Can general practice data be used for needs assessment and health care planning in an inner-London district?

The development of primary care led commissioning will increase the need for practice-based information on health and morbidity, and the NHS information strategy recommends that routinely collected health and morbidity information held on general practice computer systems should be use to inform local health needs assessment. The aim of this study was to evaluate the quality of information in six computerized practices.

A comparison was carried out of the recording of registration and social information, health risk factors, medication and record on consultations on the computer and in the manual records for a sample of patients, with an audit of morbidity coding by computer. A comparison was made of computerized disease registers with prescribing for diseases.

Computer disease registers identified over 90 percent of diabetic patients on medication, 67 percent of asthmatics, 61 percent of epileptics, and 48 percent of patients with angina. Computer recording of problems was inconsistent; practices which recorded clinical information from every consultation did not have substantially more complete disease registers. Over 90 percent of encounters and prescriptions were computerized, but there was bias in recording consultation problems. Blood pressure, smoking, alcohol, weight and height were recorded for over 50 percent of patients aged 15-74, and computerized for 79 percent (291/370) for height, but only 56 percent (274/488) for the most recent blood pressure recorded. Limited social information was recorded about patients: 45 percent (410/915) had occupation or employment status and 35 percent (230/915) ethnic group; computerized for 26 percent and 18 percent, respectively.

At present, the routine collection of information from practices would not provide reliable information for health care planning. Greater use of information in practices would improve data quality, and practice data could be used to address specific issues, if augmented by additional data, and for practice-based needs assessment.