Azeem Majeed

Imperial College London, Londinium, England, United Kingdom

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Publications (280)1478.2 Total impact

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    ABSTRACT: Hypoglycemia has been associated with an increased risk of cardiovascular (CV) events and all-cause mortality. This study assessed whether, in a nationally representative population, there is an association between hypoglycemia, the risk of CV events, and all-cause mortality among insulin-treated people with type 1 diabetes (T1D) or type 2 diabetes (T2D). This retrospective cohort study used data from the Clinical Practice Research Datalink database, and included all insulin-treated patients (≥30 years of age) with a diagnosis of diabetes. In patients who experienced hypoglycemia, hazard ratios (HRs) for CV events in people with T1D were 1.51 (95% CI 0.83, 2.75; P = ns) and 1.61 (1.17, 2.22), respectively, for those with and without a history of CV disease (CVD) before the index date. In people with T2D, the HRs for patients with and without a history of CVD were 1.60 (1.21, 2.12) and 1.49 (1.23, 1.82), respectively. For all-cause mortality, HRs in people with T1D were 1.98 (1.25, 3.17), and 2.03 (1.66, 2.47), respectively, for those with and without a history of CVD. Among people with T2D, HRs were 1.74 (1.39, 2.18) and 2.48 (2.21, 2.79), respectively, for those with and without a history of CVD. The median time (interquartile range) from first hypoglycemia event to first CV event was 1.5 years (0.5, 3.5 years) and 1.5 years (0.5, 3.0 years), respectively, for people with T1D and T2D. Hypoglycemia is associated with an increased risk of CV events and all-cause mortality in insulin-treated patients with diabetes. The relationship between hypoglycemia and CV outcomes and mortality exists over a long period. © 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.
    Diabetes care. 12/2014;
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    ABSTRACT: Background Person-centered care emphasizes a holistic, humanistic approach that puts patients first, at the center of medical care. Person-centeredness is also considered a core element of integrated care. Yet typologies of integrated care mainly describe how patients fit within integrated services, rather than how services fit into the patient¿s world. Patient-centeredness has been commonly defined through physician¿s behaviors aimed at delivering patient-centered care. Yet, it is unclear how `person-centeredness¿ is realized in integrated care through the patient voice. We aimed to explore patient narratives of person-centeredness in the integrated care context.Methods We conducted a phenomenological, qualitative study, including semi-structured interviews with 22 patients registered in the Northwest London Integrated Care Pilot. We incorporated Grounded Theory approach principles, including substantive open and selective coding, development of concepts and categories, and constant comparison.ResultsWe identified six themes representing core `ingredients¿ of person-centeredness in the integrated care context: ¿Holism¿, ¿Naming¿, ¿Heed¿, ¿Compassion¿, ¿Continuity of care¿, and ¿Agency and Empowerment¿, all depicting patient expectations and assumptions on doctor and patient roles in integrated care. We bring examples showing that when these needs are met, patient experience of care is at its best. Yet many patients felt `unseen¿ by their providers and the healthcare system. We describe how these six themes can portray a continuum between having own physical and emotional `Space¿ to be `seen¿ and heard vs. feeling `translucent¿, `unseen¿, and unheard. These two conflicting experiences raise questions about current typologies of the patient-physician relationship as a `dyad¿, the meanings patients attributed to `care¿, and the theoretical correspondence between `person-centeredness¿ and `integrated care¿.Conclusions Person-centeredness is a crucial issue for patients in integrated care, yet it was variably achieved in the current pilot. Patients in the context of integrated care, as in other contexts, strive to have their own unique physical and emotional `space¿ to be `seen¿ and heard. Integrated care models can benefit from incorporating person-centeredness as a core element.
    BMC Health Services Research 11/2014; 14(1):619. · 1.77 Impact Factor
  • Journal of the Royal Society of Medicine. 11/2014; 107(11):432-8.
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    ABSTRACT: Background The National Health Service in England has given increasing priority to improving inter-professional communication, enabling better management of patients with chronic conditions and reducing medical errors through effective use of information. Despite considerable efforts to reduce patient harm through better information usage, medical errors continue to occur, posing a serious threat to patient safety. Objectives This study explores the range, quality and sophistication of existing information systems in primary care with the aim to capture what information practitioners need to provide a safe service and identify barriers to its effective use in care pathways. Method Data were collected through semi-structured interviews with general practitioners from surgeries in North West London and a survey evaluating their experience with information systems in care pathways. Results Important information is still missing, specifically discharge summaries detailing medication changes and changes in the diagnosis and management of patients, blood results ordered by hospital specialists and findings from clinical investigations. Participants identified numerous barriers, including the communication gap between primary and secondary care, the variable quality and consistency of clinical correspondence and the inadequate technological integration. Conclusion Despite attempts to improve integration and information flow in care pathways, existing systems provide practitioners with only partial access to information, hindering their ability to take informed decisions. This study offers a framework for understanding what tools should be in place to enable effective use of information in primary care.
    Informatics in primary care 10/2014; 22(1):207-213.
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    Amal A Hassanien, Azeem Majeed, Hilary Watt
