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Biomedical subjects

M Pringle

Publications and source records attributed to M Pringle.

At least 37 records · Page 2Linked to original sources
PubMed1995

Assessment of the completeness and accuracy of computer medical records in four practices committed to recording data on computer.

BACKGROUND: General practice computer databases are being increasingly seen as a source of data for public health monitoring and commissioning. Such ambitions depend on routine clinical data being recorded with acceptable completeness and accuracy. AIM: The aim of this study was to assess the completeness and accuracy of the computer medical records in four high-recording general practices. METHOD: Four general practices in the Trent Region that use the EMIS computer system, and were known to be high recorders of clinical data on their computer databases, were selected. A retrospective analysis of the computer records, a prospective comparison of a sample of computer records with manual records, and a prospective comparison between videorecorded consultations and their manual and computer records were undertaken. RESULTS: Checks for completeness in computer recording of diabetes mellitus and glaucoma showed high levels of accurate recording, 97% and 92% respectively. Prevalence rates between practices were reasonably comparable. No practice consistently, across 10 diagnoses, recorded prevalences higher or lower than the other practices; those diagnoses with recognized objective diagnostic criteria were recorded with a more consistent prevalence than those without. Lifestyle data recording was low; overall, smoking habits and alcohol consumption were recorded for 52% and 38% of patients aged over 16 years, respectively. Comparison of the manual records with the computer records showed that the computer records were sufficiently complete with regard to diagnoses (82% of all items recorded), prescriptions (100%) and referrals (67%), but missed most of the remaining data that a manual record captured. The videorecorded validation study showed that there were no important lapses in the recording of diagnoses, prescriptions or referrals when the computer recording was compared to the actual process of the consultations. CONCLUSION: In these four high-recording practices the data in computer records were of sufficient completeness and accuracy to allow meaningful data aggregation for some diagnoses, prescriptions and referrals. Standardized protocols for defining which patients are included and excluded from major disease groups are required.

England↗
PubMed1995

Membership of the Royal College of General Practitioners by assessment: attitudes of members and non-members in one faculty area.

BACKGROUND: Fewer than half of the principals in general practice in the United Kingdom are members of the Royal College of General Practitioners. As the membership examination is closely linked to the endpoint of vocational training, a case can be made for another method of entry to the RCGP for established principals. Such a method could be membership by assessment. AIM: A study was undertaken to examine the attitudes of existing members and fellows of the RCGP to membership by assessment and to determine whether there was any demand from general practitioner principals who were not RCGP members to join by this route. METHOD: One questionnaire was sent to all RCGP members and fellows in the Vale of Trent faculty area and another questionnaire was sent to those principals in general practice in the Vale of Trent faculty area who were not RCGP members. RESULTS: In total, 396 (83%) of the 480 RCGP members and fellows responded, as did 543 (81%) of the 671 non-members in the faculty area. When asked if they were in favour of the concept of membership by assessment, 245 of the members and fellows replied yes (62%) and 138 replied no (35%). Of the non-members, 91 (17%) ahd previously been members of the RCGP; the main reason given by these general practitioners for relinquishing membership was that the annual subscription was too high (65% of 91 general practitioners). When the 451 general practitioners who had never been members were asked if they would be interested in joining the RCGP by an assessment method, 271 replied positively (60%). CONCLUSION: There was widespread support from the members and fellows of the Vale of Trent faculty of the RCGP for the concept of membership by assessment. Principals in general practice in this area who had never been members of the RCGP showed a high degree of interest in joining by this method. Despite the caveats that must be applied, for example, to ensure that the standards are set appropriately, these results indicate that membership by assessment should be explored by the RCGP, and indeed a working party on the meaning of membership of the RCGP has been convened.

Family Practice↗
PubMed1994

Do general practice computer systems assist in medical audit?

