Hajira Dambha-Miller

• MRCGP PhD FHEA
• NIHR Clinical Lecturer at University of Southampton

Objective To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. Design and outcome measures This is a systematic review of published and grey literature i...

Background: It has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient-practitioner interactions might be changing. Aim: To explore the views of patients wit...

Aim: To quantify the association between behaviour change and weight loss after diagnosis of Type 2 diabetes, and the likelihood of remission of diabetes at 5-year follow-up. Method: We conducted a prospective cohort study in 867 people with newly diagnosed diabetes aged 40-69 years from the ADDITION-Cambridge trial. Participants were identified...

Objective To examine the effect on cardiovascular (CVD) risk factors of interventions to alter consultations between practitioners and patients with type 2 diabetes. Search Strategy Electronic and manual citation searching to identify relevant randomised controlled trials (RCTs). Inclusion Criteria RCTs that compared usual care to interventions to...

Purpose: To examine the association between primary care practitioner (physician and nurse) empathy and incidence of cardiovascular disease (CVD) events and all-cause mortality among patients with type 2 diabetes. Methods: This was a population-based prospective cohort study of 49 general practices in East Anglia (United Kingdom). The study popu...

Background The increasing availability of electronic health records (EHR), encompassing routinely collected general practice, hospital, and linked national census data, presents significant opportunities to enhance our understanding of multimorbidity at scale. However, the utility and clinical impact of EHR in advancing multimorbidity research, par...

Background Multiple long-term conditions (MLTC) refers to people living with two or more long-term health conditions, which affects around 19 million people in England. Climate change is forecast to increase extreme weather events such as heatwaves, droughts and flooding. The MLTC population have been identified as a group at high-risk from extreme...

Background Research on multimorbidity, commonly defined as the presence of two or more long term conditions, has predominantly focused on biological and clinical needs. However, unmet social care needs (SCNs), including, for example, mobility limitations, financial hardship, and social isolation, can also adversely affect health outcomes. We aimed...

Social needs are sociocultural and economic factors influencing health and quality of life, including, for example, mobility limitations or financial difficulties. Multimorbidity - the presence of two or more long-term conditions (LTCs)- is an increasing public health challenge, with social needs often compounding the negative health outcomes assoc...

Introduction Multimorbidity, defined as the co-occurrence of two or more long-term conditions, is increasing rapidly and poses challenges for healthcare systems. Advances in digital technologies offer solutions by facilitating personalised, scalable care interventions that empower individuals to manage their conditions more effectively. These appli...

The UK Health Data Research Alliance presents five recommendations for improving data collection for inclusive health research.

Background: Non-attendance at diabetes appointments is common, 1-4 and associated with higher HbA1c levels, reduced medication taking, and increased complications. 1-45 Barriers to attendance are multifactorial including both logistical and psychosocial factors. 6-11 A proposed solution is the implementation of a postal diabetes annual review box...

Objective To describe which combinations of long term conditions were associated with a higher risk of hospital admission or death during winter 2021-22 (the third wave of the covid-19 pandemic) in adults in England. Design Population based cohort study. Setting Linked primary and secondary care data from the General Practice Extraction Service D...

Aim The diabetes annual review is an important part of clinical care. Non‐attendance is increasingly common and associated with poor health outcomes. At‐home self‐collection of blood tests, urine samples and anthropometric data through a postal box may facilitate engagement. We aimed to explore the views of people living with diabetes on the use of...

Purpose People living with MLTCs attending consultations in primary care frequently have unmet social care needs (SCNs), which can be challenging to identify and address. Artificial intelligence (AI) derived clusters could help to identify patients at risk of SCNs. Understanding the views of people living with MLTCs and those involved in their care...

Background: Patients can benefit when primary care practitioners communicate clinical empathy and optimism during consultations, but previous training interventions for practitioners are overly time-consuming and evidence on patient outcomes is limited. This study assessed the feasibility of a cluster-randomized controlled trial in UK general pract...

Objectives To classify older adults into clusters based on accumulating long-term conditions (LTC) as trajectories, characterise clusters and quantify their associations with all-cause mortality. Design We conducted a longitudinal study using the English Longitudinal Study of Ageing over 9 years (n=15 091 aged 50 years and older). Group-based traj...