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    ABSTRACT: To examine the indications for hospitalisations among haemodialysis patients.
    JRSM open. 10/2014; 5(10):2054270414547146.
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    ABSTRACT: The literature on integrated care is limited with respect to practical learning and experience. Although some attention has been paid to organizational processes and structures, not enough is paid to people, relationships, and the importance of these in bringing about integration. Little is known, for example, about provider engagement in the organizational change process, how to obtain and maintain it, and how it is demonstrated in the delivery of integrated care. Based on qualitative data from the evaluation of a large-scale integrated care initiative in London, United Kingdom, we explored the role of provider engagement in effective integration of services. Using thematic analysis, we identified an evolving engagement narrative with three distinct phases: enthusiasm, antipathy, and ambivalence, and argue that health care managers need to be aware of the impact of professional engagement to succeed in advancing the integrated care agenda.
    Qualitative Health Research 09/2014; · 2.19 Impact Factor
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    ABSTRACT: Objectives. The health burden of alcohol use is socially and geographically patterned in many countries. Less is known about variations in this burden between ethnic groups and whether this differs across place of residence. Methods. National cross-sectional study using hospital admission data in England. Alcohol-related admission rates, where an alcohol-related condition was either the primary diagnosis (considered as the reason for admission) or a comorbidity, were calculated using ethnic group specific rates for English regions. Results. In 2010/11 there were a total of 264,870 alcohol-related admissions in England. Admission rates were higher in the North of England than elsewhere (e.g. for primary diagnosis 161 per 100,000 population in the North vs. 62 per 100,000 in the South). These patterns were not uniform across ethnic groups however. For example, admission rates for alcohol-related comorbidity were four times higher among White Irish in London compared with those in the South of England (306 to 76 per 100,000) and four times higher in Indians living in the Midlands compared with those in the South of England (128 to 29 per 100,000). These patterns were similar for admissions with a comorbid alcohol-related condition. Conclusions. Geographical location may be an important determinant of within and between ethnic group variations in alcohol-related hospital admissions in England. While a number of factors were not examined here, this descriptive analysis suggests that this heterogeneity should be taken into account when planning interventions and services for the prevention and management of alcohol misuse.
    The Lancet 08/2014; · 39.21 Impact Factor
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    ABSTRACT: The annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008-2009 and 2012-2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances.
    The British journal of general practice : the journal of the Royal College of General Practitioners. 07/2014; 64(624):e434-9.
  • Azeem Majeed, Mariam Molokhia
    BMJ Clinical Research 06/2014; 348:g3650. · 14.09 Impact Factor
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    ABSTRACT: Introduction: Despite the importance of continuity of care and patient engagement, few studies have captured patients' views on inte-grated care. This study assesses patient experience in the Integrated Care Pilot in North West London with the aim to help clinicians and policymakers understand patients' acceptability of integrated care and design future initiatives.
    International journal of integrated care 06/2014; 14. · 1.30 Impact Factor
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    ABSTRACT: Health systems worldwide are facing shortages in health professional workforce. Several studies have demonstrated the direct correlation between the availability of health workers, coverage of health services, and population health outcomes. To address this shortage, online eLearning is increasingly being adopted in health professionals' education. To inform policy-making, in online eLearning, we need to determine its effectiveness.
    Global journal of health science 06/2014; 4(1):010406.
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    ABSTRACT: The world is short of 7.2 million health-care workers and this figure is growing. The shortage of teachers is even greater, which limits traditional education modes. eLearning may help overcome this training need. Offline eLearning is useful in remote and resource-limited settings with poor internet access. To inform investments in offline eLearning, we need to establish its effectiveness in terms of gaining knowledge and skills, students' satisfaction and attitudes towards eLearning.
    Global journal of health science 06/2014; 4(1):010405.
  • Azeem Majeed, Michael Soljak
    BMJ Clinical Research 05/2014; 348:g3388. · 14.09 Impact Factor
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    ABSTRACT: Continuous data collection and analysis have been shown essential to achieving improvement in healthcare. However, the data required for local improvement initiatives are often not readily available from hospital Electronic Health Record (EHR) systems or not routinely collected. Furthermore, improvement teams are often restricted in time and funding thus requiring inexpensive and rapid tools to support their work. Hence, the informatics challenge in healthcare local improvement initiatives consists of providing a mechanism for rapid modelling of the local domain by non-informatics experts, including performance metric definitions, and grounded in established improvement techniques. We investigate the feasibility of a model-driven software approach to address this challenge, whereby an improvement data model designed by a team is used to automatically generate required electronic data collection instruments and reporting tools. To that goal, we have designed a generic Improvement Data Model (IDM) to capture the data items and quality measures relevant to the project, and constructed Web Improvement Support in Healthcare (WISH), a prototype tool that takes user-generated IDM models and creates a data schema, data collection web interfaces, and a set of live reports, based on Statistical Process Control (SPC) for use by improvement teams. The software has been successfully used in over 50 improvement projects, with more than 700 users. We present in detail the experiences of one of those initiatives, Chronic Obstructive Pulmonary Disease project in Northwest London hospitals. The specific challenges of improvement in healthcare are analysed and the benefits and limitations of the approach are discussed.
