General practice recording of Adverse Childhood Experiences:a retrospective cohort study of GP records

Williamson, Andrea and McQueenie, Ross and Ellis, David and McConnachie, Alex and Wilson, Philip (2020) General practice recording of Adverse Childhood Experiences:a retrospective cohort study of GP records. BJGP Open, 4 (1). ISSN 2398-3795

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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. Aim: To investigate recording of ACEs in the GP clinical record and assess associations between available ACEs related Read codes and missed appointments. Design and Setting Retrospective cohort study of 824,374 anonymised GP patient records. Nationally representative sample of 136 Scottish GP practice data, 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 nonRead-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results: 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: GP practices would require substantial support to implement the recording of ACEs in the patient record. This paper adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.

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28 Nov 2019 09:10
Last Modified:
19 Sep 2023 02:19