Eleven key measures for monitoring general practice clinical activity during COVID-19: A retrospective cohort study using 48 million adults' primary care records in England through OpenSAFELY.

Autor:	Fisher L; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Curtis HJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Croker R; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Wiedemann M; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Speed V; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Wood C; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Brown A; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Hopcroft LEM; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Higgins R; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Massey J; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Inglesby P; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Morton CE; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Walker AJ; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Morley J; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Mehrkar A; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Bacon S; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Hickman G; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Macdonald O; Oxford Health Foundation Trust, Warneford Hospital, Oxford, United Kingdom., Lewis T; Royal Devon University Healthcare NHS Foundation Trust, Barnstaple, United Kingdom., Wood M; NHS England, London, United Kingdom., Myers M; Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, United Kingdom., Samuel M; Queen Mary University of London, London, United Kingdom., Conibere R; Beacon Medical Group, Plymouth, United Kingdom., Baqir W; NHS England, London, United Kingdom., Sood H; Sternhall Lane Surgery, London, United Kingdom., Drury C; Herefordshire and Worcestershire Health and Care NHS Trust, Worcester, United Kingdom., Collison K; NHS England, London, United Kingdom., Bates C; TPP, Leeds, United Kingdom., Evans D; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Dillingham I; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Ward T; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Davy S; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Smith RM; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Hulme W; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Green A; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom., Parry J; TPP, Leeds, United Kingdom., Hester F; TPP, Leeds, United Kingdom., Harper S; TPP, Leeds, United Kingdom., Cockburn J; TPP, Leeds, United Kingdom., O'Hanlon S; EMIS, Leeds, United Kingdom., Eavis A; EMIS, Leeds, United Kingdom., Jarvis R; EMIS, Leeds, United Kingdom., Avramov D; EMIS, Leeds, United Kingdom., Griffiths P; EMIS, Leeds, United Kingdom., Fowles A; EMIS, Leeds, United Kingdom., Parkes N; EMIS, Leeds, United Kingdom., MacKenna B; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.; NHS England, London, United Kingdom., Goldacre B; The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
Jazyk:	angličtina
Zdroj:	ELife [Elife] 2023 Jul 27; Vol. 12. Date of Electronic Publication: 2023 Jul 27.
DOI:	10.7554/eLife.84673
Abstrakt:	Background: The COVID-19 pandemic has had a significant impact on delivery of NHS care. We have developed the OpenSAFELY Service Restoration Observatory (SRO) to develop key measures of primary care activity and describe the trends in these measures throughout the COVID-19 pandemic. Methods: With the approval of NHS England, we developed an open source software framework for data management and analysis to describe trends and variation in clinical activity across primary care electronic health record (EHR) data on 48 million adults.We developed SNOMED-CT codelists for key measures of primary care clinical activity such as blood pressure monitoring and asthma reviews, selected by an expert clinical advisory group and conducted a population cohort-based study to describe trends and variation in these measures January 2019-December 2021, and pragmatically classified their level of recovery one year into the pandemic using the percentage change in the median practice level rate. Results: We produced 11 measures reflective of clinical activity in general practice. A substantial drop in activity was observed in all measures at the outset of the COVID-19 pandemic. By April 2021, the median rate had recovered to within 15% of the median rate in April 2019 in six measures. The remaining measures showed a sustained drop, ranging from a 18.5% reduction in medication reviews to a 42.0% reduction in blood pressure monitoring. Three measures continued to show a sustained drop by December 2021. Conclusions: The COVID-19 pandemic was associated with a substantial change in primary care activity across the measures we developed, with recovery in most measures. We delivered an open source software framework to describe trends and variation in clinical activity across an unprecedented scale of primary care data. We will continue to expand the set of key measures to be routinely monitored using our publicly available NHS OpenSAFELY SRO dashboards with near real-time data. Funding: This research used data assets made available as part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (grant ref MC_PC_20058).The OpenSAFELY Platform is supported by grants from the Wellcome Trust (222097/Z/20/Z); MRC (MR/V015757/1, MC_PC-20059, MR/W016729/1); NIHR (NIHR135559, COV-LT2-0073), and Health Data Research UK (HDRUK2021.000, 2021.0157). Competing Interests: LF, HC, RC, MW, VS, CW, AB, LH, RH, JM, PI, CM, AW, JM, SB, GH, TL, MW, WB, HS, CD, KC, DE, ID, TW, SD, RS, WH, AG No competing interests declared, AM Former employee and interim CMO of NHS Digital. Member of the RCGP health informatics group and the NHS digital GP data Professional Advisory Group, OM Received payment for:- Presenter at Psych 1 courses (College of Mental Health Pharmacy)- External assessor for Aston University modules on the PG Dip Psych Pharm course.Member of the College of Mental Health Pharmacy Council and co-lead the Education portfolio for this council. This is a charitable organisation and my work for the council is not paid, however, expenses for travel are reimbursed, MM Chair of MHRA IVD Expert Advisory Group. Unpaid, MS Between August 2018 and September 2022, employed as an NIHR funded Academic Clinical Fellow in Primary Care based at Queen Mary University London.Since September 2022, employed as a clinical research fellow on the NIHR funded AI MULTIPLY grant. All funding is awarded through Queen Mary University London, RC Honoraria for charing/presenting on webinars with Primary Care Pharmacy Association, CB Chris Bates is affiliated with TPP. The author has no financial interests to declare, JP John Parry is affiliated with TPP. The author has no financial interests to declare, FH Frank Hester is affiliated with TPP. The author has no financial interests to declare, SH Sam Harper is affiliated with TPP. The author has no financial interests to declare, JC Jonathan Cockburn is affiliated with TPP. The author has no financial interests to declare, SO Shaun O'Hanlon is affiliated with EMIS. The author has no financial interests to declare, AE Alex Eavis is affiliated with EMIS. Sits on the advisory board for OpenSAFELY and QResearch; both unpaid, RJ Richard Jarvis is affiliated with EMIS. The author has no financial interests to declare, DA Dima Avramov is affiliated with EMIS. The author has no financial interests to declare, PG Paul Griffiths is affiliated with EMIS. The author has no financial interests to declare, AF Aaron Fowles is affiliated with EMIS. The author has no financial interests to declare, NP Nasreen Parkes is affiliated with EMIS. The author has no financial interests to declare, BM Seconded to the Bennett Institute.Trustee of ICAP, a charity delivering counselling, BG BG has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he is a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science (© 2023, Fisher et al.)
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