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GP coding behaviour for non-specific clinical presentations: a pilot study.

ABSTRACT: BACKGROUND:Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions. AIM:To investigate the decision-making behaviour of GPs when applying Read codes to non-specific clinical presentations, using Lyme disease as a case example. DESIGN & SETTING:A pilot study was undertaken, involving masked semi-structured interviews of eight GPs in the North West of England. METHOD:Semi-structured interviews were carried out based on 11 clinical cases representative of Lyme disease presentations. Discrete answers were described descriptively. Interview transcripts were analysed using a thematic approach. RESULTS:Themes underpinning GPs' coding behaviour included: GP personal and professional experience; clinical evidence; diagnostic uncertainty; professional integrity and defensive practice; and patient-sourced health information and beliefs. GPs placed Lyme disease on their differential diagnosis list for five cases; in only two cases would GPs select a Lyme disease related Read code. CONCLUSION:GPs were reluctant to code with specific diagnostic Read codes when they were presented with patients with vague or unfamiliar symptomology. This masked questionnaire methodology offers a new approach to validate incidence figures, based on Read codes of non-specific conditions. The reluctance to code poses many problems for primary care EHRs research. Further research is needed to understand what drives GPs' coding behaviour.

SUBMITTER: Tulloch JS

PROVIDER: S-EPMC7465576 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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GP coding behaviour for non-specific clinical presentations: a pilot study.

Tulloch John Sp JS Beadsworth Mike Bj MB Vivancos Roberto R Radford Alan D AD Warner Jenny C JC Christley Rob M RM

BJGP open 20200825 3

<h4>Background</h4>Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions.<h4>Aim</h4>To inves ...[more]

PMID: 32636202

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Project description:BackgroundAfter hours general practice clinics provide medical attention for clients with non-emergency situations but are seeking immediate treatment and unable to wait for a general practitioner during routine opening hours. Evidence on the impact that after hours clinics have on emergency department presentations is equivocal. This study explored outcomes of the Bathurst After Hours General Practice Clinic (BAHGPC). Specifically it examined: clients' perceived urgency of, and satisfaction with their presentation to the BAHGPC; general practitioners' perception of the appropriateness of presentations to the BAHGPC; and whether the frequency of non-urgent and semi-urgent emergency department presentations at Bathurst Base Hospital has changed since the opening of the BAHGPC.MethodsClients presenting to the BAHGPC from 01/02/2015 to 30/06/2015 were asked to participate in the client presentation survey and follow-up satisfaction survey. General practitioner surveys were completed for individual clients from 01/12/2014 to 30/06/2015 to document the appropriateness of each presentation. Descriptive statistics are used to describe survey responses. Thematic analysis was applied for qualitative responses. Emergency department presentations were retrieved from the Emergency Department Data Collection. A comparison of presentations in the two years prior and subsequent to the opening of the BAHGPC was conducted using independent T-tests and Chi-square tests to compare mean presentations and proportional data for the different time periods examined.ResultsMost clients (76%) presenting to the BAHGPC classified their visit as essential. General practitioners considered most presentations to be appropriate (87%). Sixty percent (60%) of clients would have gone to the emergency department had the BAHGPC not been operational. Client satisfaction was high and 99% would use the clinic again. A significant reduction in total non-urgent presentations to the Emergency Department occurred in the two years since the opening of the BAHGPC clinic compared to the two years prior (418.5 vs. 245.5; P < 0.05).ConclusionsThere was concordance between general practitioners and clients regarding the appropriateness of presentations to the BAHGPC. The findings of this study highlight that after hours general practitioner clinics are an essential service in regional areas and contribute to reducing the burden of non-urgent presentations to the local emergency department.

Dataset Information

GP coding behaviour for non-specific clinical presentations: a pilot study.

Publications

GP coding behaviour for non-specific clinical presentations: a pilot study.

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