Peter Schofield

King's College London | KCL · Department of Primary Care and Public Health Sciences

Aims The associations of prior homelessness with current health are unknown. Using nationally representative data collected in private households in England, this study aimed to examine Common Mental Disorders (CMDs), physical health, alcohol/substance dependence, and multimorbidities in people who formerly experienced homelessness compared to peop...

Introduction Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are associated with various social determinants. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address known social determinants of mental disorders, may be an effective way to reduce the...

Background Inhaled corticosteroid (ICS) therapy has been demonstrated to reduce the risk of COPD exacerbations. It should only be prescribed to COPD patients who are not adequately controlled by dual long-acting bronchodilator therapy and who have ≥2 exacerbations per year and a blood eosinophil count ≥300cells/µL. ICS therapy is widely prescribed...

Background Refugees are at an elevated risk of some mental disorders with studies highlighting the contributing role of post-migration factors. Studies of migrant groups show neighborhood social composition, such as ethnic density, to be important. This is the first longitudinal study to examine this question for refugees and uses a novel quasi-exp...

Globally, mental disorders account for almost 20% of disease burden and there is growing evidence that mental disorders are socially determined. Tackling the United Nations Sustainable Development Goals (UN SDGs), which address social determinants of mental disorders, may be an effective way to reduce the global burden of mental disorders. We condu...

Background Impact of pre-migration trauma and post-migration settlement on refugee mental health and wellbeing is well-documented. However, little research has focused on the specific places where refugees settle and spend their daily lives within the post-migration context. This study adopts an eco-social perspective to explore the relationship be...

ObjectivesUK cities show higher incidence of psychotic disorders, but the reasons remain unclear. This case-control study uses data from one of the first and largest person-level data linkages between mental health records and the UK census to explore associations previously only assessed using ecological or smaller studies in England. Methods The...

Post-migration factors significantly influence refugee mental health. This scoping review looks at the role of place in refugee mental health. We included 34 studies in Global North high-income countries that elaborated on the place characteristics of facilities, neighbourhoods, urban and rural areas, and countries. While the role of place remains...

Background: Despite well-documented clinical benefits of longitudinal doctor-patient continuity in primary care, continuity rates have declined. Assessment by practices or health commissioners is rarely undertaken. Aim: Using the Usual Provider of Care (UPC) score this study set out to measure continuity across 126 practices in the mobile, multi...

Background: Studies typically highlight area level variation in the incidence of non-affective but not affective psychoses. We compared neighbourhood-level variation for both types of disorder, and the specific effects of neighbourhood urbanicity and ethnic density, using Danish national registry data. Methods: Population based cohort (2,224,464...

Introduction Using data from a a primary care pay-for-performance scheme targeting quality indicators, the objective of this study was to assess if people living with type 2 diabetes mellitus (T2DM) and severe mental illnesses (SMI) experienced poorer glycemic management compared with people living with T2DM alone, and if observed differences varie...

Background Many studies report an ethnic density effect whereby psychosis incidence among ethnic minority groups is higher in low co-ethnic density areas. It is unclear whether an equivalent density effect applies with other types of socioeconomic disadvantages. Methods We followed a population cohort of 2 million native Danes comprising all those...

A quality improvement (QI) scheme was launched in 2017, covering a large group of 25 general practices working with a deprived registered population. The aim was to improve the measurable quality of care in a population where type 2 diabetes (T2D) care had previously proved challenging. A complex set of QI interventions were co-designed by a team o...

Background Providing high-quality clinical care and good patient experience are priorities for most healthcare systems. Aim To understand the relationship between general practice funding and patient-reported experience. Design and setting Retrospective longitudinal study of English general practice-level data for the financial years 2013–2014 to...

Background Primary care in England is contracted to provide essential services. Many practices also provide additional services, termed ‘directed enhanced services’ (DES), for extra income. The optional nature of DES may result in inequitable service delivery. Aim To determine the range of DES activity and equity of service provision. Design & se...