This study was designed to assess the capabilities of current general practice computer software to perform medical audit. A total of 43 general practice clinical software suppliers were asked to complete a questionnaire consisting of general questions concerning their systems' responses to 85 audit questions that a practice might wish to ask in the areas of quality of care and contractual compliance. It was assumed that all systems had full patient data. Fourteen installations representing 14 systems that had been randomly selected from the responders were visited to validate the suppliers' responses. Thirty-two (74%) suppliers responded to the questionnaire and they represented 7696 installations. One supplier marketed two distinct systems giving 33 systems for analysis. The majority (52%) of responding suppliers had between 0 and 50 installations. Many shortfalls in auditing capability were demonstrated, e.g. 24% of systems were unable to audit the clinical content of a patient review, 48% were unable to audit the numbers of acute and repeat prescriptions, 51% were unable to audit emergency admissions, 70% were unable to audit the length of time a drug had been prescribed for and 85% were unable to audit the continuity of patient care. Limitations in the ability to perform even basic medical audits were demonstrated among current general practice computer systems. These have implications for the development of medical audit. Seven (21%) of the systems had no facilities for statistical analysis including percentages and 8 (24%) had no graphical abilities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Using unemployment rates to predict prescribing trends in England.

BACKGROUND: There are many factors underlying trends in prescribing levels in England. AIM: This study set out to examine prescribing trends and their relationship with three measures of morbidity. METHOD: A study was undertaken examining the interrelations between basic prescribing parameters for the 90 family health services authorities in England for the year 1 April 1989 to 31 March 1990. The trends were examined for their associations with three factors which have been linked to morbidity levels: standardized mortality ratios, the Jarman index (through its use as a deprivation index), and unemployment rates. RESULTS: Analysis revealed a strong inverse association between the number of items prescribed per patient and the net ingredient cost per item for the family health services authorities. These two factors together determined the net ingredient cost per patient. Cluster analysis was found to segregate approximately the family health services authorities geographically: the northern, urban areas of England were characterized by a high number of low cost items per patient while the southern semi-rural areas had a low number of high cost items per patient. The trend was such that the former area had a higher overall net ingredient cost per patient. Unemployment rates were the most robust determinant of the inverse trend of number of items and cost of items and were comparable with standardized mortality ratios in their individual correlations with the prescribing net ingredient cost per patient. The Jarman index was the weakest of the predictors. CONCLUSION: The results lend support to the argument that material deprivation, associated with unemployment, is an important determinant of prescribing trends, perhaps acting through its effect on morbidity, and that the Jarman index is a poor indicator of deprivation. The analysis alone cannot, however, determine cause and effect for the apparent relationship between unemployment and prescribing.

Adolescent↗
PubMed1993

Explaining variations in prescribing costs across England.

OBJECTIVE: To derive a predictive model for national prescribing behaviour in terms of basic morbidity and demographic factors. DESIGN: 24 demographic, morbidity, and practice factors were entered into a multiple regression analysis to determine the net ingredient cost per patient. SETTING: The 90 family health service authorities in England for 1989. RESULTS: For net ingredient cost per patient only two demographic factors (numbers of pensioners and the mobility of the registered population measured by list inflation) and two morbidity related factors (standardised mortality ratios and numbers of prepayment certificates issued) significantly contributed to a multiple regression model. This model explained 81% of the variation in net ingredient cost per registered patient between family health services authorities. The model also enabled a weighting factor of 4.6 (95% confidence interval 3.2 to 6.7) to be derived for the net ingredient cost for elderly patients (compared with the existing prescribing unit factor of 3). CONCLUSIONS: The model shows that variations in prescribing costs essentially reflect demand. It also suggests that the current prescribing unit value of 3 for patients aged 65 or more underestimates the extra costs of prescribing for elderly patients.

Drug Costs↗
PubMed1993

Influences on control in diabetes mellitus: patient, doctor, practice, or delivery of care?

