Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-26T18:50:10.389Z Has data issue: false hasContentIssue false
  • English
  • Français

Using electronic medical records to determine prevalence and treatment of mental disorders in primary care: a database study

Published online by Cambridge University Press:  10 April 2015

M. Gleeson ,
A. Hannigan ,
R. Jamali ,
K. Su Lin ,
J. Klimas ,
M. Mannix ,
Y. Nathan ,
R. O’Connor ,
C. O’Gorman  and
C. Dunne
...Show all authors
M. Gleeson
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
A. Hannigan
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
R. Jamali
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
K. Su Lin
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
J. Klimas
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
M. Mannix
Affiliation:
Department of Public Health, Health Services Executive West, Limerick, Ireland
Y. Nathan
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
R. O’Connor
Affiliation:
HSE Midwest/UL Specialist GP Training Programme, Limerick, Ireland
C. O’Gorman
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
C. Dunne
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
D. Meagher
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland
W. Cullen*
Affiliation:
Graduate-Entry Medical School, University of Limerick, Limerick, Ireland UCD School of Medicine & Medical Science, Dublin, Ireland
*
*Address for correspondence: Professor W. Cullen, UCD School of Medicine & Medical Science, UCD Health Sciences, Belfield, Dublin 4, Ireland. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

With prevention and treatment of mental disorders a challenge for primary care and increasing capability of electronic medical records (EMRs) to facilitate research in practice, we aim to determine the prevalence and treatment of mental disorders by using routinely collected clinical data contained in EMRs.

Methods

We reviewed EMRs of patients randomly sampled from seven general practices, by piloting a study instrument and extracting data on mental disorders and their treatment.

Results

Data were collected on 690 patients (age range 18–95, 52% male, 52% GMS-eligible). A mental disorder (most commonly anxiety/stress, depression and problem alcohol use) was recorded in the clinical records of 139 (20%) during the 2-year study period. While most patients with the common disorders had been prescribed medication (i.e. antidepressants or benzodiazepines), a minority had been referred to other agencies or received psychological interventions. ‘Free text’ consultation notes and ‘prescriptions’ were how most patients with disorders were identified. Diagnostic coding alone would have failed to identify 92% of patients with a disorder.

Conclusions

Although mental disorders are common in general practice, this study suggests their formal diagnosis, disease coding and access to psychological treatments are priorities for future research efforts.

Keywords

General practicehealth informaticsmental disordersprimary healthcaresubstance use
Type
Original Research
Information
Irish Journal of Psychological Medicine , Volume 33 , Issue 1 , March 2016 , pp. 3 - 12
Copyright
© College of Psychiatrists of Ireland 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ansseau, M, Dierick, M, Buntinkx, F, Cnockaert, P, De Smedt, J, Van Den Haute, M, Vander Mijnsbrugge, D (2004). High prevalence of mental disorders in primary care. Journal of Affective Disorders 78, 49–55.CrossRefGoogle ScholarPubMed
Bener, A, Al-Kazaz, M, Ftouni, D, Al-Harthy, M, Dafeeah, EE (2013). Diagnostic overlap of depressive, anxiety, stress and somatoform disorders in primary care. Asia-Pacific Psychiatry 5, E29–E38.CrossRefGoogle ScholarPubMed
Broers, T, Hodgetts, G, Batić-Mujanović, O, Petrović, V, Hasanagić, M, Godwin, M (2006). Prevalence of mental and social disorders in adults attending primary care centers in Bosnia and Herzegovina. Croatian Medical Journal 47, 478–484.Google ScholarPubMed
Cleary, A, Nixon, E, Fitzgerald, M (2007). Psychological health and well-being among young Irish adults. Irish Journal of Psychological Medicine 24, 139–144.CrossRefGoogle ScholarPubMed
Collins, C (2012). Research and audit in General Practice (presentation). Open Research to Inform Patient Outcomes (Online Webinar).Google Scholar
Collins, C, Janssens, K (2012). Creating a general (family) practice epidemiological database in ireland-data quality issue management. Journal of Data and Information Quality 4, 2.CrossRefGoogle Scholar
Connolly, D, Leahy, D, Bury, G, Gavin, B, McNicholas, F, Meagher, D, O'Kelly, FD, Wiehe, P, Cullen, W (2012). Can general practice help address youth mental health? A retrospective cross-sectional study in Dublin's South inner city. Early Intervention Psychiatry 6, 332–340.CrossRefGoogle ScholarPubMed
Copty, M, Whitford, D (2005). Mental health in general practice: assessment of current state and future needs. Irish Journal of Psychological Medicine 22, 83–86.Google ScholarPubMed
Cullen, W, Burns, C, Culhane, A, Davoren, P, Fahey, C (2012). Medical school and general practice – an enduring partnership. Forum 29, 10–12.Google Scholar
Cullen, W, O’Brien, S, O’Carroll, A, O’Kelly, FD, Bury, G (2009). Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care. BMC Family Practice 10, 25.CrossRefGoogle ScholarPubMed
De Jong, J, Visser, MR, Wieringa-de Waard, M (2013). Which barriers affect morbidity registration performance of GP trainees and trainers? International Journal of Medical Informatics 82, 708–716.CrossRefGoogle ScholarPubMed
De Lusignan, S (2005). The barriers to clinical coding in general practice: a literature review. Medical Informatics and the Internet in Medicine 30, 89–97.CrossRefGoogle ScholarPubMed
De Lusignan, S, Metsemakers, JF, Houwink, P, Gunnarsdottir, V, van der Lei, J (2006). Routinely collected general practice data: goldmines for research? A report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands. Informatics in Primary Care 14, 203–209.Google Scholar
Gunn, JM, Ayton, DR, Densley, K, Pallant, JF, Chondros, P, Herrman, HE, Dowrick, CF (2012). The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort. Social Psychiatry and Psychiatric Epidemiology 47, 175–184.CrossRefGoogle Scholar
Health Forum Steering Group (2008). Towards an Integrated Health Service or More of the Same? Based on the Findings of the Acute Bed Capacity Review, An Outline of the Options, Opportunities and Challenges in Developing the Right Balance Between Inpatient, Day Case and Community Based Care. Health Forum Steering Group: Dublin.Google Scholar
Health Information & Quality Authority (2012). National Standards for Safer Better Healthcare. Health Information & Quality Authority: Dublin.Google Scholar
Health Service Executive (2012). National Clinical Programmes. Health Service Executive: Dublin. http://www.hse.ie/eng/about/Who/clinical/natclinprog/ Accessed 19 March 2015.Google Scholar
Healy, D, Naqvi, S, Meagher, D, Cullen, W, Dunne, C (2013). Primary care support for youth mental health: a preliminary evidence base for Ireland’s Mid-West. Irish Journal of Medical Science 182, 237–243.CrossRefGoogle ScholarPubMed
