Informatics in Primary Care (BCS, The Chartered Institute for IT)
Not a member yet
595 research outputs found
Sort by
The comparison of cardiovascular risk scores using two methods of substituting missing risk factor data in patient medical records
Full text linkBackground Targeted screening for cardiovascular disease (CVD) can be carried out using existing data from patient medical records. However, electronic medical records in UK general practice contain missing risk factor data for which values must be estimated to produce risk scores.
Objective To compare two methods of substituting missing risk factor data; multiple imputation and the use of default National Health Survey values.
Methods We took patient-level data from patients in 70 general practices in Ealing,North West London. We substituted missing risk factor data using the two methods, applied two risk scores (QRISK2 and JBS2) to the data and assessed differences between methods.
Results Using multiple imputation, mean CVD risk scores were similar to those using default national survey values, a simple method of imputation. There were fewer patients designated as high risk (>20%) using multiple imputation, although differences were again small (10.3%compared with 11.7%; 3.0% compared with 3.4% in women). Agreement in high-risk classification between methods was high (Kappa = 0.91 in men; 0.90 in women).
Conclusions A simple method of substituting missing risk factor data can produce reliable estimates of CVD risk scores. Targeted screening for high CVD risk, using pre-existing electronic medical record data, does not require multiple imputation methods in risk estimation
Patterns of referral in a Canadian primary care electronic health record database: retrospective cross-sectional analysis
Full text linkBackground Databases derived from primary care electronic health records (EHRs) are ideally suited to study clinical influences on referral patterns. This is the first study outside the United Kingdom to use an EHR database to describe rates of referral per patient from family physicians to specialists.
Objective To use a primary care EHR database to describe referrals to specialist physicians; to partition variance in referral rates between the practice and patient levels.
Methods Retrospective cross-sectional analysis of de-identified EHRs of 33 998 patients from 10 primary care practices in Ontario, Canada. The study cohort included all patients who visited their family physician 1 April 2007 to 31 March 2008 (n_24 856). Specialist referrals for each patient were counted for 12 months following their index visit. Rates of referral were compared by sex, age, number of office visits, practice location and specialist type using t-tests or Pearson's correlation. Variance partitioning determined the proportion of variance in the overall referral rate accounted for by the practice and patient levels.
Results In total, 7771 patients (31.3%) had one or more referrals. The overall referral rate was 455/ 1000 patients/year (95% CI, 444_465). Rates were higher for females, older patients and rural practices. The referral rate correlated with thenumber of family physician office visits. Ninety-two percent of the total variance in referral rates was attributable to the patient (vs. practice) level.
Conclusions A Canadian primary care EHR database showed similar patterns of referral to those reported from administrative databases. Most variance in referral rates is explained at the patient level
Complex adaptive systems: a tool for interpreting responses and behaviours
Full text linkBackground Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes.
Objective To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics.
Methods Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective.
Results Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements.
Conclusions Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions
Large complex terminologies: more coding choice, but harder to find data - reflections on introduction of SNOMED CT (Systematized Nomenclature of Medicine - Clinical Terms) as an NHS standard
Full text linkMismatch between the prevalence of overweight and obese children and adolescents and recording in electronic health records: a cross-sectional study
Full text linkBackground The prevalence of obesity has increased dramatically in recent years. An electronic health record (EHR) can be used to identify and manage overweight and obesity by providing timely information.
Objective To estimate the prevalence of overweight and obesity using anthropometric data from an EHR and to compare it with the frequency of diagnoses of 'overweight' and 'obesity' registered by pediatricians.
Methods Cross-sectional, descriptive analytical study from a sample of records from children aged between 2 and 19 years who had at least one well-child visit registered in the EHR over the 24- month period between 2007 and 2008. The record of a diagnosis of overweight or obesity by physicians was comparedwith estimations based on body mass index (BMI; World Health Organization Growth Reference Data).
Results Of 14 743 patients aged 2_19 years, 22.1% were overweight and 9.8% were obese. By contrast, a diagnosis of overweight was registered in the EHR for 3.3% of patients, with a figure of 1.1% for obesity. The prevalence of overweight/obesity was lower in adolescents than in children and preschoolers. Based on BMI cut-off points, we found that only 11.5% of the overweight or obese patients had these diagnoses registered in the EHR. Referral to a nutritionist or endocrinolist, and the frequency of selected laboratory tests based on BMI categories vary between 11.8 and 52.5%.
Conclusion An EHR can contribute to the identification of a population at risk when there is a subregistry of these diagnoses by primary care physicians
Understanding end-user support for health information technology: a theoretical framework
Full text linkBackground Support is often considered an important factor for successful implementation and realising the benefits of health information technology (HIT); however, there is a dearth of research on support and theoretical frameworks to characterise it.
Objective To develop and present a comprehensive, holistic, framework for characterising enduser support that can be applied to various settings and types of information systems.
Method Scoping review of the medical informatics and information systems literature.
Results A theoretical framework of end-user support is presented. It includes the following facets: support source, location of support, support activities, and perceived characteristics of support and support personnel.
Conclusion The proposed framework may be a useful tool for describing and characterising enduser support for HIT. it may also be used by decision makers and implementation leaders for planning purposes
Generalisability of The Health Improvement Network (THIN) database: demographics, chronic disease prevalence and mortality rates
Full text linkIntroduction The degree of generalisability of patient databases to the general population is important for interpreting database research. This report describes the representativeness of The Health Improvement Network (THIN), a UK primary care database, of the UK population.
