Primary care consultations rates among practices using Vision® and EMIS® practice management software systems - an evaluation using the Clinical Practice Research Datalink

Problem

Combining data from GP practice management systems (PMS) may provide more accurate insights on national trends in the use of primary care services and clinical workload, data essential for health care planning and policy formulation. However, the comparability of data from different sources must be assessed before combined, to understand how factors such as differing data capture and recording methods may influence findings.

Approach

This work aimed to compare national trends in primary care consultations using anonymised longitudinal patient level data from general practices using Vision® and EMIS® systems. Data from practices which switched from Vision® to EMIS® were also considered. Consultation data from a sample of general practices in England during 01/04/2006 - 31/03/2017 were assessed. Practices continuously contributing data to CPRD during this period were included, as were patients who had at least one day of follow-up. Consultations were defined as direct contact between practice staff and patients. Staff role was grouped as GP, nurse or other health professional. Consultation location was categorised as surgery, telephone, home visit or other location. Crude annual consultations per person-year (ppy) and 95% confidence intervals were estimated separately for Vision®, EMIS® and switched practices, and stratified by financial year, gender, age-group, staff role and consultation location.

Findings

587 practices (372 EMIS®, 142 Vision® and 73 which switched from Vision® to EMIS®) were included. Crude annual consultation rates were higher among Vision® practices, increasing steadily from 5.39 ppy [95% CI: 5.38-5.39] in 2006/2007 to 8.31[8.30-8.31] in 2016/2017. Although rates among EMIS® practices were slightly higher than in Vision® in 2006/2007 (5.51[5.50-5.51]), only modest rate increases were observed in EMIS® by 2016/2017(5.63 [5.63-5.63]). Differences between systems appeared to be explained by higher consultation numbers categorised as ‘other health care professional’ and ‘other consultation location’, among Vision practices.Possible system level differences were further highlighted when examining annual consultation rates among Vision® practices that switched to EMIS®. Trends in annual rates prior to switching were similar to Vision® practices (5.76 ppy [5.75-5.77]) in 2006/2007 rising to 8.03 ppy [8.03-8.04] in 2014/2015) but tended towards rates among EMIS® practices (6.35 ppy [6.35-6.36]) in 2016/2017) after switching. Despite PMS differences in the magnitude of annual consultation rates, trends in consultations in both systems were similar - rates were higher among females, the very young and the elderly, and consultation rates by GP and nurse were similar.

Consequences

This study highlights possible systematic differences in PMS data recording, suggesting that caution is required when considering whether to combine results from multiple systems. While similarities in trends observed between PMS may be reassuring for some uses of the data, it is important to consider potential limitations and how these may be counterbalanced when making decisions about combining data.