Data quality of general practice electronic health records: the impact of a program of assessments, feedback, and training.

Objective: The aim of this study was to investigate the impact of a program of repeated assessments, feedback, and training on the quality of coded clinical data in general practice.

Design: A prospective uncontrolled intervention study was conducted in a general practice research network.

Measurements: Percentage of recorded consultations with a coded problem title and percentage of patients receiving a specific drug (e.

Is all chronic pain the same? A 25-year follow-up study.

Many apparently distinctive clinical syndromes of pain and dysfunction show considerable overlap in both population and clinical settings. If the explanation is that they all share a common underlying mechanism, then we hypothesize that any one syndrome will be unlikely to retain its distinctiveness over time. Consultation data from general practice records for 10073 women, collected between 1968 and 1978, was linked with information on pain complaints obtained from a subsequent postal survey carried out in 1994.

A brief screening tool for knee pain in primary care (KNEST). 2. Results from a survey in the general population aged 50 and over.

Objective: To use a brief screening tool to identify knee pain (all knee pain, non-chronic and chronic knee pain) and associated health-care use in the general population aged 50 yr and over.

Methods: A cross-sectional survey was mailed to 8995 individuals registered with three general practices in North Staffordshire, UK. The questionnaire included a Knee Pain Screening Tool (KNEST), the Short Form 36 (SF36), demographic questions and, for those who reported knee pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

Evaluation of a computer-assisted data entry procedure (including Teleform) for large-scale mailed surveys.

Computer-assisted data entry procedures for self-completion population surveys are previously unreported. We used Teleform for a questionnaire to registrants (aged 50+) with general practices in North Staffordshire, UK (n=8995). The survey achieved a 77% response rate.

Increased vaginal bleeding and psychological distress: a longitudinal study of their relationship in the community.

Objective: To explore the temporal relationship between the development of self-reported symptoms of vaginal bleeding and the development of psychological distress among women in the community.

Design: Prospective cohort study using postal surveys at baseline and at 6 and 12 months.

Setting: An urban four-partner general practice with 10000 registered patients.

North Staffordshire Headache Survey: development, reliability and validity of a questionnaire for use in a general population survey.

The North Staffordshire Headache Survey aims to measure the effect and impact of headaches, medicine use and healthcare utilization in a general population sample. A self-reporting questionnaire was piloted in a general population sample, with reliability being tested in a sample of pilot responders after one month and validity by comparing pilot responders with primary and secondary care headache consulters. One hundred and twenty-two (61%) responded to the pilot survey, with 56% of items having completion rates of 90% or more, and tests showed good internal consistency (>90%).

How do GPs use x rays to manage chronic knee pain in the elderly? A case study.

Objectives: To determine whether clinical signs and symptoms of osteoarthritis influence general practitioners' (GPs) decisions about x raying older patients with knee pain and whether x ray reports alter their initial treatment or referral plan.

Methods: A cross sectional survey of 1000 GPs in England and Wales using "paper cases" in three questionnaires mailed at two-weekly intervals. The first questionnaire assessed GPs' management of patients with knee pain using four case scenarios, two with features of clinical knee osteoarthritis.

A pragmatic randomised controlled trial of local corticosteroid injection and physiotherapy for the treatment of new episodes of unilateral shoulder pain in primary care.

Objectives: To compare the long term effectiveness of local steroid injections administered by general practitioners with practice based physiotherapy for treating patients presenting in primary care with new episodes of unilateral shoulder pain.

Methods: Adults consulting with shoulder pain were recruited by their general practitioner. Patients were randomly allocated to receive either corticosteroid injections or community based physiotherapy.

Syndrome of symptomatic adult acetabular dysplasia (SAAD syndrome).

Objectives: To determine the prevalence of acetabular dysplasia in subjects presenting with hip pain to primary care and its relationship with radiographic osteoarthritis (OA) of the hip.

Design: Cross sectional analysis of a prospective cohort.

Setting: 35 general practices across the UK.

A prospective study in primary care in patients without vascular disease comparing levels of coronary risk factors in those recommended for lipid-lowering drugs based on either absolute risk or absolute risk reduction.

In the United Kingdom, the current recommendation is that lipid-lowering drugs should be prescribed for primary prevention only to subjects with an absolute coronary risk (AR) greater than 15% in 5 years (i.e., myocardial infarction or angina).

Increased vaginal bleeding: the reasons women give for consulting primary care.

A previous study identified interference with life as the main reason for consultation with increased vaginal bleeding. The purpose of this study was to determine the reasons why the heaviness of periods interferes with life and how this may be related to consultation. The design was a case-control study in which questionnaires were sent to women who consulted primary care with new episodes of increased vaginal bleeding and two groups of controls: consulting controls with another illness and non-consulting community controls.

