Routine information is recorded when someone contacts their general practitioner (GP), making medical records a large and powerful resource for research. Common mental health conditions like depression, are often diagnosed by GPs and therefore recorded in GP records. However severe mental illnesses like schizophrenia are often diagnosed in specialist mental healthcare, and it is unclear how well they are recorded across different health care records. GPs play an important role in the care of people with severe mental illnesses, so it is important that their diagnoses are in GP records.
Our study will describe the proportion of people with their severe mental illness recorded in GP or mental health records alone, or in both GP and mental health care records. We will also explore whether there are differences in the type of people whose severe mental illness is, or is not, recorded in GP or mental health records. For example, people who have their severe mental illness recorded in GP records alone might be a different age, sex, or ethnicity, live in different regions, be less deprived, or seek medical help more often. We will also investigate whether specific types of severe mental illnesses are better recorded.
Our study will help us understand how to use electronic health records for severe mental illness research and allow us to recognise whether certain people are more likely to have their severe mental illnesses recorded in GP records, and therefore highlight whether some people may not receive optimal holistic care.
Electronic health records are often used to study mental illness in epidemiological research. Common mental disorders (i.e., depression, anxiety) are diagnosed and managed in primary care. Severe mental illnesses (SMI: schizophrenia, bipolar disorder, other psychoses) are diagnosed in secondary mental healthcare, with management across both primary and secondary care. How well SMIs are recorded in primary or secondary mental healthcare records is unclear. GPs are integral in care of individuals with SMIs, so recording in secondary care alone may suggest individuals are not receiving holistic care. Conversely, SMI recorded in primary care alone may suggest SMI is well managed in primary care.
We will investigate the agreement of SMI recording across English primary care and secondary mental healthcare. Adults (18years+) registered with English practices for at least one year, eligible for Mental Health Dataset (MHDS) linkage, with an SMI record in primary care or MHDS between April 2007-November 2015 are eligible for inclusion.
We will estimate proportions and describe characteristics of individuals with SMI recorded in primary or secondary mental health care alone, or in both. We will describe which specific SMI diagnoses (e.g., schizophrenia, bipolar disorder, other psychoses) are more completely recorded. We will use logistic regression to explore characteristics associated with SMI recording in both primary and secondary care. We will repeat our main analyses in sensitivity analyses including: (1) using alternative codelists to identify SMI outcomes; and (2) describing smoking status of individuals using records identified before and after the most recent SMI diagnosis. In secondary analyses, we will: (1) stratify our results by calendar periods covered by the two MHDS formats (Format 1: April 2007-March 2011, Format 2: April 2011-November 2015); and (2) describe timing between secondary care diagnosis and primary care recording for individuals whose SMI was recorded first in secondary mental healthcare.
Recording of severe mental illness (i.e., schizophrenia, bipolar disorder, and other psychoses) in primary or secondary mental health care alone, or in both primary and secondary mental health care.
Kathryn Mansfield - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Elizabeth Adesanya - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Alasdair Henderson - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Caroline Morton - Collaborator - University of Oxford
Joseph Hayes - Collaborator - University College London ( UCL )
Rohini Mathur - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Sinead Langan - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Mental Health Services Data Set (MHSDS);Patient Level Index of Multiple Deprivation;Practice Level Rural-Urban Classification