Epidemiology and medical statistics have been partner disciplines since the nineteenth century, despite disagreement between their founding fathers. This chapter begins with a summary of the discrete uses of statistical techniques in epidemiological research, followed by some guidance on constructing regression models—a common task, but one which i...

Background: Blood eosinophil count has been proposed as a predictor of response to inhaled corticosteroid (ICS) in the prevention of acute exacerbations of COPD. An optimal threshold of blood eosinophil count for prescribing ICS has not been agreed. Doubt has been cast on the role by observational studies. The role of inhaled corticosteroids in th...

Purpose The aim of this study was to explore how small area deprivation is associated with attitudes towards mental illness in a large sample of individuals living in private households in England. Method Cross-sectional data from Health Survey for England (2014) were analysed using multilevel models. The exposure of interest was the deprivation l...

Objective To explore the relationship between general practice capitation funding and quality ratings based on general practice inspections. Design Cross-sectional study pooling 3 years of primary care administrative data. Setting UK primary care. Participants 7310 practices (95% of all practices) in England which underwent Care Quality Commissi...

Background: PSYCHLOPS, a patient-generated mental health outcome questionnaire, invites clients to describe the problem that troubles them most. PSYCHLOPS was utilised in Polish primary care in the context of a brief CBT-based intervention for mild to moderate mental health problems. Aim: To explore how patients conceptualise their problems and...

Refugees are at increased risk of mental disorders. This is increasingly attributed to the post-migration context in which they live, typically socio-economically deprived urban areas. In general, neighbourhood factors are relevant to mental health outcomes. There is now research showing that neighbourhood ethnic density is related to the incidence...

Background: Neighbourhood social context might play a role in modifying mortality outcomes in severe mental illness, but has received little attention to date. Therefore, we aimed to assess in an ethnically diverse and urban location the association of neighbourhood-level characteristics and individual-level factors for all-cause, natural-cause, a...

Background Much research attention has been given to the high rates of psychosis diagnosed in the Black community. However, little has been heard about possible reasons for this from Black African and Caribbean mental health service users themselves. Aims To determine how Black African and Caribbean service users perceive and explain these apparen...

Background Mental health stigma persists despite coordinated and widely-evaluated interventions. Socioeconomic, structural, and regional context may be important in shaping attitudes to mental illness, and response to stigma interventions. Regional differences in attitudes towards mental illness could be relevant for intervention, but have not been...

Background Depression is associated with increased mortality, however, little is known about its variation by ethnicity. Methods We conducted a cohort study of individuals with ICD-10 unipolar depression from secondary mental healthcare, from an ethnically diverse location in southeast London, followed for 8 years (2007–2014) linked to death certi...

This article looks at the use of large datasets of health records, typically linked with other data sources, in mental health research. The most comprehensive examples of this kind of ‘big data’ are typically found in Scandinavian countries, although there are also many useful sources in the UK. There are a number of promising methodological innova...

Objective To assess the association of fish consumption with risk of dementia and its dose–response relationship, and investigate variations in the association among low-, middle- and high-income countries. Design A new community-based cross-sectional study and a systematic literature review. Settings Urban and rural communities in China; populat...

Chronic lung disease: LOWER RISK OF READMISSION FOR LONDON-BASED PATIENTS: A managed reduction of hospital readmissions for London-based chronic lung disease patients may not be needed. Preventing hospital readmissions for patients with chronic obstructive pulmonary disease (COPD) is a key priority to improve patient care and limit costs. However,...

Chronic obstructive pulmonary disease risk is lower in black and south Asian people than white people, when adjusting for age, sex, deprivation and smoking status. The role of smoking intensity was assessed for its contribution to ethnic differences in chronic obstructive pulmonary disease risk, a relationship not previously investigated. This cros...

Background: In international studies, greater investment in primary health care is associated with improved population health outcomes. Aim: To determine whether investment in general practice is associated with secondary care utilisation, patient satisfaction, and clinical outcomes. Design and setting: Retrospective cross-sectional study of g...

Background: For different migrant groups living in an area with few people from the same ethnic background is associated with increased psychosis incidence (the ethnic density effect). We set out to answer the question: are there generational differences in this effect? Methods: Analysis of a population based cohort (2.2 million) comprising all...

