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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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Practice proportions of emollient prescriptions that link to an eczema chapter heading in 1st five years of life Legend: Dark Shading – Not using chapter headings satisfactorily Light Shading – Using chapter headings satisfactorily
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Figure 2: Practice proportions of emollient prescriptions that link to an eczema chapter heading in 1st five years of life Legend: Dark Shading – Not using chapter headings satisfactorily Light Shading – Using chapter headings satisfactorily

Mentions: However, there is marked variation between practices in the percentage of emollient prescriptions that link to a problem heading of eczema (Figure 2). It is apparent that those 20 practices identified a-priori as not using problem headings satisfactorily included all but two practices with poor emollient to eczema linkage (Figure 2). These two were readily explained by their reliance on Read codes ("2227" Rash Present and "L4ZZ" Skin disorders not otherwise specified) that did not fit our definition of eczema, but in all likelihood were used by the practices to represent it. After excluding these 20 practices, the percentage of all emollient prescriptions appearing under a problem heading of eczema rose to 83.5%.


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)

Practice proportions of emollient prescriptions that link to an eczema chapter heading in 1st five years of life Legend: Dark Shading – Not using chapter headings satisfactorily Light Shading – Using chapter headings satisfactorily
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Practice proportions of emollient prescriptions that link to an eczema chapter heading in 1st five years of life Legend: Dark Shading – Not using chapter headings satisfactorily Light Shading – Using chapter headings satisfactorily
Mentions: However, there is marked variation between practices in the percentage of emollient prescriptions that link to a problem heading of eczema (Figure 2). It is apparent that those 20 practices identified a-priori as not using problem headings satisfactorily included all but two practices with poor emollient to eczema linkage (Figure 2). These two were readily explained by their reliance on Read codes ("2227" Rash Present and "L4ZZ" Skin disorders not otherwise specified) that did not fit our definition of eczema, but in all likelihood were used by the practices to represent it. After excluding these 20 practices, the percentage of all emollient prescriptions appearing under a problem heading of eczema rose to 83.5%.

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