Measuring disease prevalence: A comparison of musculoskeletal disease using four general practice consultation databases

Primary Care Musculoskeletal Research Centre, Keele University, Keele.
British Journal of General Practice (Impact Factor: 2.29). 02/2007; 57(534):7-14.
Source: PubMed


Primary care consultation data are an important source of information on morbidity prevalence. It is not known how reliable such figures are.
To compare annual consultation prevalence estimates for musculoskeletal conditions derived from four general practice consultation databases.
Retrospective study of general practice consultation records.
Three national general practice consultation databases: i) Fourth Morbidity Statistics from General Practice (MSGP4, 1991/92), ii) Royal College of General Practitioners Weekly Returns Service (RCGP WRS, 2001), and iii) General Practice Research Database (GPRD, 1991 and 2001); and one regional database (Consultations in Primary Care Archive, 2001).
Age-sex standardized persons consulting annual prevalence rates for musculoskeletal conditions overall, rheumatoid arthritis, osteoarthritis and arthralgia were derived for patients aged 15 years and over.
GPRD prevalence of any musculoskeletal condition, rheumatoid arthritis and osteoarthritis was lower than that of the other databases. This is likely to be due to GPs not needing to record every consultation made for a chronic condition. MSGP4 gave the highest prevalence for osteoarthritis but low prevalence of arthralgia which reflects encouragement for GPs to use diagnostic rather than symptom codes.
Considerable variation exists in consultation prevalence estimates for musculoskeletal conditions. Researchers and health service planners should be aware that estimates of disease occurrence based on consultation will be influenced by choice of database. This is likely to be true for other chronic diseases and where alternative symptom labels exist for a disease. RCGP WRS may give the most reliable prevalence figures for musculoskeletal and other chronic diseases.

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Available from: Umesh Kadam, May 22, 2014
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    • "Use of consultation data also reduces the risk of recall and selection bias, shown to influence questionnaire-based designs (Podsakoff et al., 2003). Furthermore, the CiPCA database has been shown to give comparable musculoskeletal prevalence figures to UK National Primary Care databases (Jordan et al., 2007), and such medical record databases have been shown to be suitable for epidemiological studies (Hassey et al., 2001; Benson, 2011). This study has demonstrated musculoskeletal pain consultation concordance between couples, as well as tested theoretical influences on concordance, which have shown some effect is present. "
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    ABSTRACT: Musculoskeletal pain conditions are common and create substantial burden for the individual and society. While research has shown concordance between couples for risk of some diseases, e.g. heart disease or diabetes, little information is available on such effects for musculoskeletal pain conditions. Our aims were to investigate the presence of concordance between couples for consultations about pain, and to examine theoretical influences on such concordance. This was a 1-year cross-sectional study of musculoskeletal pain consultations in a UK primary care database. In total 27,014 patients (13,507 couples) aged between 30 and 74 years were included. The main outcome measure was the presence of a musculoskeletal morbidity read code indicating a consultation for musculoskeletal conditions (any, back, neck, knee, shoulder, foot, osteoarthritis). Logistic regression was used to test associations with odds ratios (OR) and 95% confidence intervals (95% CI). Patients whose partner had a musculoskeletal pain consultation were also more likely to consult for a musculoskeletal condition (OR 1.22, 95% CI 1.12-1.32). This association was found to be strongest for shoulder disorders (OR 1.91, 95% CI 1.06-3.47). No significant associations were found for other pain conditions. Results show that partner concordance is present for consultations for some musculoskeletal conditions but not others. Possible explanations for concordance include the shared health behaviours between couples leading to potential heightened awareness of symptoms. Given the high prevalence of musculoskeletal pain within populations, it may be worth considering further the mechanisms that explain partner concordance. © 2015 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC®
    European Journal of Pain 07/2015; Early View. DOI:10.1002/ejp.744 · 2.93 Impact Factor
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    • "The patients were identified through the use of Read Codes indicating a primary care consultation for LBP. Read codes are a common method for the computerized recording of morbidity in UK primary care and are most often entered by the patients' GP at the time of consultation [21,22]. The codes selected were intended to include all cases of nonspecific LBP. "
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    ABSTRACT: To investigate associations of pain intensity in those with long-term back pain, with their partners' rating of key constructs of relationship quality: cohesion (activities together), consensus (affection, sexual relations), satisfaction (conflict, regrets). Self-report questionnaires on relationship quality (partner-rated), depression (partner-rated), relationship length, and pain intensity (patient-rated) were collected from back pain patients and their partners (N = 71). Linear regression was carried out to test for associations, standardized coefficients (β) and 95% confidence intervals (95% CI) are reported. There was no main effect between patient pain intensity and partner rating of relationship quality. However, partner ratings of relationship quality were lower if the partner reported increasing depressive symptoms. Adjusting for the effects of partner depression show that ratings of consensus (affection, sexual relations) from partners were actually higher with increasing levels of pain intensity in patients (β 0.54, 95% CI 0.17 to 0.90, P < 0.01). Furthermore lower ratings of consensus were reported where patient pain intensity interacted with partner depression (β -0.11, 95% CI-0.19 to -0.03, P < 0.05). These findings illustrate the association of pain outcomes beyond the patient within a primary care sample. Moderators of the responses about the relationship construct of consensus generated by partners appear to be partners' own level of depressive symptoms and whether their depressive symptoms are associated with the patients' pain intensity. Consultations should consider the social context of patients with pain.
    Pain Medicine 01/2014; 15(5). DOI:10.1111/pme.12366 · 2.30 Impact Factor
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    • "Data were extracted from the Consultations in Primary Care Archive (CiPCA), an anonymised database of clinical information from nine general practices in Staffordshire, UK [13]. RA patients were identified using diagnostic Read codes. "
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    ABSTRACT: Patients with rheumatoid arthritis (RA) are known to be at increased risk of vascular disease. It is not known whether screening for vascular risk factors occurs in primary care. The aim of this study was to determine whether guidance advocating cardiovascular screening in RA patients is being implemented in primary care. This study was undertaken in a UK primary care consultation database. All patients with a diagnosis of RA between 2000 and 2008, and still registered with the GP practice in 2009 were matched by age, gender and GP practice to three non-RA patients. Evidence of screening for five traditional vascular risk factors (blood pressure, lipids, glucose, weight, smoking) was compared in those with and without RA using logistic regression models. A comparison was also made with diabetes. 401 RA patients were identified and matched to 1198 non-RA patients. No differences in the overall rates of screening were found (all five risk factors: RA 24.9% vs no RA 25.6%), but RA patients were more likely to have a smoking status recorded (67% versus 62%). In contrast, those with diabetes were up to 12 times as likely to receive vascular screening. Despite the excess risk of vascular disease in patients with RA being of a similar magnitude to that seen in diabetes, patients with RA did not receive additional CVD screening in primary care, although this was achieved in patients with diabetes. More emphasis needs to be placed on ensuring those with RA are actively screened for cardiovascular disease in primary care.
    BMC Family Practice 10/2013; 14(1):150. DOI:10.1186/1471-2296-14-150 · 1.67 Impact Factor
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