Hughes, M, Byrne, M (2010). Prevalence of distress in general practitioner adult attendees. Clinical Psychology Forum 206, 33–38.CrossRefGoogle Scholar
Kaner, E, Bland, M, Cassidy, P, Coulton, S, Dale, V, Deluca, P, Gilvarry, E, Godfrey, C, Heather, N, Myles, J, Newbury-Birch, D, Oyefeso, A, Parrott, S, Perryman, K, Phillips, T, Shepherd, J, Drummond, C (2013). Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial. BMJ 346, e8501.CrossRefGoogle ScholarPubMed
Kaner, E, Bland, M, Cassidy, P, Coulton, S, Deluca, P, Drummond, C, Gilvarry, E, Godfrey, C, Heather, N, Myles, J (2009). Screening and brief interventions for hazardous and harmful alcohol use in primary care: a cluster randomised controlled trial protocol. BMC Public Health 9, 287.CrossRefGoogle ScholarPubMed
King, M, Nazareth, I, Levy, G, Walker, C, Morris, R, Weich, S, Bellón-Saameño, JÁ, Moreno, B, S̆vab, I, Rotar, D (2008). Prevalence of common mental disorders in general practice attendees across Europe. The British Journal of Psychiatry 192, 362–367.CrossRefGoogle ScholarPubMed
Kramer, TL, Owen, RR, Cannon, D, Sloan, KL, Thrush, CR, Williams, DK, Austen, MA (2003). How well do automated performance measures assess guideline implementation for new-onset depression in the veterans health administration? Joint Commission Journal on Quality and Safety 29, 479–489.Google ScholarPubMed
Lampe, L, Shadbolt, N, Starcevic, V, Boyce, P, Brakoulias, V, Hitching, R, Viswasam, K, Walter, G, Malhi, G (2012). Diagnostic processes in mental health: GPs and psychiatrists reading from the same book but on a different page. Australasian Psychiatry 20, 374–378.CrossRefGoogle ScholarPubMed
Lawlor, M, James, D (2000). Prevalence of psychological problems in Irish school going adolescents. Irish Journal of Psychological Medicine 17, 117–122.CrossRefGoogle Scholar
Leahy, D, Schaffalitzky, E, Armstrong, C, Bury, G, Cussen-Murphy, P, Davis, R, Dooley, B, Gavin, B, Keane, R, Keenan, E, Latham, L, Meagher, D, McGorry, P, McNicholas, F, O’Connor, R, O’Dea, E, O’Keane, V, O’Toole, TP, Reilly, E, Ryan, P, Sanci, L, Smyth, BP, Cullen, W (2013). Primary care and youth mental health in Ireland: qualitative study in deprived urban areas. BMC Family Practice 14, 194.CrossRefGoogle Scholar
Linzer, M, Spitzer, R, Kroenke, K, Williams, JB, Hahn, S, Brody, D, deGruy, F (1996). Gender, quality of life, and mental disorders in primary care: results from the PRIME-MD 1000 study. American Journal of Medicine 101, 526–533.CrossRefGoogle ScholarPubMed
Martin, M, Carr, A, Burke, L, Carroll, L, Byrne, S (2006). The Clonmel Project. Mental Health Service Needs of Children and Adolescents in the South East of Ireland. Health Service Executive: Clonmel.Google Scholar
Meade, B, Buckley, D, Boland, M (2009). What factors affect the use of electronic patient records by Irish GPs? International Journal of Medical Informatics 78, 551–558.CrossRefGoogle ScholarPubMed
Mitchell, AJ, Vaze, A, Rao, S (2009). Clinical diagnosis of depression in primary care: a meta-analysis. Lancet 374, 609–619.CrossRefGoogle ScholarPubMed
Murray, C, Lopez, A (1996). The Global Burden of Disease A Comprehensive Assessment of The Mortality and Disability From Diseases, Injuries and Risk Factors in 1990, and Projected To 2020. Harvard University Press: Cambridge, MA.Google Scholar
National Institute for Health and Care Excellence (2006). Bipolar Disorder, CG38, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg38. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2007). Drug Misuse: Psychosocial Interventions, CG51, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg51. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2009a). Depression in Adults, CG90, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg90. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2009b). Schizophrenia: Core Interventions in the Treatment and Management of Schizophrenia in Adults in Primary and Secondary Care, CG82, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg82. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2011a). Alcohol-Use Disorders: Diagnosis, Assessment and Management of Harmful Drinking and Alcohol Dependence, CG115, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg115. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2011b). Generalised Anxiety Disorder and Panic Disorder (With or Without Agoraphobia) in Adults, CG113, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg113. Accessed 19 March 2015.Google Scholar
National Institute for Health and Care Excellence (2012). Dementia, CG42, National Institute for Health and Care Excellence: London. http://www.nice.org.uk/guidance/cg42. Accessed 19 March 2015.Google Scholar
National Youth Council of Ireland (2009). The Truth About Youth Survey, National Youth Council of Ireland: Dublin. http://www.youth.ie/sites/youth.ie/files/The_Truth_About_Youth%2009.pdf. Accessed 18 March 2015.Google Scholar
O’Dowd, T, O’Kelly, M, O’Kelly, F (2005). Structure of General Practice in Ireland: 1982–2005. ICGP/TCD: Dublin.Google Scholar
Oireachtas (2011). Programme for Government. Oireachtas: Dublin.Google Scholar
Palin, JL, Goldner, EM, Koehoorn, M, Hertzman, C (2012). Prevalence and frequency of mental health care provided by general practitioners: differences between 2 national data sources for the same population. Canadian Journal of Psychiatry 57, 366–374.CrossRefGoogle ScholarPubMed
Power, C, O’Connor, R, Dunne, S, Finucane, P, Cullen, W, Dunne, C (2013). An evidence-based assessment of primary care needs in an economically deprived urban community. Irish Journal of Medical Science 182, 457–461.CrossRefGoogle Scholar
Roca, M, Gili, M, Garcia-Garcia, M, Salva, J, Vives, M, Garcia Campayo, J, Comas, A (2009). Prevalence and comorbidity of common mental disorders in primary care. Journal of Affective Disorders 119, 52–58.CrossRefGoogle ScholarPubMed
Rogers, CG, Heatherington, S, Carroll, M, Leonard, M, Cullen, W, Meagher, D (2013). An analysis of 100 referrals for depression from primary care to an adult mental health service. Irish Journal of Psychological Medicine 30(4).CrossRefGoogle Scholar
Schumann, I, Schneider, A, Kantert, C, Lowe, B, Linde, K (2012). Physicians’ attitudes, diagnostic process and barriers regarding depression diagnosis in primary care: a systematic review of qualitative studies. Family Practice 29, 255–263.CrossRefGoogle ScholarPubMed
Serrano-Blanco, A, Haro, JM, Palao, DJ, Luciano, JV, Pinto-Meza, A, Luján, L, Fernández, A, Roura, P, Bertsch, J, Mercader, M (2010). Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP). Social Psychiatry and Psychiatric Epidemiology 45, 201–210.CrossRefGoogle ScholarPubMed
Seyfried, L, Hanauer, DA, Nease, D, Albeiruti, R, Kavanagh, J, Kales, HC (2009). Enhanced identification of eligibility for depression research using an electronic medical record search engine. International Journal of Medical Informatics 78, e13–e18.CrossRefGoogle ScholarPubMed
Smith, SM, Ferede, A, O’Dowd, T (2008). Multimorbidity in younger deprived patients: an exploratory study of research and service implications in general practice. BMC Family Practice 9, 6.CrossRefGoogle ScholarPubMed
The Stationery Office (2006). A Vision for Change: Report of the Expert Group on Mental Health Policy in Ireland. The Stationery Office: Dublin.Google Scholar
Sullivan, C, Arensman, E, Keeley, HS, Corcoran, P, Perry, I (2004). Young People’s Mental Health: A Report of the Results from the Lifestyle and Coping Survey. National Suicide Foundation: Cork.Google Scholar
Tedstone-Doherty, D, Moran, R, Kartalova-O’Doherty, Y, Walsh, D (2007). HRB National Psychological Wellbeing and Distress Survey: Baseline Results. Dublin.Google Scholar
Toft, T, Fink, PER, Oernboel, EVA, Christensen, KAJ, Frostholm, L, Olesen, F (2005). Mental disorders in primary care: prevalence and co-morbidity among disorders. Results from the Functional Illness in Primary care (FIP) study. Psychological Medicine 35, 1175–1184.CrossRefGoogle ScholarPubMed
Trinh, NH, Youn, SJ, Sousa, J, Regan, S, Bedoya, CA, Chang, TE, Fava, M, Yeung, A (2011). Using electronic medical records to determine the diagnosis of clinical depression. International Journal of Medical Informatics 80, 533–540.CrossRefGoogle ScholarPubMed