Epidemiology of headache in an English district.

Headache prevalence, characteristics and impact in adults were measured using a cross-sectional general population survey in North Staffordshire, UK. A postal survey was mailed out to 4885 adults (aged > or = 18 years) with an adjusted response rate of 56% (n = 2662). Of respondents 93% reported headache ever and 70% in the last 3 months.

Does questionnaire structure influence response in postal surveys?

This study tested the effect of questionnaire structure on response, speed of return, and content of answers in a postal survey. All 259 patients aged 30-59 years who consulted with back pain at four UK general practices from March to June 2001 were randomly allocated to receive either a traditionally or chronologically structured self-completion questionnaire. The response was higher and the returns quicker (P =.

Predictors of hip joint replacement in new attenders in primary care with hip pain.

Background: Studies investigating the factors associated with need for total hip replacement should ideally be based on prospective investigation of new attenders in primary care.

Aim: To determine the incidence of listing for total hip replacement, and its predictors, among attenders in primary care with a new episode of hip pain.

Design Of Study: Prospective multicentre cohort study.

Previous consultation and self reported health status as predictors of future demand for primary care.

Study Objective: There has been little prospective investigation of what predicts general practice consultation. The objective of this study was to investigate the extent to which previous primary care consultation and self reported health status are predictors of future primary care consultation.

Design: Population based cohort study in two phases.

Episodes of low back pain: a proposal for uniform definitions to be used in research.

Study Design: Literature review and group discussions.

Objective: To propose uniform definitions for low back pain episodes to be used in research.

Background: Different definitions of episodes have been used in low back pain studies.

Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).

This study has used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in an unsolicited postal questionnaire to investigate the impact of knee pain and disability in the general older population. The study provides WOMAC population data for those aged over 50 and demographic and psychosocial associations with severity of WOMAC scores. A pilot survey (n=240) and repeatability study (n=80) were undertaken to test completion of the WOMAC in this new setting.

Systematic review of sexual problems: epidemiology and methodology.

We conducted a comprehensive systematic literature review of five sexual problems in order to estimate their population prevalence and to investigate issues arising from the reviewing of epidemiological literature. Two independent reviewers scrutinized abstracts, extracted data, and assessed methodological quality. Twenty-eight relevant studies were identified.

Health status in patients awaiting hip replacement for osteoarthritis.

Background: Hip osteoarthritis is a major cause of pain and disability, especially in the elderly. As part of a study investigating factors that could be associated with advanced osteoarthritis of the hip, we compared the health status of patients awaiting arthroplasty for hip osteoarthritis with controls. We further investigated the interaction of hip osteoarthritis with other variables (age, gender, social class and concurrent pain) in relation to health status.

The impact of sporadic campylobacter and salmonella infection on health and health related behaviour: a case control study.

The aim of the work was to explore the impact on general and psychological health of those with a proven bacterial gastrointestinal infection and to compare this with controls from whom no bacterial pathogen was identified. A case control study was conducted using an interviewer-administered questionnaire. Thirty-nine cases from whose faeces salmonella or campylobacter had been cultured were compared with matched controls.

The effect of diabetic control on the incidence of, and changes in, retinopathy in type 2 non-insulin dependent diabetic patients.

The purpose of this study was to investigate the association between retinopathy and the levels of diabetic control found in type 2 non-insulin dependent diabetic patients. The study covered a four-year period and used retrospective, routinely recorded general practice and optometry records from 260 patients; those with retinopathy (n = 38) and those without retinopathy (n = 222). The study demonstrated a strong relationship between the presence of retinopathy and long-term diabetic control as measured by glycosylated HbA1c, disease duration and, to a lesser extent, the level of urine microalbumin.

Effects of manual work on recovery from lateral epicondylitis.

Objectives: This study investigates the influence of manual work on the persistence of lateral epicondylitis during a 12-month follow-up period after consultation in general practice.

Methods: A cohort study was made of 164 adult consulters with tennis elbow, who had initially been recruited to a randomized controlled trial from 23 general practices in North Staffordshire and South Cheshire. As part of the recruitment process prior to treatment randomization, self-reported questionnaires on symptoms and sociodemographic characteristics were completed.

Neck and upper limb pain: more pain is associated with psychological distress and consultation rate in primary care.

Objective: To investigate the association between the extent of pain and the severity of psychological distress in neck and upper limb pain, and to establish whether extent of pain is associated with consultation frequency in primary care.

Methods: The study population was selected from responders to a general health survey conducted in a general practice in North Staffordshire, UK. Responders indicating pain in the neck or upper limb area were included.