Background Around one in four people are living with multiple long-term conditions (MLTC). Integrated care to holistically manage both health and social needs could improve outcomes for people living with MLTC, including lower rates of hospitalisation and mortality. However, given the number of people with MLTC and increasing strain on health and s...

Background Experiences of living with and seeking care for multimorbidity is a relatively under-researched field. By analysing experiences of people with multimorbidity, caregivers and care professionals, we can better understand the complex care needs of those with multimorbidity and identify improvements to care management. This paper reports fin...

The study Dambha-Miller H, Hounkpatin HO, Stuart B, Farmer A, Griffin S. Type 2 diabetes remission trajectories and variation in risk of diabetes complications: a population-based cohort study. PLoS ONE 2023;18. doi: 10.1371/journal.pone.0290791 . To read the full NIHR Alert, go to: https://evidence.nihr.ac.uk/alert/even-short-periods-of-diabetes-r...

Objective To explore the risk of a positive test result for the delta or omicron variant of the SARS-CoV-2 virus in different occupations and deprivation groups in the UK. Design Analysis of the longitudinal COVID-19 Infection Survey. Setting COVID-19 Infection Survey, conducted by the Office for National Statistics and the University of Oxford,...

Background The annual winter season poses substantial challenges to the National Health Service (NHS) in England. Hospitalisation and mortality increase during winter, especially in people with multiple long-term conditions (MLTC or multimorbidity). We aimed to describe which combinations of long-term conditions (LTC) are associated with a higher r...

Background Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions. Methods A t...

Biochemical remission of type 2 diabetes is achievable through dietary changes, physical activity and subsequent weight loss. We aim to identify distinct diabetes remission trajectories in a large population-based cohort over seven-years follow-up and to examine associations between remission trajectories and diabetes complications. Group-based tra...

Background People with multiple long-term conditions (MLTC) face health and social care challenges. This study aimed to classify people by MLTC and social care needs (SCN) into distinct clusters and quantify the association between derived clusters and care outcomes. Methods A cross-sectional study was conducted using the English Longitudinal St...

Objectives To describe the current landscape of UK electronic health record (EHR) databases and considerations of access and use of these resources relevant to researchers. Design & setting Narrative review Data sources Information was collected from the Health Data Research Innovation Gateway, publicly available websites and other published data...

Background: People with diabetes who do not attend their annual review appointments often have poorer glycaemic control and increased complication rates. A postal kit for self-collection of blood tests, urine samples, and anthropometric data may facilitate remote annual reviews and improve uptake. Aim: To explore views on a postal kit for annual...

Background: Multiple long-term conditions (MLTC) are the co-occurrence of two or more chronic long-term conditions. While numerous studies have examined health and social care needs associated with MLTC, there has been limited research exploring both clinical and non-clinical care needs of this patient cohort from a range of perspectives. Aim: T...

Background: The integration of health and social care services is a potential solution for improving care, despite monetary constraints and increasing demand. How two or more multiple long-term conditions (MLTC) cluster, interact and associate with socioeconomic factors, and affect access to unscheduled primary healthcare services is understudied....

Background People with multiple long term conditions (MLTC) face health and social care challenges. This study aimed to classify people by MLTC and Social Care Need (SCN) into distinct clusters and quantify the association between derived clusters and care outcomes. Methods A cohort study was conducted using the English Longitudinal Study of Ageing...

Objective To classify older adults with multiple long term conditions (MLTC) in clusters based on accumulating conditions as trajectories over time, characterise clusters and quantify associations between derived clusters and all-cause mortality. Design We conducted a retrospective cohort study using the English Longitudinal Study of Ageing (ELSA)...

Objectives To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the inequality by sex and occupation. Design We conducted a retrospective population-based cohort study using data from the ONS COVID-19 Infection Survey between 26 April 2020 and 31 January 2022. This is the largest nationally representative survey o...

Introduction: Multiple Long Term Conditions (MLTC) are a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for people living with MLTC. In this study, we aimed to elicit and prioritise determinants of improved care in people...

