Measuring primary health care resource utilisation (HCRU) by patients is critical for assessing health system performance. It can provide comprehensive insights on the efficiency and effectiveness of resource allocation and equity of health care service delivery, whether it be studied on the level of the health system, a patient subpopulation, or on the basis of a particular disease.
The Clinical Practice Research Datalink (CPRD) Aurum system, established in 2018, collects health information from 1,491 GP practices that are using the EMIS Web® electronic health record software. As of the system’s latest build in May 2022, it contains research-acceptable data on more than 13 million patients in England. Given its volume, it is a critical source of information for health systems research on primary HCRU.
This study aims to assess the availability and validity of data within CPRD Aurum for the measurement of HCRU, as determined through the frequency and cost of primary care consultations. Descriptive analyses will be done to investigate broad patterns in primary HCRU across patient demographics and regions of England as represented in CPRD Aurum. The validity of these measurements shall be established through assessments of data completeness and comparisons of summary statistics with the more mature CPRD GOLD system.
The study aims to inform the public health research community on the availability and validity of data within CPRD Aurum for conducting research on primary HCRU. Additionally, the exploratory analyses will improve current understanding of patterns in the frequency and cost of GP consultations across England.
The utilisation of primary health services is known to vary across a range of factors, such as patient demographics, clinical characteristics, and socioeconomic determinants of health. Understanding the extent of these variations is important to studies that aim to determine whether there are inequities in health care access across the health system or among patient subpopulations.
Given its growing coverage of registered patients, the CPRD Aurum system is a critical source of information for research on primary health care resource utilisation (HCRU). This retrospective cohort study aims to inform the public health research on the data within CPRD Aurum that can be used for deriving meaningful measurements of HCRU by providing a comprehensive assessment of the completeness and validity of relevant data elements within CPRD Aurum, and to provide a summary of the current trends in utilisation among the patients database from 2018 to 2022.
First, we shall evaluate the quality of the data elements within CPRD Aurum that can be used to measure the frequency and cost of GP consultations, then evaluate the quality of these fields based on the proportion of entries with complete and plausible entries. Second, descriptive analysis shall be conducted of summary statistics on GP consultations, to be measured across the study sample then stratified according to demographics and region of GP practice. The Index of Multiple Deprivation (IMD) will be used to factor in socioeconomic status as an additional covariate. Regression models will be used to describe associations between patient characteristics and utilisation. Third, both the data completeness assessments and summary statistics shall be compared with similar results using CPRD GOLD in order to determine whether there are significant disparities between the two data sources in terms of quality and coverage.
The following outcomes will be measured per patient:
• Annual consultation rate
• Average time between appointments
• Annual cost of prescribed treatments
The following outcomes will be measured per GP:
• Annual utilisation rate
• Volume of consultations by month and year
Ruth Keogh - Chief Investigator - London School of Hygiene & Tropical Medicine ( LSHTM )
Celina Ysabel Gacias - Corresponding Applicant - London School of Hygiene & Tropical Medicine ( LSHTM )
Helen Strongman - Collaborator - London School of Hygiene & Tropical Medicine ( LSHTM )
Jessie Oyinlola - Collaborator - CPRD
Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation