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Articles by C Millett
Total Records ( 2 ) for C Millett
  J Murray , S Saxena , C Millett , V Curcin , S de Lusignan and A. Majeed
 

Objectives. To explore trends by ethnicity in clinical risk factor recording and control among patients with coronary heart disease (CHD), during a period of major investment in quality improvement initiatives in general practice in England.

Design. Longitudinal study from 1998 to 2007, using general practice data extracted from electronic patient records of all adult patients (n = 177 412) registered in 2007.

Setting. Twenty-nine general practices in Wandsworth south-west London.

Subjects. Three thousand two hundred registered patients with a recorded diagnosis of CHD, in 2007.

Main outcome measures. Mean systolic and diastolic blood pressure and mean cholesterol of patients with CHD, for each calendar year.

Results. From 1998 to 2007, the proportion of patients with CHD who had their blood pressure recorded rose from 33.2% to 93.9% and cholesterol from 21.7% to 83.5%. Over this period, mean blood pressure decreased from 140/80 to 133/74 mmHg (P < 0.001). There was a reduction in mean cholesterol from 5.2 to 4.3 mmol/l (P < 0.001). Reductions in mean blood pressure and cholesterol occurred across all ethnic groups.

Conclusions. From 1998 to 2007, risk factor control among patients with CHD improved, with reductions in their mean blood pressure and cholesterol across all ethnic groups. Widespread policy change has helped to improve the quality and equity of primary care for heart disease patients. Health improvements predated implementation of the Quality and Outcomes Framework and have since continued. Our findings illustrate how a national health care system with universal coverage can significantly reduce inequalities and improve chronic disease care for all ethnic groups.
  A Verma , R Birger , H Bhatt , J Murray , C Millett , S Saxena , R Banarsee , S Gnani and A. Majeed
  Background

There has been little research on the impact of quality improvement initiatives on ethnic disparities in diabetes management in the UK.

 Methods

Population-based, repeated cross-sectional survey of recorded measurements, prescribing and achievement of treatment targets among 4309 patients with diabetes mellitus using electronic medical records from 26 general practices in North-West London from 1997 to 2006.

 Results

Proportions of patients having their blood pressure (BP), cholesterol and HbA1c measured and recorded increased over the study period [from 50.6% to 87.0% (P < 0.0001), 17.0% to 76.7% (P < 0.0001) and 32.9% to 74.1% (P < 0.0001), respectively]. However, some ethnic differences remained. Black patients with diabetes were less likely to achieve target BP (<140/80 mmHg) than the white group [2006 age-sex adjusted odds ratio (AOR), 0.65; 95% confidence interval (CI), 0.51–0.83]. South Asians were found to have better lipid target control (2006 AOR, 1.57; CI, 1.23–2.00), were more likely to receive oral hypoglycaemic agents (2006 AOR, 2.27; CI, 1.79–2.86) but less likely to receive insulin (2006 AOR, 0.54; CI, 0.42–0.69) than the white group.

 Conclusions

Although ethnic disparities persist in diabetes management in this study population, these are starting to be addressed, particularly in the South Asian group. All ethnic groups have benefited from recent quality initiatives in the UK.
 
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