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The Use of Electronic Medical Records to Facilitate Identification of Patients Presenting with Oro-Facial Complaints to the General Medical Practitioners

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The Use of Electronic Medical Records to Facilitate Identification of Patients Presenting with Oro-Facial Complaints to the General Medical Practitioners THE UNIVERSITY OF MANCHESTER - APPROVED ELECTRONICALLY GENERATED THESIS/DISSERTATION COVER-PAGE Electronic identifier: 12428 Date of electronic submission: 17/07/2014 The University of Manchester makes unrestricted examined electronic theses and dissertations freely available for download and reading online via Manchester eScholar at http://www.manchester.ac.uk/escholar. I hereby declare that this print version of my thesis/dissertation is a TRUE and ACCURATE REPRESENTATION of the electronic version submitted to the University of Manchester's institutional repository, Manchester eScholar. Author's signature .............................................. Date signed ......................................................... Approved electronically generated cover-page version 1.0 The Use of Electronic Medical Records To Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical Practitioners A thesis submitted to the University of Manchester for the degree of Master of Philosophy in Oral and Maxillofacial Surgery in the Faculty of Medical and Human Sciences 2013 SZE SENG CHAN SCHOOL OF DENTISTRY CONTENTS Page I. Contents 2 II. List of Tables 6 III. List of Figures 7 IV. List of Abbreviations and Acronyms 8 V. Abstract 9 VI. Declaration 10 VII. Intellectual Property Statement 11 VIII. Acknowledgement 12 1. Introduction 13 1.1 Overview of Oral Healthcare in the United Kingdom 13 (UK) 1.2 Oral Healthcare Expenditure 13 1.3 Establishment of National Health Service (NHS) 15 1.4 Reformation of NHS 16 1.5 NHS Organization Since 2012 18 1.6 Primary Care 19 1.7 Secondary Care 21 2. Justification For The Study 24 2.1 Separation of Medicine from Dentistry 24 2.2 Economic Impact of Oro-facial and/or dental 24 complaints 2 2.3 Medical and Dental Trainings 25 2.4 Health Behaviour of Patients presenting with Oro- 26 facial and/or Dental complaints 2.5 The characteristics of Patients Presenting with Oro- 27 facial and/or Dental complaints 2.6 Types of Oro-facial and/or Dental Problems 29 2.7 Quality of Care and Service Provision 29 2.8 Purpose of the Study 31 3. Objective 35 4. Method 36 4.1 Study Design 36 4.2 Patient Selection 36 4.3 City of Salford 36 4.4 Healthcare Services in Salford City 39 4.5 North West e-Health (NWeH) 41 4.6 Electronic Medical Records (EMRs) 41 4.7 EMIS Database 42 4.8 Read Codes Clinical Classification (RCCC) 43 4.9 Advantages of Using Electronic Medical Records 45 (EMRs) 4.10 Data Anonymisation 46 4.11 Data Collection 47 4.12 Data Analysis 49 4.13 Types of Outcome Measures 49 4.14 Data Storage and Disposal 49 4.15 Ethical Considerations 50 4.16 Funding 50 4.17 Publication Policy 50 5. Results 52 5.1 Number of Patients and Number of Attendances 52 3 5.2 Types of Oro-facial or/and Dental Complaint 57 5.3 Attendance Pattern by Gender 58 5.4 Attendance Pattern by Medical Co-morbidities 58 5.5 Attendance Pattern by Days of the Week 60 5.6 Attendance Pattern by Age 61 5.7 Attendance Pattern by Other Demographic Factors 62 6. Discussion 70 6.1 Challenges 70 6.1.1 Data Security 70 6.1.2 Data Quality 71 6.1.3 Coding Behaviour of GMPs 73 6.2 Main Findings 75 6.2.1 Attendance Pattern 75 6.2.2 Oro-facial or/and Dental Complaints 76 According to Age, Gender, and Ethnicity 6.2.3 Oro-facial or/and Dental Complaints 77 According to Days of the Week 6.2.4 Roles of GMPs in Managing Oro-facial 77 or/and Dental Complaints 6.2.5 Dental Abscess 78 6.3 Future Research Potentials 79 6.3.1 Potentials and Benefits 79 6.3.2 Integration of EMRs and EDRs 80 6.3.3 Ideas For Author’s Next Research 81 7. Conclusions 83 8. References 85 9. Appendices 91 9.1 Appendix 1 General Medical Practitioners In City of 91 Salford 4 9.2 Appendix 2 General Dental Practitioners In City of 95 Salford 9.3 Appendix 3 Read Codes for History and Symptoms 96 9.4 Appendix 4 Read Codes for Diagnosis of Oro- facial 98 Malignant Neoplasm 9.5 Appendix 5 Read Codes for Oro-facial Diagnosis 99 9.6 Appendix 6 Read Codes for Diagnosis of Oro-facial 116 Fractures 9.7 Appendix 7 Data Sharing Agreement 117 9.8 Appendix 8 Approval Letter from Governance 128 Committee for NWeH Words: 24,770 5 LIST OF TABLES Page Table 1 Read Codes for Diabetes Mellitus 44 Table 2 Entry of Read codes to EMRs for Diabetes Mellitus 45 Table 3 List of Important Read Codes for Oro-facial Complaints 48 Table 4 Number of Patients Presenting with Tooth Related Problems 53 and Number of Attendances in PMCs from 1st January 2009 to 15th December 2012 Table 5 Number of Patients with Non-tooth related problems and 53 Number of Attendances in PMCs from 1st January 2009 to 15th December 2012 Table 6 Number of Patients and Number of