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Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Carey IM, Cook DG, De Wilde S, Bremner SA, Richards N, Caine S, Strachan DP, Hilton SR - BMC Fam Pract (2003)

Bottom Line: Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure.Period prevalence rates will be underestimated in DIN unless this structure is taken into account.The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Community Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. sgjd450@sghms.ac.uk

ABSTRACT

Background: The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies.

Methods: Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated.

Results: Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily.

Conclusion: Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue.

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Scatter plots of mean number of days with a prescription versus mean number of days with a diagnosis by practice in the DIN and GPRD birth cohorts (minimum 25 children per practice) Top figure – (a) DIN: Mean number of days with a prescription issued vs. diagnostic code (without linkage, n = 140). Middle figure – (b) DIN: Mean number of days with a prescription issued vs. diagnostic or linked diagnostic code (n = 140). Bottom figure – (c) GPRD: Mean number of days with a prescription issued vs. diagnostic code (n = 437)
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Figure 1: Scatter plots of mean number of days with a prescription versus mean number of days with a diagnosis by practice in the DIN and GPRD birth cohorts (minimum 25 children per practice) Top figure – (a) DIN: Mean number of days with a prescription issued vs. diagnostic code (without linkage, n = 140). Middle figure – (b) DIN: Mean number of days with a prescription issued vs. diagnostic or linked diagnostic code (n = 140). Bottom figure – (c) GPRD: Mean number of days with a prescription issued vs. diagnostic code (n = 437)

Mentions: The inter-practice relationship between prescribing and recording of diagnostic codes is displayed in Figure 1, separately for each database. In order to limit the role of sampling error, only practices with at least 25 children are included in the plots. Generally high prescribing practices are also those which use the most diagnostic codes, however the correlation was much weaker in DIN (r = 0.41, Figure 1a) than in GPRD (r = 0.81 Figure 1c). Adjustment for linkage in DIN produced a similar correlation (r = 0.85, Figure 1b) to that seen in GPRD.


Implications of the problem orientated medical record (POMR) for research using electronic GP databases: a comparison of the Doctors Independent Network Database (DIN) and the General Practice Research Database (GPRD).

Carey IM, Cook DG, De Wilde S, Bremner SA, Richards N, Caine S, Strachan DP, Hilton SR - BMC Fam Pract (2003)

Scatter plots of mean number of days with a prescription versus mean number of days with a diagnosis by practice in the DIN and GPRD birth cohorts (minimum 25 children per practice) Top figure – (a) DIN: Mean number of days with a prescription issued vs. diagnostic code (without linkage, n = 140). Middle figure – (b) DIN: Mean number of days with a prescription issued vs. diagnostic or linked diagnostic code (n = 140). Bottom figure – (c) GPRD: Mean number of days with a prescription issued vs. diagnostic code (n = 437)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC240086&req=5

Figure 1: Scatter plots of mean number of days with a prescription versus mean number of days with a diagnosis by practice in the DIN and GPRD birth cohorts (minimum 25 children per practice) Top figure – (a) DIN: Mean number of days with a prescription issued vs. diagnostic code (without linkage, n = 140). Middle figure – (b) DIN: Mean number of days with a prescription issued vs. diagnostic or linked diagnostic code (n = 140). Bottom figure – (c) GPRD: Mean number of days with a prescription issued vs. diagnostic code (n = 437)
Mentions: The inter-practice relationship between prescribing and recording of diagnostic codes is displayed in Figure 1, separately for each database. In order to limit the role of sampling error, only practices with at least 25 children are included in the plots. Generally high prescribing practices are also those which use the most diagnostic codes, however the correlation was much weaker in DIN (r = 0.41, Figure 1a) than in GPRD (r = 0.81 Figure 1c). Adjustment for linkage in DIN produced a similar correlation (r = 0.85, Figure 1b) to that seen in GPRD.

Bottom Line: Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure.Period prevalence rates will be underestimated in DIN unless this structure is taken into account.The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Community Health Sciences, St George's Hospital Medical School, Cranmer Terrace, London SW17 0RE. sgjd450@sghms.ac.uk

ABSTRACT

Background: The General Practice Research Database (GPRD) and Doctor's Independent Network Database (DIN), are large electronic primary care databases compiled in the UK during the 1990s. They provide a valuable resource for epidemiological and health services research. GPRD (based on VAMP) presents notes as a series of discrete episodes, whereas DIN is based on a system (MEDITEL) that used a Problem Orientated Medical Record (POMR) which links prescriptions to diagnostic problems. We have examined the implications for research of these different underlying philosophies.

Methods: Records of 40,183 children from 141 practices in DIN and 76,310 from 464 practices in GRPD who were followed to age 5 were used to compare the volume of recording of prescribing and diagnostic codes in the two databases. To assess the importance and additional value of the POMR within DIN, the appropriateness of diagnostic linking to skin emollient prescriptions was investigated.

Results: Variation between practices for both the number of days on which prescriptions were issued and diagnoses were recorded was marked in both databases. Mean number of "prescription days" during the first 5 years of life was similar in DIN (19.5) and in GPRD (19.8), but the average number of "diagnostic days" was lower in DIN (15.8) than in GPRD (22.9). Adjustment for linkage increased the average "diagnostic days" to 23.1 in DIN. 32.7% of emollient prescriptions in GPRD appeared with an eczema diagnosis on the same day compared to only 19.4% in DIN; however, 86.4% of prescriptions in DIN were linked to an earlier eczema diagnosis. More specifically 83% of emollient prescriptions appeared under a problem heading of eczema in the 121 practices that were using problem headings satisfactorily.

Conclusion: Prescribing records in DIN and GPRD are very similar, but the usage of diagnostic codes is more parsimonious in DIN because of its POMR structure. Period prevalence rates will be underestimated in DIN unless this structure is taken into account. The advantage of the POMR is that in 121 of 141 practices using problem headings as intended, most prescriptions can be linked to a problem heading providing a specific reason for their issue.

Show MeSH
Related in: MedlinePlus