Simon de Lusignan

Simon de Lusignan
University of Oxford | OX · Nuffield Department of Primary Care Health Sciences

BSc MBBS MSc MD(Res) FHEA FBCS CITP FACHI FFCI FRCGP

About

798
Publications
126,529
Reads
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15,360
Citations
Introduction
I am a senior academic GP with research interests in: 1. How to use routinely collected computerised medical record (CMR) data for surveillance, quality improvement and research. 2. How to incorporate technology into clinical workflow - using a range of methods including video 3. New roles in primary care, particularly those enabled by technology.
Additional affiliations
June 2019 - September 2019
University of Oxford
Position
  • Professor
February 2014 - present
Royal College of General Practitioners
Position
  • Managing Director
February 2011 - August 2015
University of Surrey
Position
  • Head of Department
Education
October 1976 - July 1982
The Medical College of St. Bartholomnew's Hospital
Field of study
  • Medicine

Publications

Publications (798)
Chapter
Full-text available
In this paper, we present a Business Analytics (BA) framework, which addresses the challenge of analysing primary care outcomes for both patients and clinicians from multiple data sources in an accurate manner. A review of the process monitoring literature has been conducted in the context of healthcare management and decision making and its findin...
Chapter
Full-text available
The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, providing sentinel surveillance since 1967. We report the interdisciplinary informatics required to run such a system. We used the Donabedian framework to describe the interdisciplinary informatics roles that s...
Article
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...
Article
Full-text available
Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as Engl...
Article
Full-text available
We investigated thrombocytopenic, thromboembolic and hemorrhagic events following a second dose of ChAdOx1 and BNT162b2 using a self-controlled case series analysis. We used a national prospective cohort with 2.0 million(m) adults vaccinated with two doses of ChAdOx or 1.6 m with BNT162b2. The incidence rate ratio (IRR) for idiopathic thrombocytope...
Article
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Background In England, most prescribing of direct-acting oral anticoagulants for atrial fibrillation (AF) is in primary care. However, there remain gaps in our understanding of dosage and disparities in use. We aimed to describe trends in direct oral anticoagulant (DOAC) prescribing, including dose reduction in people with renal impairment and othe...
Article
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are both considered to be part of standard care in the management of glycemia in type 2 diabetes. Recent trial evidence has indicated benefits on primary kidney end points for individual drugs within each medication class. Despit...
Article
Full-text available
Background: Smoking is attributed to both micro- and macrovascular complications at any stage of metabolic deregulation including prediabetes. Current global diabetes prevention programmes appear to be glucocentric, and do not fully acknowledge the ramifications of cardiorenal risk factors in smokers and ex-smokers. A more holistic approach is need...
Article
Full-text available
Background Accurate assessment of COVID-19 severity in the community is essential for patient care and requires COVID-19-specific risk prediction scores adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms, and risk factors, we aimed to develop and validate two COVID-19-specific risk prediction scor...
Preprint
Background Anaemia is common in chronic kidney disease (CKD). It is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anaemia in CKD in this setting are needed. Methods We c...
Article
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Background General Practitioners (GPs) report high levels of burnout, job dissatisfaction, and turnover intention. The complexity of presenting problems to general practice makes diagnostic uncertainty a common occurrence that has been linked to burnout. The interrelationship between diagnostic uncertainty with other factors such as burnout, job sa...
Preprint
Full-text available
Background: Anaemia is common in chronic kidney disease (CKD). It is associated with increased cardiovascular risk and reduced quality of life, but is often sub-optimally managed. Most patients are managed in primary care alongside other comorbidities. Interventions to improve the management of anaemia in CKD in this setting are needed. Methods: W...
Article
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Aims: To compare different packages of care across care providers in Scotland on foot-related outcomes. Methods: A retrospective cohort study with primary and secondary care electronic health records from the Scottish Diabetes Registry, including 6,845 people with type 2 diabetes and a first foot ulcer occurring between 2013 and 2017. We assesse...
