Hull Sally A, Rivas Carol, Bobby Jacqui, Boomla Kambiz, Robson John
Centre for Health Sciences, Barts and the London Queen Mary's School of Medicine, London, UK.
Inform Prim Care. 2009;17(2):67-78. doi: 10.14236/jhi.v17i2.718.
Equity of service provision by age, ethnicity and sex is a key aim of Government policy in the UK. The prevalence, natural history and management of common chronic conditions, such as diabetes and hypertension, vary between ethnic groups. Developing and monitoring responsive local services requires accurate measures of ethnicity and language needs. Hence establishing the ethnic composition of GP populations is important.
To compare three methods of estimating the ethnic composition of GP registered populations in three east London primary care trusts (PCTs).
Self-reported ethnicity, routinely collected at practice level (and considered the 'gold standard'), was compared with two indirect methods of attributing ethnicity. The indirect method currently used in the UK assigns ethnicity to GP populations based on geographical postcode attribution from the national census. A proposed alternative indirect method uses the ethnic breakdown of hospital admission data from practice lists to attribute ethnicity to the whole practice population. Comparisons were made between practice self-report recording and these two indirect methods. Bland-Altman plots were used to assess the agreement between methods of measurement.
Data from 103 practices, covering 70% of the GP registered population, was used. The hospital admission method showed better agreement with practice self-report data than the census attributed method. For white populations Bland-Altman plots showed a mean difference of 1.4% (95% CI-14.9 to 17.7) between hospital admission and practice data, and a mean difference of 12.5% (95% CI-6.2 to 31.1) between census attributed and practice data. Differences were also found for south Asian and black populations.
Practice ethnicity measured using hospital attendance data is in closer agreement with practice recording of self-reported ethnicity than the census attribution method. Census attribution may provide misleading information on the ethnic composition of practice populations. We recommend that healthcare commissioners change to this method of measurement when practice self-report data is not available.
按年龄、种族和性别提供公平的服务是英国政府政策的一个关键目标。糖尿病和高血压等常见慢性病的患病率、自然史和管理在不同种族群体之间存在差异。制定和监测响应性的地方服务需要准确衡量种族和语言需求。因此，确定全科医生服务人群的种族构成很重要。
比较三种估算伦敦东部三个初级保健信托基金（PCT）中全科医生注册人群种族构成的方法。
将在诊所层面常规收集的自我报告种族（被视为“金标准”）与两种间接的种族归属方法进行比较。英国目前使用的间接方法是根据全国人口普查的地理邮政编码归属为全科医生服务人群确定种族。一种提议的替代间接方法是利用来自诊所名单的医院入院数据的种族分类，将种族归属到整个诊所人群。对诊所自我报告记录与这两种间接方法进行了比较。采用布兰德-奥特曼图评估测量方法之间的一致性。
使用了来自103家诊所的数据，涵盖了70%的全科医生注册人群。医院入院方法与诊所自我报告数据的一致性比人口普查归属方法更好。对于白人人群，布兰德-奥特曼图显示医院入院数据与诊所数据之间的平均差异为1.4%（95%置信区间为-14.9至17.7），人口普查归属数据与诊所数据之间的平均差异为12.5%（95%置信区间为-6.2至31.1）。南亚和黑人人群也存在差异。
与人口普查归属方法相比，使用医院就诊数据测量的诊所种族与自我报告种族的诊所记录更一致。人口普查归属可能会提供关于诊所人群种族构成的误导性信息。我们建议，当没有诊所自我报告数据时，医疗保健专员应改用这种测量方法。
