Wyatt Steven, Mohammed Mohammed A, de Dumast Lyvia, Marshall Tom
The Strategy Unit, NHS Midlands and Lancahsire Commissioning Support Unit, Stoke on Trent, UK
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Open. 2024 Dec 5;14(12):e088845. doi: 10.1136/bmjopen-2024-088845.
Although primary care is central to healthcare provision, inconsistent methods and data sources mean that relatively little is known about long-term trends in general practice consultation rates. We aimed to explore long-term trends in English general practice consultation rates using two electronic health records databases, Clinical Practice Research Datalink Gold and Aurum, from 1995 to 2021.
Consultations were identified and classified using a set of rules and code lists. Consultation rates were calculated as the ratio of the count of consultations and the registration duration. We used negative binomial regression to model the relationship between the number of consultations and the patient's age, sex and year from each database. These models are then used to estimate annual crude consultation rates for England.
The number of general practices in the Gold database decreased from 346 (1995) to 41 (2021), while in Aurum, it increased from 555 (1995) to 1347 (2021). In Gold, the average number of consultations per person-year increased from 2.91 in 1995 to 5.12 in 2012, then fell to 4.59 in 2019 and to 4.12 in 2021. In Aurum, average consultations per person-year rose from 2.17 (1995) to 4.89 (2012), then fell to 4.76 (2019) and rose again to 5.40 (2021). Half of the total increase in consultations from Aurum was due to a new consultation code, for 'AccurX consultations', an electronic messaging system for communication with patients.
Trends in general practice consultation showed three distinct epochs: rising from 1995 to 2012, falling from 2012 to 2019 and rising in Aurum but falling in Gold from 2019 to 2021. Consultation rates in Gold were higher than Aurum until the inclusion of a new consultation code in Aurum in 2019, which underscores the need for operational definitions of a consultation.
尽管初级保健是医疗服务的核心，但方法和数据来源不一致意味着人们对全科医疗咨询率的长期趋势了解相对较少。我们旨在利用两个电子健康记录数据库——临床实践研究数据链黄金版（Clinical Practice Research Datalink Gold）和奥鲁姆（Aurum），探究1995年至2021年期间英国全科医疗咨询率的长期趋势。
使用一组规则和代码列表来识别和分类咨询。咨询率计算为咨询次数与注册时长的比率。我们使用负二项回归来模拟每个数据库中咨询次数与患者年龄、性别和年份之间的关系。然后使用这些模型来估计英格兰的年度粗咨询率。
黄金版数据库中的全科医疗机构数量从1995年的346家减少到2021年的41家，而在奥鲁姆数据库中，该数量从1995年的555家增加到2021年的1347家。在黄金版数据库中，人均年咨询次数从1995年的2.91次增加到2012年的5.12次，然后在2019年降至4.59次，2021年降至4.12次。在奥鲁姆数据库中，人均年咨询次数从1995年的2.17次上升到2012年的4.89次，然后在2019年降至4.76次，并在2021年再次升至5.40次。奥鲁姆数据库中咨询次数总增长的一半归因于一个新的咨询代码，即“AccurX咨询”，这是一种用于与患者沟通的电子消息系统。
全科医疗咨询趋势呈现出三个不同阶段：1995年至2012年上升，2012年至2019年下降，2019年至2021年在奥鲁姆数据库中上升但在黄金版数据库中下降。在2019年奥鲁姆数据库纳入新的咨询代码之前，黄金版数据库的咨询率高于奥鲁姆数据库，这凸显了咨询操作定义的必要性。