Table S3. Estimated prevalence of Type 2 diabetes mellitus across ethnic groups, by age and severe mental illness status.

Table S1. Relative risk (95% CI) for Type 2 diabetes mellitus in people with severe mental illness vs. no severe mental illness; stratified by ethnicity and age (ten year bands). Table S2. Risk difference (RD) with 95% Confidence Intervals for estimated prevalence of Type 2 diabetes mellitus in people with severe mental illness compared to people...

Advances in information technology and data storage, so-called ‘big data’, have the potential to dramatically change the way we do research. We are presented with the possibility of whole-population data, collected over multiple time points and including detailed demographic information usually only available in expensive and labour-intensive surve...

Introduction Living in an area with few people from the same ethnic background has been associated with increased incidence of psychosis (the ethnic density effect). Objectives Compare associations between neighbourhood ethnic density and incidence of non-affective psychosis for first and second generation migrants. Methods Population based cohor...

Background: Rates of psychotic disorder are raised for many migrant groups. Understanding the role played by the social context in which they live may help explain why. This study investigates the effect of both neighbourhood ethnic density and urbanicity on the incidence of non-affective psychosis for migrant groups. Method: Population based co...

Tobacco smoking remains one of the greatest public health problems facing the UK today. It varies significantly by ethnic group. This study aimed to??? determine whether ethnic differences in smoking behaviour are related to neighbourhood level own-group ethnic density across south and east London. The association between ethnic density and indiv...

Aims: To investigate whether the association of severe mental illness with Type 2 diabetes varies by ethnicity and age. Methods: We conducted a cross-sectional analysis of data from an ethnically diverse sample of 588 408 individuals aged ≥18 years, registered to 98% of general practices (primary care) in London, UK. The outcome of interest was pr...

Background This study focuses on health care received by people with serious mental illness (SMI). The aim is to examine the economic implications of different locations of management of care and the views of service users and staff regarding services set up as alternatives to secondary care. Objectives Specific objectives are to (1) identify peop...

Background The burden of morbidity represented by patients with long term conditions (LTCs) varies substantially between general practices. This study aimed to determine the characteristics of general practices with high morbidity burden. Method Retrospective cross-sectional study; general practices in England, 2014/15. Three composite morbidity me...

Background: It has been observed that mental disorders, such as psychosis, are more common for people in some ethnic groups in areas where their ethnic group is less common. We set out to test whether this ethnic density effect reflects minority status in general, by looking at three situations where individual characteristics differ from what is...

Background: Suboptimal treatment of cardiovascular diseases (CVD) among patients with severe mental illness (SMI) may contribute to physical health disparities. Aim: To identify SMI characteristics associated with meeting CVD treatment and prevention guidelines. Design and setting: Population-based electronic health record database linkage bet...

Background Lower risk of COPD has been reported in black and Asian people, raising questions of poorer recognition or reduced susceptibility. We assessed prevalence and severity of COPD in ethnic groups, controlling for smoking. Method A retrospective cross-sectional study using routinely collected primary care data in London. COPD prevalence, sev...

Purpose: People with severe mental illnesses (SMI) experience a 17- to 20-year reduction in life expectancy. One-third of deaths are due to cardiovascular disease. This study will establish the relationship of SMI with cardiovascular disease in ethnic minority groups (Indian, Pakistani, Bangladeshi, black Caribbean, black African and Irish), in th...

Background: Studies have linked ethnic differences in depression rates with neighbourhood ethnic density although results have not been conclusive. We looked at this using a novel approach analysing whole population data covering just over one million GP patients in four London boroughs. Method: Using a dataset of GP records for all patients reg...

Background: Concerns about adverse effects on patient satisfaction may be an important obstacle to attempts to curtail antibiotic prescribing. Aim: To determine the relationship between antibiotic prescribing in general practice and reported patient satisfaction. Design and setting: Retrospective cross-sectional study of general practices in E...

