Development of a primary care research network focused on chronic disease: a feasibility study for both practices and research networks

Abstract

Background: High quality data should be a key resource for research and planning of healthcare, but low quality general practice data has been documented internationally. This study assessed the feasibility of collecting reliable chronic disease data in Irish general practice, using a program of training and feedback to improve the quality of coding for chronic conditions in practice information systems. Methods: Training in chronic disease coding and reporting was provided to a purposive sample of general practices in Ireland. From July to December 2020, practices reported the number of patients receiving free medical care, and the number of patients coded with each of eight chronic conditions: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), heart failure (HF), atrial fibrillation (ATF), transient ischaemic attack (TIA) and cerebrovascular accident/stroke (CVA). Calculated prevalences were compared with national and international estimates. Results: We recruited and trained 16 practices with 65.5 full-time equivalent GPs and a study-eligible patient population of 36,327. There was a large degree of variation across practices for all conditions. For example, in July, reported prevalence of IHD ranged from 0.3% to 10.2% (a 34-fold difference), and reported prevalence of HF ranged from 0.2% to 4.0% (a 20-fold difference). No single practice had high or low prevalences across all conditions. Changes over time across all practices were minimal, averaging between 0.1% and 0.3% for all conditions. By December, a large degree of variation across practices remained. Across all conditions, average prevalences were higher than previously published estimates. Conclusions: Although hampered by the COVID-19 pandemic, it was feasible to implement this programme of training and feedback to report on chronic disease data recorded in general practice. Coding quality in Irish general practice is highly varied, and improvement would require a greater degree of intervention, including audit.