OBJECTIVE: To assess patient, doctor, practice, and process of care variables for their effect on glycaemic control in diabetes mellitus, and to quantify their relative effects. DESIGN: Search of general practice medical records, patient questionnaires and examination, doctor questionnaire, videotaping and analysis of consultations, and practice questionnaire. SETTING: 12 practices with 32 participating general practitioners in Nottinghamshire. SUBJECTS: 318 patients randomly selected from those with diabetes in each practice, 10 for each participating doctor. MAIN OUTCOME MEASURE: Glycaemic control as measured by random glycated haemoglobin A1c estimation (random haemoglobin A1 measurement). RESULTS: Glycaemic control was significantly related to the disease process as measured by years since diagnosis, treatment group, and number of diabetes related clinical events. Females had significantly worse control than males. Other patient factors, such as age, social class, lifestyle, attitudes, satisfaction, and knowledge, had no association with glycaemic control. Of all the doctor factors examined, only doctors who professed a special interest in diabetes achieved significantly better glycaemic control. Bigger and better equipped practices and those with a diabetic miniclinic had patients with significantly better glycaemic control, as did those with access to dietetic advice. Patients attending hospital clinics had worse glycaemic control, but this seemed to be attributable to the case mix and practice characteristics. Shared care did not contribute to the multiple linear regression model. CONCLUSION: Glycaemic control among diabetic patients in the community is related to such factors as treatment group, sex, and years since diagnosis; it is also related to the organisation and process of care. The findings support concentrating diabetic care on partners with special interests in diabetes in well equipped practices with adequate dietetic support.

Attitude of Health Personnel↗
PubMed1993

Study of 500 patients attending an osteopathic practice.

The experiences of 500 consecutive patients presenting with a new episode of illness at a five practitioner osteopathic practice in an east midlands town is reported. The osteopath completed a structured questionnaire about each patient who then completed two symptom questionnaires, one before treatment and a second four months later. Questionnaires were completed by osteopaths for 495 patients (99.0%). Almost all patients completed the first questionnaire (98.6%) and 367 patients (73.4%) completed the second questionnaire. Female patients had more treatment sessions than male patients (3.2 versus 2.7 over the four month period, P < 0.01) and suffered from more spinal muscular problems and postural imbalance than males (P < 0.05). The commonest diagnostic group was spinal joint sprain and patients with this diagnosis reported significantly better symptom improvement at four months than those in other diagnostic groups. Greater improvement at four months was also associated with shorter duration of illness before treatment (P < 0.001). The 147 patients who had seen their general practitioner before attending the osteopath had worse symptoms of a longer duration than the 347 patients who had not seen their general practitioner (P < 0.001), but showed greater improvement in symptoms over the subsequent four months. It is concluded that suitable patients should be encouraged to attend an osteopath early on in an illness. In subsequent episodes, if osteopathic treatment is of benefit to them, patients should attend before they see their general practitioner.

Adult↗
PubMed1991

Training for minor surgery in general practice during preregistration surgical posts.

OBJECTIVE: To study the teaching of minor surgery to preregistration house officers in surgery and their confidence in their skills. DESIGN: Questionnaire survey of consultants and vocational trainees. SETTING: Trent, Oxford, and East Anglian Regional Health Authorities. SUBJECTS: All consultant surgeons (n = 148) with preregistration house officers on their firm and all first year vocational trainees in general practice (n = 165). MAIN OUTCOME MEASURES: Time spent teaching minor surgery to preregistration house officers; source of teaching; trainees' confidence in their skills in 15 minor surgical procedures and degree of confidence that consultants expected their junior house officers to achieve. RESULTS: 137 (93%) consultants and 139 (84%) vocational trainees replied; 131 of the consultants' replies and all the trainees' replies were analysable. Only 14 consultants had a curriculum for teaching junior house officers, and 90 offered less than four hours' teaching a week. Only 11 trainees thought that their firm had had a curriculum, and 102 reported having received under two hours' teaching a week. The consultants indicated that they did most of the teaching, but the trainees reported having received most of their teaching from junior registrars. Seventy nine consultants attempted to teach minor surgery. They expected their junior house officers to acquire greater confidence in their skills in minor surgery than did the other consultants, but overall the confidence expected was low. The trainees were more confident than the consultants expected them to be, but overall confidence was still low. Those who had received more teaching were significantly more confident. CONCLUSIONS: The educational potential of the post of preregistration house officer in surgery seems underexploited, particularly with regard to teaching skills in minor surgery.

Attitude of Health Personnel↗