Routinely-collected general practice data are complex, but with
systematic processing can be used for quality improvement and
research

Lusignan, Simon de; Hague, N; Vlymen, Jeremy van; Kumarapeli, Pushpa

doi:10.14236/jhi.v14i1.615

Cited by 28 publications

(23 citation statements)

References 15 publications

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“…Generally the Read coding system is an extensive system which facilitates very detailed coding of diagnoses and other code domains [19] such that this mapping mismatch is limited. Additional limitations of using routinely collected primary care data in research have also previously been described and include the loss of information recorded in the record as free text [40] which may have led to some missing cases in our data.…”

Section: Discussionmentioning

confidence: 99%

Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitor: Comparing Trial Data and Real-World Use

et al. 2017

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IntroductionThe first cardiovascular safety trial in the sodium-glucose co-transporter-2 (SGLT2) inhibitor drug class, the Empagliflozin Cardiovascular Outcomes and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, demonstrated significant cardiovascular risk reduction with empagliflozin. It is currently not clear what proportions of people with type 2 diabetes (T2DM) have the same high cardiovascular risk as those included in the trial, and will therefore be likely to experience the same cardiovascular benefit. We aimed to identify and describe the proportion of people with T2DM from a representative English national population who have the comparable high cardiovascular risk to those included in the EMPA-REG trial.MethodA cross-sectional analysis of cardiovascular risk in people with T2DM and a subgroup prescribed SGLT2 inhibitors. Patients were identified from the Royal College of General Practitioners Research and Surveillance Centre database. Cardiovascular risk factors were identified from electronic patient records.ResultsFrom 1,238,909 patients at 128 GP practices, we identified 60,327 adults with T2DM (mean age 66.1 years, SD 13.9) of whom 55.6% were male. From these 1642 (2.7%) people had been initiated on an SGLT2 inhibitor (mean age 58.1 years, SD 10.4; 58.8% male). In the complete T2DM group only 15.7% (95% CI 15.5–16.0%) had the same high cardiovascular risk as those included in the EMPA-REG trial. In those already initiated on SGLT2 inhibitors this proportion was 11.1% (95% CI 9.8–12.4%). Whilst the proportion was higher in the oldest age groups, in those 70+ years old less than a quarter met the EMPA-REG trial high cardiovascular risk criteria.ConclusionsThe EMPA-REG trial results are applicable only to a small proportion of people with T2DM and a smaller proportion of those currently treated with SGLT2 inhibitors. Additional data are required to identify any cardiovascular benefit in people with lower cardiovascular risk.FundingAstraZeneca.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-017-0254-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitor: Comparing Trial Data and Real-World Use

et al. 2017

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“…However, data retrieval from the EMR is still complex [10] and in some cases registration of data is inadequate [14]. Because clinical consultation is a complex interaction between caregiver and patient, in EMRs the information is often recorded as a mixture of free-text and coded data [15]. Registration, here understood to be all or part of patient information, is influenced by personal, cultural, technical, health system and financial factors [9].…”

Section: Introductionmentioning

confidence: 99%

A structured registration program can be validly used for quality assessment in general practice

Fokkens

Wiegersma

Reijneveld

2009

BMC Health Serv Res

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BackgroundPatient information, medical history, clinical outcomes and demographic information, can be registered in different ways in registration programs. For evaluation of diabetes care, data can easily be extracted from a structured registration program (SRP). The usability of data from this source depends on the agreement of this data with that of the usual data registration in the electronic medical record (EMR).Aim of the study was to determine the comparability of data from an EMR and from an SRP, to determine whether the use of SRP data for quality assessment is justified in general practice.MethodsWe obtained 196 records of diabetes mellitus patients in a sample of general practices in the Netherlands. We compared the agreement between the two programs in terms of laboratory and non-laboratory parameters. Agreement was determined by defining accordance between the programs in absent and present registrations, accordance between values of registrations, and whether the differences found in values were also a clinically relevant difference.ResultsNo differences were found in the occurrence of registration (absent/present) in the SRP and EMR for all the laboratory parameters. Smoking behaviour, weight and eye examination were registered significantly more often in the SRP than in the EMR. In the EMR, blood pressure was registered significantly more often than in the SRP. Data registered in the EMR and in the SRP had a similar clinical meaning for all parameters (laboratory and non-laboratory).ConclusionsLaboratory parameters showed good agreement and non-laboratory acceptable agreement of the SRP with the EMR. Data from a structured registration program can be used validly for research purposes and quality assessment in general practice.

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“…He did acknowledge that the quality, continuity and safety of care were improved by the availability of EHRs, alleging that US privacy (Health Insurance Portability and Accountability Act) regulations only served to confound the 'flower guy' trying to make hospital deliveries rather than to secure the individual's record! Considering what the UK calls 'secondary uses' of data 9 for research purposes, Caplan additionally questioned who would be the trusted holders of such data and how they would be accredited (qualified) to control such data. Tangentially, he wondered whether consideration of health data from Atsugewi native American Indians for genetic factors underlying diabetes might defame their cultural origins in 'the Spirits' when the research suggested genetic factors originating in China.…”

Section: People Volunteering Their Pehr For Researchmentioning

confidence: 99%

Personal electronic health records: from biomedical research to people's health

Roberts

2009

Journal of Innovation in Health Informatics

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Routinely-collected general practice data are complex, but with systematic processing can be used for quality improvement and research

Cited by 28 publications

References 15 publications

Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitor: Comparing Trial Data and Real-World Use

Sodium-Glucose Co-transporter 2 (SGLT2) Inhibitor: Comparing Trial Data and Real-World Use

A structured registration program can be validly used for quality assessment in general practice

Personal electronic health records: from biomedical research to people's health

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