Transcript An overview of public health and its practice

Primary Care
Data
Andy Muirhead (Derby City PH)
Analyst Training Course 2012
Day 2 – Session 4
Learning outcomes
 To appreciate the range of information available to
inform public health needs assessments,
interventions and monitoring
 To critically assess such data sources and consider
ways of making them more useful
 To look at examples of routine use and ad hoc use of
public health data
What is Primary Care?
Health Services that play a central role in the community;
usually a patient’s 1st contact:
General Practice
Pharmacists
Dentists
Midwives
Optometrists
Comparative numbers
of health events in England
Deaths England
Births England
Depression (GHQ) 11.3 %
Limiting longstanding illness 19%
Admissions
A&E attendances (experimental)
Practice nurse consultations 2pp
GP consultations 4pp
0
100
200
Millions
What is Primary Care Data?
• Describes what is delivered by Primary Care
Practitioners (e.g. Patient Registers,
immunisations, cervical screening)
• Describes other information about a
population looked after by a primary care
organisation (e.g. emergency admissions to
hospital, deaths, breast screening).
Primary Care Data Sources
1. Direct from GP systems
 QOF, GP audit data
2. Activities taking place in primary care
 prescribing, screening, immunisations, etc
3. Patients registered with GP practices
 hospital activity, mortality data, etc
Patient registrations data
Strengths:
• Full register of all patients registered with GP
practice
• Full postcodes; can be used in linkage
• Age, sex, socio-demographic information
• In general, data is up-to-date.
Patient registrations data
Weaknesses:
• Often a considerable ‘lag’ in registrations and
de-registrations:
• Births and deaths
• Migration; especially students
• People may appear on multiple registers
• Not everyone is registered.
The Quality and Outcomes
Framework (QOF)
• A voluntary annual reward and incentive programme detailing
GP practice achievement results.
• Contains ‘disease registers’ for a variety of chronic conditions
(e.g. Diabetes, Stroke, CHD).
• Contains indicators relating to the care of patients by disease
register (e.g. the proportion of those with CHD who have had
a BP reading in the last 15 months)
• Covers England, SHAs, PCTs, GPs.
Latest QOF guidance
http://www.nhsemployers.org/
→ Pay and contracts
→ General Medical Services contract
→ Quality and Outcomes Framework
Accessing the Data
http://www.ic.nhs.uk/qof
 Supporting information
 Data tables
 Exception reporting
http://www.qof.ic.nhs.uk/
 Online GP database
http://www.ic.nhs.uk/qof
http://www.qof.ic.nhs.uk/
Exercise
• Load the online GP database (http://www.ic.nhs.uk/qof).
• For the 2 practices “H85691” and “E81631”;
 Under ‘Display options’ click ‘Clinical Prevalence’ and
‘England Average’,
 Compare and contrast the prevalence.
? What are the possible reasons for any differences?
? What does this tell us about unmet need?
Example 1; Benchmarking against Peers
Example 2; Comparing to Expected
QOF : Things to Bear in Mind
Prevalence data represent ‘crude’ rates, i.e. they are not adjusted for case-mix (age / sex /
ethnicity / deprivation / etc) or any other risk factors.
Raw QOF data cannot be used to compare practices directly
QOF prevalence definitions may differ from those used in other sources :
QOF definition: Raised blood pressure based on at least 3 separate occasions.
HSE: taking antihypertensive medication or raised blood pressure (based on 1
reading).
Apparent low prevalence may be due to incomplete disease registers on GP databases (poor data
entry / case finding)
Changes in the underlying prevalence over time may be due to changes in definition (e.g.
Diabetes), improved disease registers, or changes in the true prevalence
Changes over time in QOF data should be viewed with caution
Patient-level data not available
2009: practice QOF prevalence extracted 31 March, practice list size extracted 1 Jan
External knowledge is always very useful when interpreting QOF results
Prescribing
data
Prescribing data
• Electronic Prescribing Analysis and CosT; ePACT.net
• A service which allows real time on-line analysis of the
previous sixty months prescribing data.
• Data is updated on a monthly basis (5 weeks after the
dispensing month) and can be selected according to:
•
•
•
•
Reporting period (i.e. month, quarter, year),
Prescribing organisation (e.g. practice, PCT)
BNF classification (chapter to presentation level)
Controlled drugs tag.
http://www.nhsbsa.nhs.uk/prescriptions
See also: Electronic Prescribing & Financial Information for Practices (ePFIP)
Prescribing data- example
ePACT.net; Considerations
• Timely and accurate data on prescribing
• Data available at GP, PCT and National level
• No patient-level data (cannot be linked to either)
• Requires training, registration and N3 (NHS)
connection
Immunisations data
Immunisations
• Routinely recorded using COVER (Cover of Vaccination
Evaluated Rapidly)
• Flu Vaccinations for those aged 65 and over and those with
conditions putting them at risk from flu
• Decline in MMR uptake following concerns over its safety. But
if less than 95% of children are immunised against measles
outbreaks will occur (herd immunity)
www.hpa.org.uk
 Contains PCT-level rates.
(Topics → Infectious Diseases → Vaccine Coverage)
Immunisations-example
Referrals data
Referrals
• Data not always readily available
• First outpatient attendance rate is a proxy measure
• Crude rate inappropriate as age/sex/deprivation
structure of the population needs to be taken into
consideration – hence standardise. Use indirect
method (with PCT as standard) because of sparsity of
data in age/sex/deprivation groups.
• Outlying GPs challenged during performance visits
Referrals (2)
• GPs encouraged to consider whether referral to
secondary care is appropriate or not (peer reference)
• May result in resources being redirected or services
configured differently (eg practice based
dermatology clinics)
First outpatient attendances
NHS Comparators
NHS Comparators
• www.nhscomparators.nhs.uk
• Benchmarking of activity, referrals, outcomes and costs.
• Covers England, SHAs, PCTs, GPs.
• 100s of comparators covering the whole ‘pathway of care’;
not just primary care.
• Indicator sets include: QOF, Prescribing, GP Survey, Hospital
Activity, Programme Budgeting, ‘Better Care, Better Value’.
• Requires registration.
www.nhscomparators.nhs.uk
Other Sources:
 GP Patient Databases:
General Practice Research Database www.gprd.com
QResearch
www.qresearch.org
The Health Improvement Network www.thin-uk.com
 GP Patient Surveys:
www.dh.gov.uk/en/Publicationsandstatistics/PublishedSurvey/GPpatientsurvey2007
 Weekly Returns Service:
www.rcgp.org.uk/clinical_and_research/rsc.aspx
Additional Information:
• User’s Guide to Data Collected in Primary Care in England:
• http://www.erpho.org.uk/viewResource.aspx?id=12899
• Primary Care Internet Guide:
• http://www.thehealthwell.info/node/30691
• NHS Evidence - National Library for Public Health:
• http://www.library.nhs.uk/rss/directory/feed.aspx?feedID=128
• Online learning resource for Public Health practitioners:
• http://www.healthknowledge.org.uk/