Methods Demographics, deprivation (Townsend), Quality and Outcomes Framework (QOF) condition prevalence and deaths from THIN were compared with national statistical and QOF 2006/ 2007 data.
Results Demographics were similar although THIN contained fewer people aged under 25 years. Condition prevalence was comparable, e.g. 3.5% diabetes prevalence in THIN, 3.7% nationally. More THIN patients lived in the most affluent areas (23.5% in THIN, 20% nationally). Between 1990 and 2009, standardised mortality ratio ranged from 0.81 (95% CI: 0.39_1.49; 1990) to 0.93 (95% CI: 0.48_1.64; 1995). Adjusting for demographics/ deprivation, the 2006 THIN death rate was 9.08/ 1000 population close to the national death rate of 9.4/1000 population.
Conclusion THIN is generalisable to the UK for demographics, major condition prevalence and death rates adjusted for demographics and deprivation
Primary care provider perceptions and use of a novel medication reconciliation technology
Full text linkBackground Although medication reconciliation (MR) can reduce medication discrepancies, it is challenging to operationalise. Consequently, we developed a health information technology (HIT) to collect a patient medication history and make it available to the primary care (PC) provider. We deployed a self-service kiosk in a PC clinic that permits patients to indicate a medication adherence history. Patient responses are immediately viewable in the legacy electronic health record. This paper describes a survey developed to assess PC provider perceptions of our HIT and HIT implementation effectiveness.
Methods We developed and administered a survey to all PC providers to assess technology implementation effectiveness. The survey included scales measuring (1) user attitudes towards MR, (2) perceptions of our HIT and (3) the local organisational climate for implementation. We also assessed the consistency and quality of tool use.
Results Nearly 90% of PC providers responded to the survey and 58% indicated that they were familiar with the technology and had seen the tool output. Most providers believed that MR represented an important safety intervention, although 43% did not believe that they had the necessary resources to manage discrepancies. Composite scale scores for the 58% of respondents familiar with the HIT indicate that the majority favoured our tool over usual care. However, composite scale scores suggest that the climate for implementation at our facility was suboptimal. Overall, the quality and consistency of tool use among providers was very heterogeneous.
Conclusions A patient self-service kiosk offers an efficientmechanismto collect amedication adherence history; provider survey responses indicate that they appreciated and used the MR kiosk output. Nonetheless, opportunities exist to improve data displays and embed decision support to facilitate discrepancy management
Development of a database for cervical cytology reports
Full text linkBackground Cervical cancer is an important cause of female mortality. Its incidence, however, has been drastically reduced by early detection using the Papanicolaou screening method. As a result of the widespread use of this method, a large amount of cytological information has to be stored, printed and handled efficiently. This paper describes a database system designed to manage information from studies of cervical cytology, which was developed at the Faculty of Medical Sciences, National University of La Plata, Argentina.
Methods Information needs were assessed by interviews with physicians and analysis of cytology reports. The database was developed using MS Access 2007.
Results The database is designed to collect, display, sort and print patient demographics, clinical data and cytological studies. Diagnoses can be stored either as international classifications or as free text. The database contains 45 tables and 50 forms for data entry, editing and display. This information can be exported to spreadsheets and statistical packages.
Conclusion This database gives users easy access to patients' cytological diagnoses and provides a useful tool for physicians and public health researchers
Computer-assisted history-taking systems (CAHTS) in health care: benefits, risks and potential for further development
Full text linkBackground A computer-assisted history-taking system (CAHTS) is a tool that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Despite the many possible applications and even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice.
Objective Through an interpretative review of the literature, we provide an overview of the field of CAHTS, which also offers an understanding of the impact of these systems on policy, practice and research.
Methods We conducted a search and critique of the literature on CAHTS. Using a comprehensive set of terms, we searched: MEDLINE, EMBASE, The Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, The Cochrane Central Register of Controlled Trials, The Cochrane Methodology Register, Health Technology Assessment Database and the NHS Economic Evaluation Database over a ten-year period (January 1997 to May 2007) to identify systematic reviews, technical reports and health technology assessments, and randomised controlled trials.
Results The systematic review of the literature suggests that CAHTS can save professionals' time, improve delivery of care to those with special needs and also facilitate the collection of information, especially potentially sensitive information (e.g. sexual history, alcohol consumption). The use of CAHTS also has disadvantages that impede the process of history taking and may pose risks to patients. CAHTS are inherently limited when detecting non-verbal communication, may pose irrelevant questions and frustrate the users with technical problems. Our review suggests that barriers such as a preference for pen-and-paper methods and concerns about data loss and security still exist and affect the adoption of CAHTS. In terms of policy and practice, CAHTS make input of data from disparate sites possible, which facilitates work from disparate sites and the collection of data for nationwide screening programmes such as the vascular risk assessment programme for people aged 40_74, now starting in England.
Conclusions Our review shows that for CAHTS to be adopted in mainstream health care, important changes should take place in how we conceive, plan and conduct primary and secondary research on the topic so that we provide the framework for a comprehensive evaluation that will lead to an evidence base to inform policy and practice