UK Prevalence Data
Wednesday, 3 October 2007
Although we don't have full practice level data for Wales and England yet there is some national level data. We can work out prevalence in all four of the countries and for the UK as a whole. They are listed below. Smoking is not in the table as it is not listed at the national level but should be available when the practice level data comes through.
On the subject of practice level data there is some more information on the information centre website. They are planning to send out CDs so I will apply for one. Unfortunately there is a postal strike over the next week which may affect delivery somewhat. There should certainly be some demand. The 2006 full data database has been downloaded from this site over eight hundred times.
No news from Wales as yet.
| England | Scotland | N Ireland | Wales | UK | |
|---|---|---|---|---|---|
| Asthma | 5.78% | 5.48% | 5.75% | 6.53% | 5.79% |
| Atrial fibrillation | 1.29% | 1.27% | 1.25% | 1.61% | 1.30% |
| Cancer | 0.91% | 0.92% | 0.79% | 0.93% | 0.91% |
| Chronic kidney disease | 2.39% | 1.82% | 2.44% | 2.28% | 2.34% |
| COPD | 1.43% | 1.86% | 1.53% | 1.94% | 1.49% |
| Coronary heart disease | 3.54% | 4.55% | 4.18% | 4.28% | 3.67% |
| Dementia | 0.40% | 0.55% | 0.52% | 0.42% | 0.41% |
| Depression Screening | 7.24% | 7.50% | 7.56% | 7.39% | |
| Depression Ever | 6.25% | 6.13% | 7.27% | 6.55% | |
| Diabetes mellitus | 3.66% | 3.52% | 3.17% | 4.21% | 3.66% |
| Epilepsy | 0.60% | 0.72% | 0.74% | 0.73% | 0.62% |
| Heart failure | 0.78% | 0.88% | 0.81% | 0.51% | 0.78% |
| Hypertension | 12.51% | 12.61% | 11.68% | 14.26% | 12.58% |
| Hypothyroid | 2.55% | 3.14% | 2.90% | 3.13% | 2.63% |
| Learning disabilities | 0.26% | 0.41% | 0.32% | 0.30% | 0.28% |
| Mental health | 0.71% | 0.79% | 0.75% | 0.72% | 0.72% |
| Obesity | 7.42% | 7.01% | 8.38% | 9.64% | 7.53% |
| Palliative care | 0.09% | 0.10% | 0.10% | 0.10% | |
| Stroke and TIA | 1.61% | 1.97% | 1.62% | 1.97% | 1.66% |
Labels: prevalence, published_data, site news
Prevalence data for England and Northern Ireland
Thursday, 3 May 2007
Prevalence data is starting to get out! In the table below you can see the data from England and Northern Ireland. The English data was taken from QMAS at the start of April and the NI data from their official prevalence bulletin. I would recommend the NI bulletin for further reading as there are a lot of nice charts showing the spread of the prevalence. When comparing the data with previous years it is important to remember that there have been big rule changes in mental health and smaller one in LVD. Also of note is that the palliative care prevalence is for information only and does not change the cash value of points as the others do.
There are couple of figures in the NI bulletin I don't understand - mainly the depression 2 and LVD 3 listings. I can't quite see the relevance but I will ask!
| Prevalence Area | England | Northern Ireland |
|---|---|---|
| CHD | 3.551 | 4.196 |
| LVD | 0.790 | 0.818 |
| Stroke | 1.615 | 1.619 |
| Hypertension | 12.466 | 11.651 |
| Diabetes | 3.629 | 3.138 |
| COPD | 1.425 | 15.33 |
| Epilepsy | 0.590 | 0.745 |
| Thyroid | 2.490 | 2.872 |
| Cancer | 0.897 | 0.778 |
| Palliative Care | 0.087 | 0.090 |
| Mental Health | 0.716 | 0.753 |
| Asthma | 5.771 | 5.78 |
| Dementia | 0.400 | 0.526 |
| Depression* | 7.004 | 6.5 |
| Kidney Disease | 2.242 | 2.307 |
| Atrial Fibrillation | 1.295 | 1.252 |
| Obesity | 7.223 | 7.989 |
| Learning disabilities | 0.256 | 0.316 |
| Smoking - for recording** | 19.557 | 18.55 |
* I am not sure exactly what this depression figure means. I think it is the number of people eligible for depression screening.
