Public Health Intelligence

Clinical information within the primary care electronic health record (and linked health and social care records) can inform public health action and service improvement. A coherent research effort is needed to derive robust and validated procedures for handling and analysing these data.

Our multidisciplinary team has established a programme of musculoskeletal health intelligence research using local and national databases and international collaboration. This has included:

  • Rigorous derivation of musculoskeletal health and care indicators; 
  • Harmonising code lists across databases/countries; 
  • Validation studies using linked cohort datasets/expert consensus; 
  • Testing/implementing procedures for describing trends in occurrence; 
  •  Application in hypothesis-generating and hypothesis-testing observational studies and primary care intervention studies; 
  •  Dissemination to policymakers, practitioners and public.

Occurrence of Morbidity

We have used clear definitions of prevalence and incidence of morbidity to highlight how common morbidities and symptoms are in primary care and to allow comparison between databases both nationally and internationally. This has included cross-mapping of Read Codes to ICD10 codes.

  • Yu D, Peat GM, Bedson J, Jordan KP. Annual consultation incidence of osteoarthritis estimated from population-based healthcare data in England. Rheumatology, in press.
  • Jordan KP, Jöud A, Bergknut C, Croft P, Edwards JJ, Peat G, Petersson IF, Turkiewicz A,  Wilkie R, Englund M. International comparisons of the prevalence of health care for musculoskeletal disorders using population-based health care data from England and Sweden. Annals of the Rheumatic Diseases, 2014;73:1:212-218. http://www.ncbi.nlm.nih.gov/pubmed/23345602 
  • Wood L, Muller S, Peat G. The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording. Primary Health Care Research and Development, 2011;12:2:157-64. http://www.ncbi.nlm.nih.gov/pubmed/21457600 
  • Jordan KP, Kadam UT, Hayward R, Porcheret M, Young C, Croft P. Annual consultation prevalence of regional musculoskeletal problems in primary care: an observational study. BMC Musculoskeletal Disorders, 2010; 11:144. http://www.ncbi.nlm.nih.gov/pubmed/20598124 
  • Menz HB, Jordan KP, Roddy E, Croft PR. Characteristics of primary care consultations for musculoskeletal foot and ankle problems in the UK. Rheumatology, 2010;49:7:1391-1398. http://www.ncbi.nlm.nih.gov/pubmed/20403912 
  • Hughes H, Jordan KP, Rajaratnam G, Fawcett S, Croft P. Recent changes in general practice morbidity in older people. Age and Ageing, 2008;37:5:572-575. http://www.ncbi.nlm.nih.gov/pubmed/18487261 
  • Jordan K, Clarke AM, Symmons DPM, Fleming D, Porcheret M, Kadam UT, Croft P. Measuring disease prevalence: a comparison of musculoskeletal disease using four general practice consultation databases. British Journal of General Practice, 2007;57:7-14. http://www.ncbi.nlm.nih.gov/pubmed/17244418 

Trends in Management and Impact of Guidelines

We have categorised the 300+ pain medications available for GPs to prescribe into six groups: from basic analgesia through increasingly potent opioids and NSAIDs. This has allowed us to describe the management of painful musculoskeletal conditions and assess the impact of directives and guidelines on primary care prescribing.

  • Ndlovu M, Bedson J, Jones PW, Jordan KP. Pain medication management of musculoskeletal conditions at first presentation in primary care: analysis of routinely collected medical record data. BMC Musculoskeletal Disorders, 2014;15:418. http://www.ncbi.nlm.nih.gov/pubmed/25492581 
  • Bedson J, Belcher J, Martino OI, Ndlovu M, Rathod T, Walters K, Dunn KM, Jordan KP. The effectiveness of national guidance in changing analgesic prescribing in primary care from 2002 to 2009: an observational database study. European Journal of Pain, 2013;17:434-443. http://www.ncbi.nlm.nih.gov/pubmed/22865816

Assessment of Quality of Care

We have derived quality indicators for the primary health care of osteoarthritis through an extensive systematic review. The indicators were then included in a pop-up electronic template for use during consultations. This has allowed us to measure and change the quality of care for osteoarthritis.

  • Edwards JJ, Jordan KP, Peat G, Bedson J, Croft PR, Hay EM, Dziedzic KS. Quality of Care for Osteoarthritis: the effect of a point-of-care consultation recording template. Rheumatology, 2014; doi: 10.1093/rheumatology/keu411. http://www.ncbi.nlm.nih.gov/pubmed/25336538
  • Edwards J, Khanna M, Jordan JL, Jordan KP, Bedson J, Dziedzic K. Quality indicators for the primary care of osteoarthritis: a systematic review. Annals of the Rheumatic Diseases, 2015;74;3:490-8. http://www.ncbi.nlm.nih.gov/pubmed/24288012 

Extending and Enhancing the Routine Record

We are developing patient-reported outcome measures, developing and evaluating screening and prognostic indicators embedded in the primary care record, and using innovative approaches to obtaining regular measurements of patient symptoms. Further information will be included here shortly.

Dissemination

We have disseminated to policymakers, practitioners and public through peer-reviewed publications, collaborative publications with Arthritis Research UK and our own bulletin, Musculoskeletal Matters.

We have a Collaborative Agreement with Public Health England, which supports our intelligence research in musculoskeletal health.