographic groups. Results Recording smoking status increased from 55.5% to 64.2% for men (p<0.001) and from 67.9% to 75.8% for women (p<0.001). All groups benefitted from the increase, but younger patients remained less likely to be asked about smoking than older patients. White patients were less likely to be asked than those from other ethnic groups. Smoking cessation advice increased from 32.7% to 54.0% for men (p<0.001) and from 35.4% to 54.1% for women (p<0.01) and there was little variation between groups for this outcome. Recorded smoking prevalence reduced from 25.0% to 20.8% for men (p<0.001) and from 16.1% to 12.5% for women (p<0.001). White patients and those from more deprived areas remained more likely to be smokers than other groups. Conclusion The introduction of QOF+ was associated with general improvements in recording of smoking outcomes, but inequalities in ascertainment and smoking prevalence with respect to age, ethnicity and deprivation persisted. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail:
    Nicotine & Tobacco Research 05/2015; DOI:10.1093/ntr/ntv107 · 3.30 Impact Factor
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    Michael Soljak · Azeem Majeed
    JAMA Internal Medicine 05/2015; 175(5):862. DOI:10.1001/jamainternmed.2015.69 · 13.12 Impact Factor
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    ABSTRACT: The cardiovascular and mortality risk in patients with incident type 2 diabetes in relation to smoking status and concurrent use of metformin is not well known. The risks of myocardial infarction (MI), stroke and mortality in incident type 2 diabetes patients were evaluated in relation to their smoking status with and without concurrent use of metformin. Cohort study in 82205 incident type 2 diabetes patients from the United Kingdom Clinical Practice Research Datalink. During 5.4 years of median follow-up, among patients without cardiovascular disease (CVD) history before diagnosis of diabetes (n=63166), compared to non-smokers without metformin treatment, current smokers with and without metformin had 8% (HR: 1.08; 95% CI: 0.81, 1.45) and 32% (HR: 1.32; 95% CI: 1.07, 1.65) increased risk of MI or stroke respectively. The respective HR (95% CI) for mortality in these patients were 0.96 (0.83, 1.11) and 1.86 (1.68, 2.07). The HR for mortality among ex-smokers with and without concurrent metformin treatment were 0.92 (0.83, 1.11) and 1.19 (1.10, 1.30) respectively. Ex-smokers did not have elevated risk of MI or stroke, irrespective of metformin treatment. Similar beneficial modifiable effects of metformin among ex- and current smokers were observed in patients with cardiovascular disease before diagnosis of diabetes (n=19039). In type 2 diabetes patients, concurrent treatment with metformin attenuates the observed higher cardiovascular and mortality risk in ex- and current smokers. In addition to smoking cessation support, treatment with metformin, particularly in ex- and current smokers, should be encouraged. This article is protected by copyright. All rights reserved.
    Journal of Diabetes 04/2015; DOI:10.1111/1753-0407.12302 · 1.93 Impact Factor
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    ABSTRACT: Objectives Health system reforms in England are opening broad areas of clinical practice to new providers of care. As part of these reforms, new entrants - including private companies - have been allowed into the primary care market under ‘alternative provider of medical services’ contracting mechanisms since 2004. The characteristics and performance of general practices working under new alternative provider contracts are not well described. We sought to compare the quality of care provided by new entrant providers to that provided by the traditional model of general practice.
    Journal of the Royal Society of Medicine 04/2015; 108(5). DOI:10.1177/0141076815583303 · 2.12 Impact Factor
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    Ailsa J McKay · Raju K K Patel · Azeem Majeed
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    ABSTRACT: Tobacco control needs in India are large and complex. Evaluation of outcomes to date has been limited. To review the extent of tobacco control measures, and the outcomes of associated trialled interventions, in India. Information was identified via database searches, journal hand-searches, reference and citation searching, and contact with experts. Studies of any population resident in India were included. Studies where outcomes were not yet available, not directly related to tobacco use, or not specific to India, were excluded. Pre-tested proformas were used for data extraction and quality assessment. Studies with reliability concerns were excluded from some aspects of analysis. The Framework Convention on Tobacco Control (FCTC) was use as a framework for synthesis. Heterogeneity limited meta-analysis options. Synthesis was therefore predominantly narrative. Additional to the Global Tobacco Surveillance System data, 80 studies were identified, 45 without reliability concerns. Most related to education (FCTC Article 12) and tobacco-use cessation (Article 14). They indicated widespread understanding of tobacco-related harm, but less knowledge about specific consequences of use. Healthcare professionals reported low confidence in cessation assistance, in keeping with low levels of training. Training for schoolteachers also appeared suboptimal. Educational and cessation assistance interventions demonstrated positive impact on tobacco use. Studies relating to smoke-free policies (Article 8), tobacco advertisements and availability (Articles 13 and 16) indicated increasingly widespread smoke-free policies, but persistence of high levels of SHS exposure, tobacco promotions and availability-including to minors. Data relating to taxation/pricing and packaging (Articles 6 and 11) were limited. We did not identify any studies of product regulation, alternative employment strategies, or illicit trade (Articles 9, 10, 15 and 17). Tobacco-use outcomes could be improved by school/community-based and adult education interventions, and cessation assistance, facilitated by training for health professionals and schoolteachers. Additional tobacco control measures should be assessed.
    PLoS ONE 04/2015; 10(4):e0122610. DOI:10.1371/journal.pone.0122610 · 3.23 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-830. DOI:10.1016/S0016-5085(15)32822-5 · 16.72 Impact Factor
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    Thomas E Cowling · Matthew J Harris · Azeem Majeed
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    ABSTRACT: As the general election in the UK approaches and NHS policies are set to take centre stage, Thomas E Cowling, Matthew J Harris, and Azeem Majeed discuss the evidence, uncertainty, and debate behind access to primary care
    BMJ (online) 03/2015; 350(mar31 2):h1513. DOI:10.1136/bmj.h1513 · 17.45 Impact Factor
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    ABSTRACT: Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003). However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke. Exception reporting allows practitioners to exclude patients from target calculations if certain criteria are met, e.g. informed dissent of the patient for treatment. There were no statistically significant improvements in mean blood pressure, cholesterol or HbA1c levels. Thus, achievement of higher payment thresholds in the local pay for performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.
    PLoS ONE 03/2015; 10(3):e0119185. DOI:10.1371/journal.pone.0119185 · 3.23 Impact Factor
  • Azeem Majeed
    BMJ Clinical Research 03/2015; 350(mar04 18):h1124. DOI:10.1136/bmj.h1124 · 14.09 Impact Factor
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    Thomas E Cowling · Matthew J Harris · Azeem Majeed
    JAMA Internal Medicine 03/2015; 175(3):467. DOI:10.1001/jamainternmed.2014.7853 · 13.12 Impact Factor
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    ABSTRACT: Varicella and Herpes Zoster are common infectious diseases. Various studies have estimated rates of infection for both manifestations of these infections; however rates of hospital admissions across the country have not previously been described. This paper presents data on hospital admissions in England for Varicella and Herpes Zoster from 2001/2002 to 2010/2011. Time trends study of all hospital admissions for Varicella and Herpes Zoster from 2001/2002 to 2010/2011 in England. Hospital admissions across England from 2001/2002 to 2010/2011. We included all patients admitted to hospital from 2001/2002 to 2010/2011 diagnosed with Varicella and Zoster according to the International Classification of Diseases version 10 (ICD-10). The main outcome measures were admission rates by year and diagnosis and age-specific admission rates for Varicella and Zoster from 2001/2002 to 2010/2011. We analysed data from Hospital Episode Statistics which include patient characteristics such as age which was used here in order to standardise rates to the relevant population. We also used mid-year population estimates from the Office for National Statistics for standardisation purposes. All analyses were conducted using Stata v12.0. The hospital admission rate for Varicella cases has risen by 1.8% over the 10-year study period. While the overall admission rates for Herpes Zoster have decreased by 4% from 2001/2002 levels. The vast majority of Varicella and Zoster admissions were not associated with any complications. The introduction of Herpes Zoster vaccine is anticipated to decrease hospital admissions in older age groups further. A repeat of this study after a further period of time would help to evaluate the impact of the introduction of Herpes Zoster vaccine in England on hospital admissions.
    01/2015; 6(1):2054270414562984. DOI:10.1177/2054270414562984

