Learning objectives: You will learn about data sources and types of information available in primary care.
Primary care data can be used to capture information on population health with computerised systems, allowing greater flexibility in terms of data capture. Understanding service utilisation and prescribing behaviour relies on analysis of primary care data.
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In the UK, 90% of reported ill health is captured at GP practice level, so primary care data is very important. There is potential to offer a huge amount of information on health of population, but it has been historically very difficult to access. Most GP Practices are now computerised, and in some areas may allow public health staff direct access to the data. Changes in the NHS have resulted in improved primary care data collection.
There are two data sources that can be considered for primary care, namely the Quality Management and Analysis System (QMAS) and General Practice Research Database (GPRD).
QMAS came into operation in 2004, and supports a new GP contract which depends partly on quality of care as well as numbers of patients registered. Almost all practices are submitting data. Its primary function is financial, and awards payment under the Quality and Outcomes Framework (QOF). The database is replicated for other purposes, including public health. The replica is managed by the prescribing support unit, based at the information centre for health and social care (QOF)
Data are collected on a number of clinical domains, which vary over time. They currently include:
- mental health
QOF data enables local prevalence to be estimated for the conditions it covers. These may be compared with other prevalence studies such as the Health Survey for England.
One of the strengths of this data source is that the new GP contract gives an incentive to GPs to improve completeness of data. It encourages the establishment of disease registers. There are incentives to identify more registered patients needing to be on disease registers and receive treatment.
One of the weaknesses of QMAS is that raw data are not available to PCT or public health departments. Instead, some ready analysed data are available. This is limited as there is no age, sex, or ethnicity breakdown; comparable analyses may be inappropriate; and there is no information on co-morbidity, and significant under recording of some indicators.
An alternative source for primary care data is the General Practice Research Database (GPRD)
This is a proprietary product, only accessible to public health departments on a fee-paying basis. It is a longitudinal anonymised database, and claims to be the largest source of computerised information on morbidity and prescription activity in GP practices, holding data from 1987 to present. Participating practices agree guidelines on recording clinical data.
The strengths of this data source are that it is continually assessed for quality, is available for research questions, and there are standards for recording which allow collation of the data. The weakness is that the geographical coverage is incomplete, representing and only a small proportion of self-selecting practices across the country (450 or so).