Article
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Background Influenza surveillance systems vary widely between countries and there is no framework to evaluate national surveillance systems in terms of data generation and dissemination. This study aimed to develop and test a comparative framework for European influenza surveillance. Methods Surveillance systems were evaluated qualitatively in fiv...
Article
Objective: While the COVID-19 pandemic provided a global stimulus for digital health capacity, its development has often been inequitable, short-term in planning, and lacking in health system coherence. Inclusive digital health and the development of resilient health systems are broad outcomes that require a systematic approach to achieving them. T...
Article
As the COVID-19 pandemic began in early 2020, primary care influenza sentinel surveillance networks within the Influenza - Monitoring Vaccine Effectiveness in Europe (I-MOVE) consortium rapidly adapted to COVID-19 surveillance. This study maps system adaptations and lessons learned about aligning influenza and COVID-19 surveillance following ECDC /...
Article
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...
Article
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Introduction: Through the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA. Methods: Visit definitions were agreed on centrally, implement...
Article
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Real-world evidence (RWE) increasingly informs public health and healthcare decisions worldwide. A large database has been created (“Integrated Dataset”) that integrates primary care electronic medical records with pharmacy and medical claims data on >123 million US patients since 2014. This article describes the components of the Integrated Datase...
Preprint
BACKGROUND Innovation in seasonal influenza vaccine development has resulted in a wider range of formulations becoming available. Understanding vaccine coverage across populations including the timing of administration is important when evaluating vaccine benefit-risk. OBJECTIVE We carried out this study to report the representativeness of the Eng...
Preprint
BACKGROUND The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conduct...
Article
Full-text available
IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe.AimUsing a multicentre test-negative study, we measured COVID-19 vaccine effectiveness (VE) against symptomatic infection.Methods Individuals with COVID-19 or acute respiratory symptoms at primary care/community level in 10 European countries were tested for SARS-...
Article
Full-text available
Introduction: Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, help...
Article
Tissue examination by hand remains an essential technique in clinical practice. The effective application depends on skills in sensorimotor coordination, mainly involving haptic, visual, and auditory feedback. The skills clinicians have to learn can be as subtle as regulating finger pressure with breathing, choosing palpation action, monitoring inv...
Preprint
Introduction Long COVID, a new condition whose origins and natural history are not yet fully established, currently affects 1.5 million people in the UK. Most do not have access to specialist long COVID services. We seek to optimise long COVID care both within and outside specialist clinics, including improving access, reducing inequalities, helpin...
Article
Full-text available
Aims: To determine whether achieving early glycaemic control, and any subsequent glycaemic variability, was associated with any change in risk of major adverse cardiovascular events (MACE). Materials and methods: A retrospective cohort analysis from the Oxford-Royal College of General Practitioners Research and Surveillance Centre database - a l...
Article
Objectives To monitor changes in seroprevalence of SARS-CoV-2 antibodies in populations over time and between different demographic groups. Methods A subset of practices in the Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network provided serum samples, collected when volunteer patients had r...
Article
Background Atopic dermatitis (AD) is associated with immune dysregulation, but epidemiological data on the pattern of autoimmune comorbidity in people with AD are limited. Objective To determine the risk of autoimmune conditions in people newly diagnosed with AD. Methods Retrospective cohort analysis (January 2009-December 2018), using the UK-bas...
Article
Full-text available
Objectives To describe rates and variation in uptake of pneumococcal and measles, mumps and rubella (MMR) vaccines in children and associated change in vaccine-preventable diseases (VPDs) across the first and second waves of the COVID-19 pandemic. Methods Retrospective database study of all children aged <19 registered with a general practice in t...
Article
Full-text available
Background: Colchicine has been proposed as a COVID-19 treatment. Aim: To determine whether colchicine reduces time to recovery and COVID-19-related admissions to hospital and/or deaths among people in the community. Design and setting: Prospective, multicentre, open-label, multi-arm, randomised, controlled, adaptive platform trial (PRINCIPLE)...
