General practice recording of adverse childhood experiences: a retrospective cohort study of GP records

Andrea E. Williamson*, Ross McQueenie, David A. Ellis, Alex McConnachie, Philip Wilson

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background Adverse childhood experiences (ACEs) are linked to negative health outcomes in adulthood. Poor engagement with services may, in part, mediate the association between adverse outcomes and ACEs. While appointment recording is comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical record (GPR). Aim To investigate recording of ACEs in the GPR and assess associations between available ACE-related Read codes and missed appointments. Design & setting Retrospective cohort study of 824 374 anonymised GPRs. Nationally representative sample of 136 Scottish general practices; data collected 2013–2016. Method Read codes were mapped onto ACE questionnaire and wider ACE-related domains. Natural language processing (NLP) was used to augment capture of non-Read-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results In total, 0.4% of patients had a record of any code that mapped onto the ACE questionnaire, contrasting with survey-reported rates of 47% in population samples. This increased only modestly by including inferred ACEs that related to safeguarding children concerns, wider aspects of ACEs, and adult consequences of ACEs. Augmentation via NLP did not substantially increase capture. Despite poor recording, there was an association between ever having an ACE code recorded and higher rates of missing GP appointments. Conclusion General practices would require substantial support to implement the recording of ACEs in the GPR. This study adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.
Original languageEnglish
JournalBJGP Open
Early online date18 Feb 2020
DOIs
Publication statusE-pub ahead of print - 18 Feb 2020

Fingerprint

General Practice
Appointments and Schedules
Cohort Studies
Retrospective Studies
Natural Language Processing
Health
Population
Surveys and Questionnaires

Keywords

  • general practice
  • adverse childhood experiences
  • appointments and schedules
  • healthcare utilization

Cite this

General practice recording of adverse childhood experiences : a retrospective cohort study of GP records. / Williamson, Andrea E.; McQueenie, Ross; Ellis, David A.; McConnachie, Alex; Wilson, Philip.

In: BJGP Open, 18.02.2020.

Research output: Contribution to journalArticle

Williamson, Andrea E. ; McQueenie, Ross ; Ellis, David A. ; McConnachie, Alex ; Wilson, Philip. / General practice recording of adverse childhood experiences : a retrospective cohort study of GP records. In: BJGP Open. 2020.
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title = "General practice recording of adverse childhood experiences: a retrospective cohort study of GP records",
abstract = "Background Adverse childhood experiences (ACEs) are linked to negative health outcomes in adulthood. Poor engagement with services may, in part, mediate the association between adverse outcomes and ACEs. While appointment recording is comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical record (GPR). Aim To investigate recording of ACEs in the GPR and assess associations between available ACE-related Read codes and missed appointments. Design & setting Retrospective cohort study of 824 374 anonymised GPRs. Nationally representative sample of 136 Scottish general practices; data collected 2013–2016. Method Read codes were mapped onto ACE questionnaire and wider ACE-related domains. Natural language processing (NLP) was used to augment capture of non-Read-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results In total, 0.4{\%} of patients had a record of any code that mapped onto the ACE questionnaire, contrasting with survey-reported rates of 47{\%} in population samples. This increased only modestly by including inferred ACEs that related to safeguarding children concerns, wider aspects of ACEs, and adult consequences of ACEs. Augmentation via NLP did not substantially increase capture. Despite poor recording, there was an association between ever having an ACE code recorded and higher rates of missing GP appointments. Conclusion General practices would require substantial support to implement the recording of ACEs in the GPR. This study adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.",
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author = "Williamson, {Andrea E.} and Ross McQueenie and Ellis, {David A.} and Alex McConnachie and Philip Wilson",
note = "This study was supported by a Scottish Government Chief Scientist Office research grant (reference number: CZH/4/41118) with Safe Haven and data linkage costs supported in lieu by the Data Sharing and Linkage Service (DSLS) at Scottish Government. These funding bodies had no role in the design of the study, nor in the collection, analysis and interpretation of data, nor in writing the manuscript.",
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AU - Wilson, Philip

N1 - This study was supported by a Scottish Government Chief Scientist Office research grant (reference number: CZH/4/41118) with Safe Haven and data linkage costs supported in lieu by the Data Sharing and Linkage Service (DSLS) at Scottish Government. These funding bodies had no role in the design of the study, nor in the collection, analysis and interpretation of data, nor in writing the manuscript.

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N2 - Background Adverse childhood experiences (ACEs) are linked to negative health outcomes in adulthood. Poor engagement with services may, in part, mediate the association between adverse outcomes and ACEs. While appointment recording is comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical record (GPR). Aim To investigate recording of ACEs in the GPR and assess associations between available ACE-related Read codes and missed appointments. Design & setting Retrospective cohort study of 824 374 anonymised GPRs. Nationally representative sample of 136 Scottish general practices; data collected 2013–2016. Method Read codes were mapped onto ACE questionnaire and wider ACE-related domains. Natural language processing (NLP) was used to augment capture of non-Read-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results In total, 0.4% of patients had a record of any code that mapped onto the ACE questionnaire, contrasting with survey-reported rates of 47% in population samples. This increased only modestly by including inferred ACEs that related to safeguarding children concerns, wider aspects of ACEs, and adult consequences of ACEs. Augmentation via NLP did not substantially increase capture. Despite poor recording, there was an association between ever having an ACE code recorded and higher rates of missing GP appointments. Conclusion General practices would require substantial support to implement the recording of ACEs in the GPR. This study adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.

AB - Background Adverse childhood experiences (ACEs) are linked to negative health outcomes in adulthood. Poor engagement with services may, in part, mediate the association between adverse outcomes and ACEs. While appointment recording is comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical record (GPR). Aim To investigate recording of ACEs in the GPR and assess associations between available ACE-related Read codes and missed appointments. Design & setting Retrospective cohort study of 824 374 anonymised GPRs. Nationally representative sample of 136 Scottish general practices; data collected 2013–2016. Method Read codes were mapped onto ACE questionnaire and wider ACE-related domains. Natural language processing (NLP) was used to augment capture of non-Read-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results In total, 0.4% of patients had a record of any code that mapped onto the ACE questionnaire, contrasting with survey-reported rates of 47% in population samples. This increased only modestly by including inferred ACEs that related to safeguarding children concerns, wider aspects of ACEs, and adult consequences of ACEs. Augmentation via NLP did not substantially increase capture. Despite poor recording, there was an association between ever having an ACE code recorded and higher rates of missing GP appointments. Conclusion General practices would require substantial support to implement the recording of ACEs in the GPR. This study adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.

KW - general practice

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