    Journal of biomedical informatics. 05/2014;
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    ABSTRACT: Objective: To examine the performance assessments and cognitive function of practitioners referred to the National Clinical Assessment Service (NCAS). Design: Retrospective observational study. Setting: Practitioners referred to NCAS for performance assessment due to suspected performance problems. Participants: One hundred and nine practitioners over the age of 45 years referred to NCAS between 1 September 2008 and 30 June 2012. Main outcome measures: Reasons for referral of practi-tioners and their characteristics; details of their assess-ments including screening for cognition using Addenbrooke's Cognitive Examination Revised (ACE-R); outcome of the process. Results: Reasons for referral included 'clinical difficulties' and 'governance or safety issues'. Eighty-seven practi-tioners scored above 88 on ACE-R. Twenty-two were found to have an ACE-R score of 88. On further assess-ment, 14 of these 22 practitioners were found to have cognitive impairment. The majority of all practitioners were found to be performing below the expected level of practice for someone at their grade and specialty. Of those scoring 88 on the screening, only seven continued in clinical practice. Conclusions: A high proportion of practitioners scoring poorly on ACE-R were found to have cognitive impairment following detailed neuropsychological testing, the youngest aged 46 years. Many were working in isolation. Nearly all practitioners scoring poorly on ACE-R were international medical graduates; reasons for this are unclear. Performance assessment results showed persisting failings in the practitioners' record keeping and in their assessment of patients. Our findings highlight the need for increased vigilance and training of responsible officers to recognise performance problems and emphasise the importance of comprehensive assessment.
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    ABSTRACT: In England, the National Institute for Health and Care Excellence (NICE) produces guidelines for the management of hypertension. In 2006, the NICE guidelines introduced an ethnic-age group algorithm based on the 2004 British Hypertension Society guidelines to guide antihypertensive drug prescription. A longitudinal retrospective study with 15933 hypertensive patients aged 18 years or over and registered with 28 general practices in Wandsworth, London in 2007 was conducted to assess variations in antihypertensive prescribing. Logistic models were used to measure variations in the odds of being prescribed the 2006 NICE first line recommended monotherapy among NICE patient groups over the period. From 2000 to 2007, the percentage of patients prescribed the recommended monotherapy increased from 54.2% to 61.4% (p < 0.0001 for annual trend). Over the study period, black patients were more likely to be prescribed the recommended monotherapy than younger non-black patients (OR 0.16, 95% CI 0.12 - 0.21) and older non-black patients (OR 0.49, 95% CI 0.37 - 0.65). After the introduction of the NICE guidelines there was an increase in the NICE recommended monotherapy (OR 1.44, 95% CI 1.19 - 1.75) compared with the underlying trend. Compared to black patients, an increase in the use of recommended monotherapy was observed in younger non-black patients (OR 1.49, 95% CI 1.17 - 1.91) but not in older non-black patients (OR 0.58, 95% CI 0.46 - 0.74). The introduction of the 2006 NICE guideline had the greatest impact on prescribing for younger non-black patients. Lower associated increases among black patients may be due to their higher levels of recommended prescribing at baseline. The analysis suggests that guidelines did not impact equally on all patient groups.
    BMC Health Services Research 02/2014; 14(1):87. · 1.77 Impact Factor
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    ABSTRACT: To determine all-cause mortality in patients with a first myocardial infarct who were treated with simvastatin compared with high-potency statin and simvastatin/ezetimibe combination. Despite statin use, residual cardiovascular risk remains. Therapeutic options include more potent statins or addition of ezetimibe. There is no clinical outcome data on the use of ezetimibe in such patients. Retrospective longitudinal study using the United Kingdom General Practice Research Database. Patients who had survived 30 days after their first acute myocardial infarct (AMI), had not received prior statin or ezetimibe therapy and were started on a statin within 30 days of AMI were included. Three groups were identified according to their follow-up: (i) simvastatin monotherapy; (ii) high-potency statin group (patients who started on simvastatin and switched to atorvastatin or rosuvastatin); and (iii) ezetimibe/statin combination group (patients who received ezetimibe in addition to statin). 9597 patients (57% male, mean age of 65±13 years) matched study criteria: simvastatin (n=6990 (72.8%)); high-potency statin (n=1883, (19.6%)); and ezetimibe/statin combination (n=724 (7.5%)). During a mean follow-up of 3.2 years, there were 1134 (12%) deaths. In the multivariate proportional hazards model, the adjusted HR for high-potency statin and ezetimibe group were 0.72 (95% CI 0.59 to 0.88, p<0.001) and 0.96 (95% CI 0.64 to 1.43, p=0.85), respectively. A similar result was also obtained in the propensity score analysis that took into account covariates that predicted drug treatment groups. Patients switched to a high-potency statin had a significantly reduced mortality compared with simvastatin monotherapy. There was no observed mortality benefit in the ezetimibe group.
    Heart (British Cardiac Society) 02/2014; · 5.01 Impact Factor