Preprint
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Background: Respiratory syncytial virus (RSV) commonly causes lower respiratory tract infections (LRTI) and hospitalisation in children. In 2019/20, the Europe-wide RSV ComNet standardised study protocol was developed to measure the clinical and socio-economic disease burden of RSV infections amongst children <5 years of age in primary care. RSV...
Article
Background: Respiratory syncytial virus (RSV) commonly causes lower respiratory tract infections (LRTI) and hospitalisation in children. In 2019-2020, the Europe-wide RSV ComNet standardised study protocol was developed to measure the clinical and socio-economic disease burden of RSV infections amongst children <5 years of age in primary care. RSV...
Preprint
Full-text available
Background: Long covid (LC) is defined as fatigue, breathlessness, cognitive dysfunction and a variety of other symptoms occurring after coronavirus-2019 disease (COVID-19). (1,2) Over a million people in the UK are estimated to have prolonged symptoms after COVID-19, with 60% of long covid patients reporting extended symptoms lasting months, and 2...
Preprint
Full-text available
Backgrounds The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as, Eng...
Preprint
Full-text available
Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as, Eng...
Article
Full-text available
Background Coronavirus disease 2019 (COVID-19) has disproportionately affected people with mental health conditions. Aims We investigated the association between receiving psychotropic drugs, as an indicator of mental health conditions, and COVID-19 vaccine uptake. Method We conducted a cross-sectional analysis of a prospective cohort of the Nort...
Preprint
Full-text available
Background People with multiple health conditions are more likely to have poorer health outcomes and greater care and service needs; a reliable measure of multimorbidity would inform management strategies and resource allocation. This study aims to develop and validate a modified version of the Cambridge Multimorbidity Score in an extended age rang...
Article
Full-text available
Background: Most studies of long covid (symptoms of COVID-19 beyond 4 weeks) have focused on people hospitalised in their initial illness. Long covid is thought to be under-recorded in UK primary care electronic records. Objective: We sought to determine which symptoms people present to primary care following COVID-19, and whether presentation d...
Article
Full-text available
Background: Several countries restricted the administration of ChAdOx1 to older age groups in 2021 over safety concerns following case reports and observed versus expected analyses suggesting a possible association with cerebral venous sinus thrombosis (CVST). Large datasets are required to precisely estimate the association between Coronavirus Di...
Article
Full-text available
Introduction The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received t...
Preprint
Full-text available
Background: Following COVID-19 up to 40% of people have ongoing health problems, referred to as “post-acute COVID-19” or long covid (LC). LC varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical characteris...
Article
Full-text available
Background: Smoking is attributed to both micro- and macrovascular complications at any stage of metabolic deregulation including prediabetes, particularly those who develop the disease at a young age. Current global diabetes prevention programmes appear to be glucocentric, and do not fully acknowledge the ramifications of cardiorenal risk factors...
Article
Full-text available
Background: Following COVID-19, up to 40% of people have ongoing health problems, referred to as "post-acute COVID-19" or 'long covid'. Long covid varies from a single persisting symptom to a complex multi-system disease. Research has flagged that this condition is under recorded in primary care record; and seeks to better define its clinical char...
Article
Background: Alopecia areata (AA) is a common cause of non-scarring hair loss that can have a profound psychological impact. Objective: To assess the co-occurrence of depression and anxiety in adults with AA compared to the general population, and evaluate the mental health treatment burden and impact on time-off work and unemployment. Methods:...
Article
Full-text available
Introduction: Total population mortality rates have been falling and life expectancy increasing for more than 30 years. Diabetes remains a significant risk factor for premature death. Here we used the Oxford Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) practices to determine diabetes-related vs non-diabetes-re...
Article
Full-text available
Background Valproate is a teratogenic drug that should be avoided during the preconception period and pregnancy. The aim was to explore general practitioners’ (GPs) prescription patterns over time, describe trends, and explore inter-practice variation within primary care. Methods We identified women of childbearing age (12–46 years old) in the Roy...
Article
Full-text available
Background While population estimates suggest high vaccine effectiveness against SARS-CoV-2 infection, the protection for health care workers, who are at higher risk of SARS-CoV-2 exposure, is less understood. Methods We conducted a national cohort study of health care workers in Wales (UK) from 7 December 2020 to 30 September 2021. We examined up...
