RT Journal Article
SR Electronic
T1 GP coding behaviour for non-specific clinical presentations: a pilot study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP bjgpopen20X101050
DO 10.3399/bjgpopen20X101050
VO 4
IS 3
A1 John SP Tulloch
A1 Mike BJ Beadsworth
A1 Roberto Vivancos
A1 Alan D Radford
A1 Jenny C Warner
A1 Rob M Christley
YR 2020
UL http://bjgpopen.org/content/4/3/bjgpopen20X101050.abstract
AB Background Clinical coding is an integral part of primary care. Disease incidence studies based on primary care electronic health records (EHRs) rely on the accuracy of these codes. Current code validation methods are not appropriate for non-specific conditions and provide limited information about GPs' decision-making behaviour around coding. Qualitative methods could offer insight into decision-making behaviour around coding of patients with non-specific conditions.Aim To investigate the decision-making behaviour of GPs when applying Read codes to non-specific clinical presentations, using Lyme disease as a case example.Design & setting A pilot study was undertaken, involving masked semi-structured interviews of eight GPs in the North West of England.Method Semi-structured interviews were carried out based on 11 clinical cases representative of Lyme disease presentations. Discrete answers were described descriptively. Interview transcripts were analysed using a thematic approach.Results Themes underpinning GPs’ coding behaviour included: GP personal and professional experience; clinical evidence; diagnostic uncertainty; professional integrity and defensive practice; and patient-sourced health information and beliefs. GPs placed Lyme disease on their differential diagnosis list for five cases; in only two cases would GPs select a Lyme disease related Read code.Conclusion GPs were reluctant to code with specific diagnostic Read codes when they were presented with patients with vague or unfamiliar symptomology. This masked questionnaire methodology offers a new approach to validate incidence figures, based on Read codes of non-specific conditions. The reluctance to code poses many problems for primary care EHRs research. Further research is needed to understand what drives GPs’ coding behaviour.