Background Knowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety. Objective We aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records. Methods “Harm” is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study’s results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers’ assessments. Study data will comprise demographic data of all 9000 patients and reviewers’ assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0. Results We have recruited practices and collected electronic records from 9078 patients. Reviews of these records are under way. The study is expected to be completed in August 2017. Conclusions The design of this complex study is presented with discussion on data collection methods, sampling weights, power analysis, and statistical approach. This study will show the epidemiology of patient harms recorded in general practice records for all of New Zealand and will show whether this epidemiology differs by rural location and clinic size.

AIM:To investigate the effectiveness of linking primary and secondary care data using an encrypted national health index (ENHI).METHODS:Primary care patient registers from 106 practices collected by the Dunedin Research Unit of the Royal New Zealand College of General Practitioners (RNZCGP) for the year 2001 were linked to the entire National Minimum Data Set (NMDS) for 2001 using an ENHI. The success of matching using the ENHI was measured, and primary and secondary care populations were compared in terms of hospital utilisation (number of discharges, length of stay, major diagnostic category [MDC]).RESULTS:86,608 unique general practice ENHIs were successfully linked to the NMDS for the study period. Date of birth was matched on ENHIs (96.6%), sex (99.1%), and ethnicity (84.0%). Hospital morbidity and hospital utilisation (in terms of number of discharges and length of stay) were similar for general practice patient admissions and the entire NMDS admission data set.CONCLUSIONS:Data collected in general practice linked well to secondary care data using the ENHI. Linked primary and secondary care data sets will provide a sound basis for research into publicly funded healthcare.

AIM:To determine how inhaled budesonide, beclomethasone and fluticasone are prescribed by general practitioners in New Zealand.METHODS:Retrospective study of computerised clinical records from 42 general practices in New Zealand for the period 1 July 1997 to 30 June 1998. The study population comprised 174 929 consulting patients, of whom 9878 patients were prescribed budesonide, fluticasone, or beclomethasone with full dosing instructions.RESULTS:The mean daily prescribed dose was higher for patients receiving inhaled budesonide (886 microg) than beclomethasone (547 microg), a difference of 339 microg (95% CI 311 microg to 367 microg), and fluticasone (508 microg), a difference of 378 microg (95% CI 344-412). The difference between mean daily prescribed doses of beclomethasone and fluticasone was 39 microg (95% CI 15-63). The overall difference was consistent across age groups and with different types of inhalation device. Evidence of systematic prescribing of higher doses of budesonide to patients with more severe asthma was not found. Patients prescribed fluticasone were more likely to have been prescribed oral steroids in the preceding year.CONCLUSIONS:Conclusions about the relative potencies of inhaled corticosteroids cannot be made with the data presented. However, data presented show that inhaled corticosteroids have not been prescribed in line with their reported relative potencies. This study provides benchmark data for the prescribing of inhaled steroids in New Zealand general practice.

AIM:To describe patterns of prescribing in general practice for New Zealanders aged 13 to 19 years.METHODS:The computerised records of 225 348 consulting patients from 48 general practices from around New Zealand were examined. A subset of 20 216 consulting patients (53.2% female) aged 13 to 19 years was selected and their prescribed medications analysed. General practice prescribing was described in terms of demographic characteristics and health-card eligibility.RESULTS:Patients aged 13 to 19 consult and are prescribed to less than the population as a whole (3.2 consultations versus 5.0, and 2.4 scripts versus 4.9 per annum). Females were prescribed to more frequently than males (2.7 prescriptions per consulting patient per annum versus 2.0). Patients with a community services card were prescribed to more frequently than those without (2.9 prescriptions per consulting patient per annum versus 2.0). Respiratory drugs were most frequently prescribed (primarily anti-asthma medications), followed by medications for the treatment of infections, the genito-urinary system (mainly oral contraceptives), dermatological medications, and medications for treatment of the nervous system (mainly analgesics).CONCLUSIONS:Patients aged 13 to 19 consult and are prescribed to less frequently than the population as a whole. Asthma appears to be the major source of chronic illness for this population. Prescribing data presented here provide valuable baseline data for further research.

AIM:To assess the completeness of primary care data collected by the Royal New Zealand College of General Practitioners' (RNZCGP) Dunedin Research Unit, and assess the feasibility of creating a New Zealand national minimum data set for primary care.METHODS:Patients from 42 practices contributing data to the Dunedin Research Unit made up the study population. A six-month sample of data was evaluated for completeness, and compliance to a minimum data set structure. Rates of recording patient identifiers, sex, ethnicity, community services card status, consultation identifier and date, prescriptions and Read codes were calculated for each practice and registered patient.RESULTS:Patient demography, NHI and community services card status were all well recorded (date of birth 99.3%, sex 98.9%, NHI 94.8%, CSC 100.0%). Read codes and ethnicity were still poorly recorded, although there was wide variation between practices.CONCLUSIONS:The completeness of data collected by the Dunedin Research Unit appears to be improving, although there is wide variation between contributing practices. The capability to create a primary care national minimum data set exists, but this will not become a reality until suitable education programmes and support are supplied for general practitioners and other staff members who record patient information.

AIM:To describe patterns of prescribing in general practice for New Zealanders aged 65 years and over.METHODS:The computerised records of 139 359 consulting patients from 31 general practices from around New Zealand were examined. A subset of 17 497 consulting patients aged 65 years and over was selected and their prescribed medications examined. Utilisation was described in terms of demographic characteristics and health card eligibility.RESULTS:84.6% of all consulting patients received one or more prescriptions during the study period. Patients were prescribed a mean of 19.7 medication items per annum. Females were prescribed to significantly more times than males for patients aged 79 and under. Community services card (CSC) holders were prescribed to more frequently than patients without a CSC in all age groups. 29.5% of all medication items were from the cardiovascular system Anatomical Therapeutic Chemical (ATC) grouping.CONCLUSIONS:There is a high level of exposure to medication in populations of older people. This is a reflection of older persons' morbidity and also indicates an urgent need to examine the data further for potential drug interactions and side effects.