Article
Full-text available
Background Frailty is a common condition in older adults and has a major impact on patient outcomes and service use. Information on the prevalence in middle-aged adults and the patterns of progression of frailty at an individual and population level is scarce. To address this, a cohort was defined from a large primary care database in England to de...
Article
Background: COVID-19 vaccines approved in the UK are highly effective in general population cohorts, however, data on effectiveness among individuals with clinical conditions that place them at increased risk of severe disease are limited. Methods: We used GP electronic health record data, sentinel virology swabbing and antibody testing within a co...
Preprint
Full-text available
BACKGROUND Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM d...
Preprint
Full-text available
Background Accurate assessment of COVID-19 severity in the community is essential for best patient care and efficient use of services and requires a risk prediction score that is COVID-19 specific and adequately validated in a community setting. Following a qualitative phase to identify signs, symptoms and risk factors, we sought to develop and val...
Article
Full-text available
Background: Social distancing and other non-pharmaceutical interventions to reduce spread of COVID-19 infection in the UK have led to substantial changes in delivering ongoing care for patients with chronic conditions, including type 2 diabetes mellitus (T2DM). Clinical guidelines for management and prevention of complications for people with T2DM...
Preprint
IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe. We measured COVID-19 vaccine effectiveness (VE) against symptomatic infection, using a multicentre test-negative study at primary care/community level in Europe.Methods Patients presenting with COVID-19/ARI symptoms at primary care/community level in 10 countries...
Article
Full-text available
Background It remains unclear to what extent reductions in urgent referrals for suspected cancer during the COVID-19 pandemic were the result of fewer patients attending primary care compared to GPs referring fewer patients. Methods Cohort study including electronic health records data from 8,192,069 patients from 663 English practices. Weekly con...
Article
Full-text available
Objectives At the end of 2020, many countries commenced a vaccination programme against SARS-CoV-2. Public health authorities aim to prevent, and interrupt, outbreaks of infectious disease in social care settings. We aimed to investigate the association between the introduction of the vaccination programme and the frequency and duration of COVID-19...
Article
Full-text available
Both adequate coverage and adherence to paediatric immunisation schedules are required for optimal protection against vaccine preventable diseases. We studied the timeliness of routine paediatric vaccinations according to the NHS’s immunisation schedule and potential factors of schedule adherence. Immunisation data was obtained from the Royal Colle...
Article
Full-text available
Introduction Alopecia areata (AA) is a common cause of immune-mediated non-scarring hair loss. Links between AA and common mental health, autoimmune and atopic conditions, and common infections have previously been described but remain incompletely elucidated and contemporary descriptions of the epidemiology of AA in the UK are lacking. Methods an...
Preprint
BACKGROUND Sodium-glucose co-transporter-2 inhibitor (SGLT2i)s and glucagon-like peptide-1 receptor agonist (GLP-1RA)s are both considered to be standard care in the management of glycaemia in type 2 diabetes. Recent trial evidence has indicated benefits on primary renal endpoints for individual drugs within each medication class. Despite potential...
Article
Background Sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are both considered to be part of standard care in the management of glycemia in type 2 diabetes. Recent trial evidence has indicated benefits on primary kidney end points for individual drugs within each medication class. Despite...
Article
Full-text available
Background Registries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe. Objectives We aimed to report on the organization of different sourc...
Article
Full-text available
Background The UK COVID-19 vaccination programme has prioritised vaccination of those at the highest risk of COVID-19 mortality and hospitalisation. The programme was rolled out in Scotland during winter 2020–21, when SARS-CoV-2 infection rates were at their highest since the pandemic started, despite social distancing measures being in place. We a...
Preprint
Full-text available
Objectives: Colchicine has been proposed as a COVID-19 treatment, but its effect on time to recovery is unknown. We aimed to determine whether colchicine is effective at reducing time to recovery and COVID-19 related hospitalisations/dea