Objectives Concerns have been raised about a possible link between bisphosphonate use, and in particular alendronate, and upper gastrointestinal (UGI) cancer. A number of epidemiological studies have been published with conflicting results. We conducted a systematic review and meta-analysis of observational studies, to determine the risk of esophag...

Background: Demand for England's accident and emergency (A&E) services is increasing and is particularly concentrated in areas of high deprivation. The extent to which primary care services, relative to population characteristics, can impact on A&E is not fully understood. Aim: To conduct a detailed analysis to identify population and primary ca...

Background: Black people in London are at significantly lower risk of COPD than white people (OR 0.44; 0.39 to 0.51) when age, smoking, sex and deprivation are accounted for, but disease seems no less severe. Genetic factors in the metabolism and addictive potential of nicotine have been considered in these differences. The role of number of cigare...

This study explores the relationship between alcohol consumption, health, ethnicity and socioeconomic deprivation. 27 991 people aged 65 and over from an inner-city population, using a primary care database. Primary outcome measures were alcohol use and misuse (>21 units per week for men and >14 for units per week women). Older people of black and...

Hypertension is the most prevalent cardiovascular long-term condition in the UK and is associated with a high rate of multimorbidity (MM). Multimorbidity increases with age, ethnicity and social deprivation. Previous studies have yielded conflicting findings about the relationship between MM and blood pressure (BP) control. Our aim was to investiga...

Background Hospitalizations for COPD are associated with poor patient prognosis. Length of stay (LOS) of COPD admissions in a large urban area and patient and hospital factors associated with it are described. Methods Retrospective longitudinal study. All COPD patients registered with London general practitioners and admitted as an emergency with...

Background COPD hospitalisations are associated with poor patient prognosis and are the major cost of the condition. Aim The study aimed to describe the distribution of length of stay of repeated admissions among patients hospitalised with COPD exacerbations. It examined variation in length of stay between different hospitals and the secondary c...

Background: Statins are an important intervention for primary and secondary cardiovascular disease (CVD) prevention. We aimed to establish the variation in primary preventive treatment for CVD with statins in the English population. Methods: Cross sectional analyses of 6155 English primary care practices with 40,017,963 patients in 2006/7. Linea...

Objective: To investigate the impact of rising primary care prescribing of inhaled long-acting anti-muscarinic (LAMA) and combined inhaled long-acting beta-agonist and corticosteroid (LABA+ICS) drugs on COPD admissions. Design: Retrospective analysis of COPD admission and prescribing data routinely collected between 2001 and 2010. Setting: Rep...

Background Serious mental illness (SMI) is associated with elevated mortality compared to the general population; the majority of this excess is attributable to co-occurring common physical health conditions. There may be variation within the SMI group in the distribution of physical co/multi-morbidity. This study aims to a) compare the pattern of...

Background: Patients with coronary heart disease (CHD) who are depressed have an increased risk of further cardiac events and higher mortality. Aim: To use a patient generated instrument (PSYCHLOPS) to define categories of concerns in patients with CHD. To define the psychometric characteristics of patients in each category. Design and setting:...

Background: Increased prescribing of inhaled long-acting anti-muscarinic (LAMA) and combined inhaled long-acting β2-agonist and corticosteroid (LABA+ICS) drugs for the treatment of chronic obstructive pulmonary disease (COPD) has led to hopes of reduced hospital admissions from this disease. Aims: To investigate the impact of rising primary care...

The Government has introduced personal health budgets in England's National Health Service (NHS). A three-year programme of pilots has shown that personal health budgets have improved outcomes and are generally cost-effective. They are seen as a key step toward creating a personalized service. However, the Government is attributing the success of t...

Background: Quality indicators for primary care focus predominantly on the public health model and organisational measures. Patient experience is an important dimension of quality. Accreditation for GP training practices requires demonstration of a series of attributes including patient-centred care. Aim: The national GP Patient Survey (GPPS) wa...

Background: Relatively little is known about how people and groups who function in boundary-spanning positions between different sectors, organisations and professions contribute to improved quality of health care and clinical outcomes. Objectives: To explore whether or not boundary-spanning processes stimulate the creation and exchange of knowled...