Objectives Uptake of influenza, pneumococcal and shingles vaccines in older adults vary across regions and socioeconomic backgrounds. In this study, we study the coverage and factors associated with vaccination uptake, as well as refusal in the unvaccinated population and their associations with ethnicity, deprivation, household size and health con...

Heterogeneous studies have demonstrated ethnic inequalities in the risk of SARS-CoV-2 infection and adverse COVID-19 outcomes. This study evaluates the association between ethnicity and COVID-19 outcomes in two large population-based cohorts from England and Canada and investigates potential explanatory factors for ethnic patterning of severe outco...

Aim: In the United Kingdom people with diabetes who do not attend annual review appointments often have higher Haemoglobin A1c (HbA1c) levels.1-3 We aim to determine the acceptability of self-collected posted capillary blood samples, and if they produce accurate and reliable HbA1c results. Methods: We include adult studies comparing capillary bl...

Diversity is on the rise globally. To mention just a few of diversity’s dimensions in the UK, 10 million (14.5%) of the country’s citizens were born outside the UK, 9 million (14%) of the population is non-white, and there are 6 religions with at least 250,000 adherents.1 A similar picture presents itself in many other parts of the world. In the US...

Abstract Objective To estimate the risk of Long COVID by socioeconomic deprivation and to further examine the socioeconomic inequalities in Long COVID by sex and occupational groups. Design We analysed data from the COVID-19 Infection Survey conducted by the Office for National Statistics between 26/04/2020 and 31/01/2022. This is the largest and...

Background Weight loss, hyperglycaemia and diabetes are known features of pancreatic cancer. We quantified the timing and the amount of changes in body mass index (BMI) and glycated haemoglobin (HbA1c), and their association with pancreatic cancer from five years before diagnosis. Methods A matched case-control study was undertaken within 590 prim...

p>Background: Multiple Long Term conditions (MLTC) are a major health care challenge associated with high service utilisation and expenditure. Once established, the trajectory to an increased number and severity of conditions, hospital admission, increased social care need and mortality is multifactorial. The role of wider environmental determinant...

Background Concerns have been raised that angiotensin-converting enzyme-inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) might facilitate transmission of severe acute respiratory syndrome coronavirus 2 leading to more severe coronavirus disease (COVID-19) disease and an increased risk of mortality. We aimed to investigate the association...

Background A more comprehensive understanding and measurement of adult social care need could contribute to efforts to develop more effective, holistic personalised care, particularly for those with Multiple Long Term Conditions. Progress in this area faces the challenge of a lack of clarity in the literature relating to how social care need is ass...

Background: Worldwide there are an estimated 463 million people with diabetes. In the UK people with diabetes are offered annual review which includes monitoring of Haemoglobin A1c (HbA1c). This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these reviews often ha...

Background: Limited recent observational data have suggested that there may be a protective effect of oestrogen on the severity of COVID-19 disease. Our aim was to investigate the association between hormone replacement therapy (HRT) or combined oral contraceptive pill (COCP) use and the likelihood of death in women with COVID-19. Methods: We un...

Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim To quantify change in treatment burden, determine factors associated with this change, and evaluate a re...

Background Practitioner expressions of optimism and empathy may improve treatment engagement, adherence and patient satisfaction but are not delivered consistently amidst the challenges of everyday clinical practice. Aims To explore primary care practitioner (PCP) views about optimistic and empathic communication in consultations; and to identify...

Objectives To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes. Design Retrospective cohort study. Setting 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2013 an...

Objective To explore primary care practitioners’ (PCPs) and patients’ priorities and concerns for healthcare interactions for osteoarthritis (OA) in primary care. Methods We searched Embase, CINAHL, Medline, PsychInfo (1990 to present) for primary qualitative and mixed methods studies with findings concerning healthcare interactions for OA symptom...

Introduction Worldwide there are an estimated 463 million people with diabetes. [1] In the UK people with diabetes are offered an annual review including monitoring of Haemoglobin A1c (HbA1c). [2] [3] This can identify people with diabetes who are not meeting their glycaemic targets, enabling early intervention. Those who do not attend these review...

Background As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the physical and psycho-social needs of this cohort. This study describes and summarises current evidence, clinical provision and progress towards integrated primary care and social services for older adults with multim...

Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors a...

BACKGROUND Multiple long-term health conditions (Multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality and health-care expenditure. Strategies to tackle this have primarily focused on addressing biological aspects of disease, but MLTC-M are also the result of and associated with additional psycho...

Background: Multiple long-term health conditions (multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality, and health care expenditure. Strategies to address this have primarily focused on the biological aspects of disease, but MLTC-M also result from and are associated with additional psychosocia...

Background: Primary care consultations for respiratory tract symptoms including identifying and managing COVID-19 during the pandemic have not been characterized. Methods: A retrospective cohort analysis using routinely collected records from 70,431 adults aged 18+ in South England within the Electronic Care and Health Information Analytics (CHI...

BACKGROUND: Growing demand from an increasingly ageing population with multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could utilise resources more efficiently, and improve experiences for patients, their families, and carers. There is limited evid...

Aims There is increasing interest in using stratification in type 2 diabetes to target resources, individualize care, and improve outcomes. We aim to systematically review and collate literature that has utilised population stratification methods in the study of adults with type 2 diabetes; and to describe and compare stratification methodologies,...

Background: Empathic communication and positive messages are important components of “placebo” effects and can improve patient outcomes, including pain. Communicating empathy and optimism to patients within consultations may also enhance the effects of verum, i.e., non-placebo, treatments. This is particularly relevant for osteoarthritis, which is...

Acknowledgment: The authors thank the EMIS (Egton Medical Information Systems) practices that contribute to the database as well as the University of Nottingham and University of Oxford for expertise in establishing, developing, and supporting the QResearch database. QResearch acknowledges funding from the Nottingham Biomedical Research Centre fund...

Background The current GP workforce is insufficient to manage rising demand in patient care within the out-of-hours (OOH) primary care services. To meet this challenge, non-medical practitioners (NMPs) are employed to fulfil tasks traditionally carried out by GPs. It is important to learn from experiences of task-shifting in this setting to inform...

Importance Although children mainly experience mild COVID-19 disease, hospitalization rates are increasing, with limited understanding of underlying factors. There is an established association between race and severe COVID-19 outcomes in adults in England; however, whether a similar association exists in children is unclear. Objective To investig...

p>Over the next 20 years, the proportion of over-65s in the UK will rise by a quarter, ¹ around two-thirds of whom will live with multimorbidity (multiple long-term conditions). ² This change in demographic is likely to lead to a significant growth in care needs, ³ further increasing demand on primary care and socia...

The impact of COVID‐19 has underlined the need for reliable information to guide clinical practice and policy. This urgency has to be balanced against disruption to journal handling capacity and the continued need to ensure scientific rigour. We examined the reporting quality of highly disseminated COVID‐19 research papers using a bibliometric anal...

Pancreatic cancer is the 10th most common cancer diagnosed; despite recent advances in many areas of oncology, survival remains poor, in part owing to late diagnosis. Whilst primary care data are used widely for epidemiology and pharmacovigilance, they are less used for observing survival. In this study we extracted a pancreatic cancer cohort from...

Background: Growing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There...

Aim To quantify the association between type 2 diabetes remission and 5-year incidence of cardiovascular disease outcomes, overall and in pre-defined subgroups. Methods Retrospective cohort analysis of 60,287 adults with type 2 diabetes from the Care and Health Information Analytics (CHIA) database. Multivariable Cox models were used to assess the...

The purpose of this study was to quantify the association between weight change and the likelihood of remission of type 2 diabetes in a population‐based cohort without intensive interventions. We undertook a retrospective analysis of adults with type 2 diabetes registered across 150 primary care practices in Southern England, United Kingdom, within...

Introduction Recent evidence suggests that ethnic minority groups are disproportionately at increased risk of hospitalisation and death from SARS-CoV-2 infection. Population-based evidence on potential explanatory factors across minority groups and within subgroups is lacking. This study aims to quantify the association between ethnicity and the ri...

Background Osteoarthritis (OA) causes pain and disability. An empathic optimistic consultation approach can improve patient quality of life, satisfaction with care, and reduce pain. However, expressing empathic optimism may be overlooked in busy primary care consultations and there is limited understanding of patients’ views about this approach. A...

