Generating information from electronic patient records in general practice: a description of clinical care and gender inequalities in coronary heart disease using data from over two million patient records

Objectives To describe the epidemiology of coronary heart disease (CHD) in England and the activity of primary healthcare teams in managing patients with CHD, and also to demonstrate the utility of computerised patient records in providing access to epidemiological data and data reflecting healthcare activity. Design A descriptive survey of CHD and related clinical data, recorded using computerised clinical records, entered by primary healthcare teams. Aspects reported include prevalence of CHD, together with additional data reflecting clinical monitoring activity, therapeutic interventions and comorbidity in patients affected by CHD. Setting 317 general practices in 23 English primary care trusts (PCTs). Data acquisition MIQUEST was used to interrogate 2 252 274 computerised patient records. Data were extracted in the form of sex and age aggregated counts of patients meeting a range of extraction criteria. Results The observed crude prevalence of CHD is 40.3 per 1000 (males 46.6, females 34.2). A variety of findings are presented relating to the treatment, monitoring and comorbidities of CHD. Significant and systematic gender inequalities are demonstrated to exist in the monitoring and treatment of CHD. Conclusions Extraction of data from computerised patient records is a valuable and practicable method of generating information to inform clinicians and National Health Service (NHS) organisations. Systematic gender disparities exist in the care delivered to patients with CHD. Summary points CHD affects approximately 4% of the population in England. A significant gender gradient exists with approximately 4.7% of males being affected and 3.4% of females. This study provides persuasive confirmatory evidence of previously demonstrated gender disparities in the monitoring and treatment of CHD. The data also strongly support the suggestion that such gender disparities are systematic in nature. The study provides evidence of feasibility and potential value of remote interrogation of computerized clinical records in primary care to provide detailed information about population health characteristics and clinical activity to both the clinical community and NHS organisations.