Free-text analysis of general practice out-of-hours (GPOOH) use by people with advanced cancer: an analysis of coded and uncoded free-text data

Abstract

Background: People with advanced cancer frequently use the GP Out-of-Horus (GPOOH) service. Significant amounts of routine GPOOH data are uncoded, and therefore omitted from existing healthcare datasets. Aim: To conduct a free-text analysis of a GPOOH dataset, to identify reasons for attendance and care delivered through GPOOH to people with advanced cancer. Design and setting: Analysis of GPOOH healthcare dataset containing all coded and free-text information for 5,749 attendances, from a cohort of 2,443 people who died from cancer in Tayside, Scotland in 2012-2015. Method: Random sampling methods selected 575 consultations for free-text analysis, each analysed by two independent reviewers, to determine assigned presenting complaints, key and additional palliative care symptoms recorded in free-text, evidence of anticipatory care planning and free-text recording of dispensed medications. Interrater reliability concordance established through Kappa testing. Results: Over half of all coded reasons for attendance (n=293, 51.0%) were ‘other’ or missing. Free-text analysis demonstrated that nearly half (n=284, 49.4%) of GPOOH attendances by people with advanced cancer were for pain or palliative care. More than half of GPOOH attendances (n=325, 56.5%) recorded at least one key or additional palliative care symptom in free-text, with the commonest being breathlessness, nausea, vomiting and cough. Anticipatory care planning was poorly recorded in both coded and uncoded records. Uncoded medications were dispensed in over a quarter of GPOOH consultations. Conclusion: GPOOH delivers a substantial amount of pain management and palliative care, much of which is uncoded and therefore unrecognised and under-reported in existing large healthcare data analyses.

Community antibiotic prescribing in patients with COVID-19 across three pandemic waves: a population-based study in Scotland, UK

“…Another limitation is that the indication for the antibiotic prescriptions was unavailable, potentially including antibiotics prescribed for other conditions. However, primary care coding is of variable quality and utility for research, 41 and patients presenting with a febrile illness coded as something else but subsequently diagnosed as COVID-19 would be missed by coding inclusion criteria. Bacteriology data were not included, and some individuals may have had bacterial secondary or coinfection with appropriate antibiotic treatment.…”

Community Antibiotic Prescribing in Patients with COVID-19 Across Three Pandemic Waves: A Population-Based Cohort Study

“…A limitation of this study is that data on the coded indication for the antibiotic prescriptions were unavailable, so we have potentially included antibiotics prescribed for other conditions. However, primary care coding is of variable quality and utility for research, 28 and patients presenting with a febrile illness coded as something else but subsequently diagnosed as COVID-19 would be missed by coding. Bacteriology data were not included, and some individuals may have had bacterial secondary or co-infection with appropriate antibiotic treatment.…”