Introduction Recent evidence suggests that influenza vaccination may offer protection against COVID-19 severity. Our aim was to quantify the association between influenza vaccination status and risk of hospitalisation or all-cause mortality in people diagnosed with COVID-19. Methods A retrospective cohort study using routinely collected health rec...

The use of big data containing millions of primary care medical records provides an opportunity for rapid research to help inform patient care and policy decisions during the first and subsequent waves of the coronavirus disease 2019 (COVID-19) pandemic. Routinely collected primary care data have previously been used for national pandemic surveilla...

Background The successful management of hypertension requires sustained engagement in self-care behaviour such as adhering to medication regimens and diet. Bandura’s Social Cognitive Theory suggests that self-efficacy is a major determinant of engagement in self-care behaviour. Self-efficacy refers to an individual’s belief in their capacity to exe...

Objective: To investigate the association between Hormone Replacement Therapy (HRT) or Combined Oral Contraception (COCP) use, and the likelihood of death in women with COVID-19. Design: A cohort study Setting: 465 general practices in England within the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) pri...

Background: Growing demand from an ageing population, chronic preventable disease and multimorbidity has resulted in complex health and social care needs requiring more integrated services. Integrating primary care with social services could more efficiently utilise resources, and improve experiences for patients, their families and carers. There i...

Background: Given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: Counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely-used measure of socia...

Background: As the prevalence of older adults with multimorbidity increases, greater integration of services is necessary to manage the range of physical and social needs of the population. The aim of this study is to describe and summarise current evidence, clinical provision and progress towards integrated primary care and social services for old...

Background: given the effect of chronic diseases on risk of severe COVID-19 infection, the present pandemic may have a particularly profound impact on socially disadvantaged counties. Methods: counties in the USA were categorised into five groups by level of social vulnerability, using the Social Vulnerability Index (a widely used measure of socia...

Several studies have reported a higher rate of COVID-19 mortality in men.[1–3] A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups,[3–5] especially among healthcare providers.[6]

Objective To review evidence on routinely prescribed drugs in the UK that could upregulate or downregulate ACE2 and potentially affect COVID-19 disease. Design Systematic review. Data source MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science. Study selection Any design with animal or human models examining a currently prescribed UK...

Background: Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. Objective: To quantify the association between primary care experience and remission of Type 2 diabetes over...

Background Tobacco smoking is a major cause of chronic disease and premature mortality. Its effects are socially patterned. Observational studies show that low socioeconomic status [SES] is associated with higher smoking prevalence and lower cessation rates. Interventions in primary care may improve or exacerbate health inequalities depending on so...

Several studies have reported a higher rate of COVID-19 mortality in men compared with women. A higher rate of COVID-19 mortality has also been reported in Black, Asian and minority ethnic (BAME) groups, compared with White ethnicity, especially among healthcare providers. While some studies attempted to examine if existing disparities could be exp...

Background The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs that up- or down-regulate ACE2 expression are, therefore, of critical research interest as agents that might promote...

A recent systematic review of randomized trials suggested that empathic communication improves patient health outcomes. However, the methods for training healthcare practitioners (medical professionals; HCPs) in empathy and the empathic behaviours demonstrated within the trials were heterogeneous, making the evidence difficult to implement in routi...

Background Empathy is a key health care concept and refers to care that incorporates understanding of patient perspective’s, shared decision making, and consideration of the broader context in which illness is experience. Evidence suggests experiences of doctor empathy correlate with improved health outcomes and patient satisfaction. It has also be...

Objective: To review evidence on routinely prescribed drugs in the UK that could up or downregulate Angiotensin Converting Enzyme 2 (ACE2) and potentially affect COVID-19 disease Design: Systematic review Data source: MEDLINE, EMBASE, CINAHL, the Cochrane Library and Web of Science Study selection: Any design with animal or human models examining a...

Background: The SARS-CoV-2 virus causing COVID-19 binds human angiotensin-converting enzyme 2 (ACE2) receptors in human tissues. ACE2 expression may be associated with COVID-19 infection and mortality rates. Routinely prescribed drugs which up- or down-regulate ACE2 expression are therefore of critical research interest as agents which might promot...