Publication Stats

3k Citations
1,478.20 Total Impact Points

Institutions

  • 2005–2014
    • Imperial College London
      • • Department of Primary Care and Public Health
      • • Faculty of Medicine
      Londinium, England, United Kingdom
    • The Kings College
      Gatlinburg, Tennessee, United States
  • 2013
    • Isfahan University of Medical Sciences
      • Epidemiology and Biostatistics Department
      Eşfahān, Ostan-e Esfahan, Iran
  • 2012–2013
    • University of Oxford
      • Department of Primary Care Health Sciences
      Oxford, ENG, United Kingdom
    • The University of Edinburgh
      • Centre for Population Health Sciences
      Edinburgh, SCT, United Kingdom
    • Taipei City Hospital
      T’ai-pei, Taipei, Taiwan
  • 2008–2013
    • London School of Hygiene and Tropical Medicine
      • Faculty of Epidemiology and Population Health
      Londinium, England, United Kingdom
  • 2011–2012
    • University of Surrey
      • Department of Health Care Management and Policy
      Guilford, England, United Kingdom
    • University of Split
      Spalato, Splitsko-Dalmatinska, Croatia
  • 2000–2008
    • University College London
      • • Department of Statistical Science
      • • School of Public Policy
      London, ENG, United Kingdom
  • 2003–2007
    • University of California, San Francisco
      • • Division of General Internal Medicine
      • • Division of Hospital Medicine
      San Francisco, CA, United States
    • University of Nottingham
      Nottigham, England, United Kingdom
  • 2006
    • Medical University of South Carolina
      • Department of Family Medicine
      Charleston, SC, United States
  • 2004–2005
    • Office for National Statistics
      Londinium, England, United Kingdom
    • St. George's School
      • Division of General Practice and Primary Care
      Middletown, Rhode Island, United States
  • 2002–2005
    • University College London Hospitals NHS Foundation Trust
      Londinium, England, United Kingdom
    • University of Leicester
      Leiscester, England, United Kingdom
  • 2002–2004
    • King's College London
      Londinium, England, United Kingdom
  • 2002–2003
    • Johns Hopkins University
      Baltimore, Maryland, United States