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GPs warned not to base disease registers on Read codes alone

Basing practice heart disease registers purely on Read codes is inaccurate and misses one patient in three with the

condition, Government-funded research reveals

The additional checks needed to set up an accurate CHD register in preparation for the quality framework will take an average three-partner practice 27 hours, the study of 46 practices found.

Using Read codes alone missed 31 per cent of patients with CHD. And 15 per cent of patients who had a Read code indicating CHD did not have relevant conditions.

The findings undermine claims from GP negotiators that GPs can use Read codes to set up disease registers 'in 10 minutes'.

GPC negotiator Dr Laurence Buckman has said: 'The difference between an accurate and inaccurate register is fractional.'

The researchers identified 3,803 patients with a pre-

existing Read code for CHD. But 570 had no evidence of CHD in their notes, even though many were being prescribed statins inappropriately.

A trawl through the records of 7,726 patients who had no Read code for CHD but who had been prescribed one of five cardiac drugs ­ including statins, aspirin and ?-blockers ­ revealed a further 1,447 cases of CHD, according to a report in Journal of Public Health Medicine (September).

Using a combination of Read code checks and note sifting to compile an accurate register would take an average three-partner practice with 5,500 patients about 27 hours, the study concluded.

Identifying each additional CHD patient by trawling notes cost £10.20, but the researchers said this was cheap compared with potential benefits of secondary prevention.

The GPC has recommended using Read codes G3% and G30 to identify CHD patients.

But study leader Dr Jeremy Gray, a south London GP, said: 'Using G3 as the identifying mechanism for the new contract will be a real issue. There are patients with definite heart disease who are not coded with G3 and patients with G3 who don't have heart disease.'

Dr Gray, director of the Government-funded Battersea Research Group, added: 'The simplest way of reaching your quality targets will be to declassify patients who don't meet the parameters required.'

GP negotiator Dr Andrew Dearden said using Read codes for initial registers was sufficient and not intensive.

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