Attendance for All Oro- 54 facial Complaints in PMCs from 1st January 2009 to 15th December 2012 Table 7 The Read Codes Included in the Diagnostic Groups 56 Table 8 Attendance Pattern for Oro-facial or/and Dental Complaints 61 and Non-dental Complaints by Age Table 9 Attendance Pattern by Ethnicity 64 Table 10 Attendance Pattern by Religion 66 Table 11 Attendance Pattern by Social Group 68 6 LIST OF FIGURES Page Pie-Chart Fifteen most common oro-facial or/and dental complaints 57 presented to GMPs from 1st January 2009 to 15th December 2012 Graph 1 Attendance Pattern for Oro-facial or/and dental complaints 59 and non-dental complaints by the gender Graph 2 Attendance Pattern for Oro-facial or/and dental complaints 59 and non-dental complaint by medical co-morbidities Graph 3 Attendance Pattern for Oro-facial or/and dental complaints 60 and non-dental complaints by days of the week Graph 4 The Trend of Attendance for 15 Most Common Oro-facial 63 or/and dental Complaints 7 LIST OF ABBREVIATIONS AND ACRONYMS A&E Accident and Emergency Department DCB Dental Corporate Bodies EDRs Electronic Dental Records EMRs Electronic Medical Records GDPs General Dental Practitioners GMPs General Medical Practitioners ICD International Classification of Diseases IGPs Information Governance Principles IT Information Technology NWeH North West Electronic Health Organisation NHS National Health Service PMCs Primary Medical Cares PCTs Primary Care Trusts RCCC Read Code Clinical Classification SHAs Strategy Health Authorities SIR Salford Integrated Records UK United Kingdom USA United State of America WHO World Health Organisation 8 ABSTRACT The University of Manchester SzeSeng Chan Master of Philosophy in Oral and Maxillofacial Surgery The Use of Electronic Medical Records to Facilitate Identification of Patients Presenting With Oro-facial Complaints To The General Medical Practitioners January 2014 Aims : To study the pattern of attendance of patients who present to General Medical Practitioners (GMPs) with oro-facial or/and dental complaints. Data Source : All the Primary Medical Cares (PMCs) in the North West e-health database (NWeH). Population : All the patients of 54 PMCs in Salford who had registered themselves with GMPs from January 2009 to 15th December 2012. Method : A secondary analysis is performed on electronic consultation data entered daily at PMCs. The medical events were recorded by using Read Codes Clinical Classification system (RCCC). An agreed list of codes was designed by the investigators to recognise patients presenting with oro-facial complaints. The data extracted was anonymised. A descriptive analysis is used to define the patients’ characteristics. Result : There were 20,216 patients who visited their GMPs for at least one or more oro-facial or/and dental complaints by 2012. Of all the 908,062 medical attendance at PMCs, 10.4% were related to oro-facial or/and dental problems. This represents 9.39% of the patients (n =215,382) from population of Salford who have registered themselves with GMPs. Oral aphthous ulcer was the commonest oro-facial disease presented to GMPs. Discussion : Major challenges faced included data ownership and security issues, incomplete data and inconsistent data; and variation of data quality due to differences of coding behaviour of GMPs. The attendances for oro-facial or/and dental complaints were 1.94 time higher during weekdays than at weekend. A small but gradual rise was noted in the number of attendance related to dental abscess. This development may be the result of spending cut in NHS dental service. Conclusion : The attendance rate for oro-facial and/or dental complaints varied between PMCs in Salford, but was significant and may have far-reaching implications on dental care planning in the United Kingdom (UK). 9 DECLARATION That no portion of the work referred to in the thesis has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning. 10 Copyright Statement I. The author of this dissertation (including any appendices and/or schedules to this dissertation) owns certain copyright or related rights in it (the “Copyright”) and s/he has given The University of Manchester certain rights to use such Copyright, including for administrative purposes. II. Copies of this dissertation, either in full or in extracts and whether in hard or electronic copies, may be made only in accordance to the Copyright, Designs and Patents Act 1988 (as amended) and regulations issued under it or, where appropriate, in accordance with licensing agreements which the University has entered into. This page must form any part of any such copies made. III. The ownership of certain Copyright, designs, patents, trademarks and other intellectual property (the “Intellectual Property”) and any reproductions of copyright work in the dissertation, for example graphs, and tables (“Reproductions”), which may described in this dissertation, may not be owned by the author and may be owned by a third party.
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