Publication Stats

5k Citations
2,049.19 Total Impact Points


  • 2005–2015
    • Imperial College London
      • • School of Public Health
      • • Department of Primary Care and Public Health
      • • Imperial College Clinical Imaging Facility
      • • Faculty of Medicine
      Londinium, England, United Kingdom
  • 2009–2014
    • Imperial Valley College
      IPL, California, United States
    • The University of Edinburgh
      • Centre for Population Health Sciences
      Edinburgh, Scotland, United Kingdom
  • 2006
    • Medical University of South Carolina
      • Department of Family Medicine
      Charleston, SC, United States
  • 2002–2006
    • University of Leicester
      • Department of Health Sciences
      Leiscester, England, United Kingdom
    • St George's, University of London
      Londinium, England, United Kingdom
    • University College London Hospitals NHS Foundation Trust
      Londinium, England, United Kingdom
  • 1998–2005
    • Office for National Statistics
      Londinium, England, United Kingdom
  • 2004
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2002–2004
    • King's College London
      Londinium, England, United Kingdom
  • 2003
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2002–2003
    • University of California, San Francisco
      • Department of Medicine
      San Francisco, California, United States
  • 2000–2003
    • University College London
      • School of Public Policy
      London, ENG, United Kingdom
  • 1999
    • Kingston University
      Kingston, England, United Kingdom