Information from General Practice (CMR)

Introduction

Continuous Morbidity Recording is a set of data collected from every face-to-face doctor-patient contact in a set of practices across Scotland. All mainland health boards are represented in the 62 (as at 28 January 1999) practices participating in CMR. The practices provide an adequate representation of the Scottish population in terms of age, sex, deprivation and urban/rural mix.

The data set includes:

• Patient identifier (this is generated by the GPASS computer system and is practice specific)
• Date of birth
• Diagnosis (up to ten per contact)
• Sex
• Modifier (first, recurrence or persistent - for each diagnosis)
• Postcode
• Date of consultation

As patients often present with multiple problems, up to ten diagnoses can be recorded for each contact. Each diagnosis is given a modifier which describes whether it is either the first time the problem has presented, a recurrence of a previous problem or a persistent problem.

Contacts are recorded by every doctor (including locums) but not contacts seen by other practice staff - eg practice nurses; health visitors. (Pilot studies involving the collection of practice nurse contact data are underway in selected practices). All doctor contacts (including contacts with temporary residents) are captured - i.e. surgery consultations; clinics; home visits; out of hours (this includes practice patients seen by other doctors, e.g. co-operative doctors).

Each diagnosis is coded using the Read coding system. There are a considerable number of Read codes available and, for most analyses, individual Read codes are too detailed. There is also considerable scope for variation in the use of codes between different practices. Because of this, analysts and medical staff within ISD have grouped the codes into clinically meaningful conditions to aid the analysis of CMR data.

Information is fed back to the participating practices in the form of individual monthly and quarterly reports. An ad hoc analysis service is provided by ISD Scotland to the NHSiS in general, from an aggregated, anonymised, central file.

Analysis

The analysis below utilises data from the 50 practices for which data were available for the whole of the period 1 April 1997 to 31 March 1998. The data comprises consultations with only those individuals attending during this period.

It is important to note that the figures do not reflect the prevalence of Drug Misuse in the community. It is known that people who misuse drugs are often not in contact with any service. The figures do, however, give an insight into some characteristics of those who misuse drugs and present to a General Practitioner.

Table 33 Drug Abuse - Number of patients diagnosed (total and first diagnosis only);

Table 33 shows that 692 males and 333 females were diagnosed as drug users, of these 313 males and 155 females were first diagnosed within the period. Males therefore accounted for 68 per cent of drug users. This is a similar percentage to that reported to the Scottish Drug Misuse Database (70 per cent, Table 5) by all participating services.

Charts 21 and 22 presents consultation rates for the ten most common conditions/illnesses of males and females aged 15-44 for whom a diagnosis of Drug Misuse has been recorded in the period. The charts also include, for comparative purposes, the consultation rates of those individuals without a diagnosis of Drug Misuse in the period.

For males with a diagnosis of Drug Misuse, affective depression, alcohol problems and anxiety were the most commonly reported reasons for consultation - there were 341 consultations per 1000 Drug Misuse patients for affective depression, 340 consultations per 1000 for alcohol problems and 296 consultations per 1000 for anxiety. This compares respectively to consultation rates of 148, 48 and 109 consultations per 1000 non Drug Misuse patients.

For females with a diagnosis of Drug Misuse the most commonly reported reasons for consultation are anxiety and affective depression - 763 consultations per 1000 Drug Misuse patients for anxiety, and 730 consultations per 1000 for affective depression. This compares respectively to consultation rates of 177 and 339 consultations per 1000 non Drug Misuse patients.

It may be seen that in general females attend more often than males, and that this is true for those who have received a diagnosis of Drug Misuse, as well as those who have not. However, charts 21 and 22 show that Drug Misusers attended far more commonly than those who did not receive a diagnosis of Drug Misuse, when comparing these groups on specific conditions. This was particularly true for male drug users who in the period attend far more frequently than males who were not drug users.

Charts 21 and 22 show the most commonly reported conditions among those who misuse drugs. However, some patients may attend for the same condition on a number of occasions. Table 34 presents the proportion of patients presenting with a specific diagnosis at least once during the period. From this it can be seen that for male drug users, 15 per cent have received a diagnosis of anxiety and 14 per cent have received a diagnosis of affective depression, compared to only 6 per cent and 5 per cent (respectively) of non drug using males.

For females, whether using drugs or not, family planning is the most frequent reason recorded for attending the GP. However, 26 per cent of female drug users present with affective depression compared to 11 per cent for non drug users, and 26 per cent present with anxiety compared to only 9 per cent of non drug users.

Table 34 Proportion of patients presenting with specific diagnosis

In summary

• The proportion of males and females in the Drug Misuse group is similar to that found in other treatment populations, despite the fact that many non-drug using females are, in general, more common attenders at general practice.
• Affective depression and anxiety are common reasons for consultation among both those with a diagnosis of Drug Misuse, and those without. However, this is more pronounced in the Drug Misuse group, who demonstrate many more consultations for each of these conditions.
• In general, women attend more commonly at their general practitioner, and tend to consult more frequently for specific conditions, particularly anxiety and affective depression. This is true for both those with a diagnosis of Drug Misuse and those without. Women drug users attend far more commonly than non-drug users with such conditions.