** This is the number of people eligible to be asked regularly about their smoking. It is the combined prevalence of diabetes, hypertension, heart disease, COPD and stroke
Labels: prevalence, published_data
Measuring Prevalence
Sunday, 29 April 2007
One of the questions often asked by GPs about QOF data is what their prevalence data should be. There are three ways to measure the prevalence of a condition. First you can ask doctors, second ask patients and thirdly you can get out there and thoroughly examine a random group of people.
The data from QOF on this site is definitely in the first camp. I have come across some interesting disease prevalence models which try to compare QOF data against data from the Health Survey for England which is largely, as the name suggests a survey of the asking patients variety. It does however features some objective measurement by nurses as well.
There is only analysis for heart disease and hypertension. In heart disease there is a small reduction in prevalence in QOF compared to the HSE estimation. This is probably down to a lack of coding. The differences in hypertension prevalence are much larger with the HSE prevalence over double the QOF prevalence.
Now I have to admit that I boggled at this for a while. Could it really be that a quarter of all my patients had hypertension? Well the answer by strict interpretation seems to be "Yes". In fact the data, including the difference between the diagnosed and the actively treated has been observed for some time.
Now I don't propose to go through the rights and wrongs of this but the fact remains that prevalence varies widely possibly predictably depending who you ask. We don't have the official figures for this year's prevalence but kidney disease seems certain to come in well under expectations.
So before making comparisons make sure that data is all coming from the same sources. We await the official figures (traditionally Wales has been early with them but not this year).
Labels: analysis, prevalence
Prevalence Thresholds
Wednesday, 28 February 2007
In a comment on my prevalence day post it was suggested that I could publish exactly what the cut off levels were for each area in each country. These are simply 5% of the maximum prevalence in each area. Always happy to oblige - and the table is below for 2005/6.
(if you have no idea what I am talking about it might be worth reading the original article first)
| England | N. Ireland | Scotland | Wales | |
|---|---|---|---|---|
| STROKE | 1.19% | 0.3% | 0.25% | 0.56% |
| LVD | 0.27% | 0.09% | 0.17% | 0.18% |
| CHD | 1.43% | 0.43% | 0.57% | 1.14% |
| BP | 2.51% | 1.1% | 1.36% | 2.85% |
| DM | 0.81% | 0.31% | 0.38% | 0.96% |
| COPD | 0.87% | 0.33% | 0.39% | 0.63% |
| EPILEPSY | 0.23% | 0.09% | 0.14% | 0.18% |
| THYROID | 0.8% | 0.28% | 0.79% | 1.56% |
| CANCER | 0.16% | 0.08% | 0.12% | 0.35% |
| MH | 1.77% | 0.19% | 0.27% | 0.21% |
| ASTHMA | 1.07% | 0.59% | 0.69% | 1.95% |
Also interesting is the number of practices that fell beneath the threshold in each area. What is particularly interesting in that the seems almost exclusively English problem. Being so much larger than the other countries an 'outlier' practice is more likely. In the smallest country - Northern Ireland - there are virtually no practices below the threshold at all. The number in the table are the proportion of practices below the threshold who will be rounded up.
| England | N. Ireland | Scotland | Wales | |
|---|---|---|---|---|
| STROKE | 34% | 0% | 2% | 6% |
| LVD | 29% | 5% | 7% | 9% |
| CHD | 5% | 0% | 1% | 6% |
| BP | 1% | 0% | 0% | 6% |
| DM | 1% | 0% | 1% | 6% |
| COPD | 27% | 1% | 3% | 9% |
| EPILEPSY | 3% | 0% | 5% | 6% |
| THYROID | 5% | 0% | 1% | 9% |
| CANCER | 4% | 1% | 5% | 11% |
| MH | 97% | 3% | 16% | 13% |
| ASTHMA | 0% | 0% | 1% | 5% |
Labels: prevalence
Happy Prevalence Day!
Wednesday, 14 February 2007
Those of us whose day has not be entirely filled with the opening of cards it is also national prevalence day. Although the computers will not do the actual calculation for another month today is the day that is taken as a baseline for all of the prevalence calculations. My thoughts drift back a year to a nursing home in London.
Before I explain why I think this way I should probably explain the significance of prevalence. When the contract was first presented the value of points to a practice depended solely on the number of patients (or at least notional Carr-Hill patients). There was some fuss at time, not least pointing out that this was a disincentive to diagnose as the targets would be harder for the same amount of money. Thus an adjustment was put in. It could not be make the value of a point directly proportional to the prevalence as this would basically be a return to item of service payments. In the end the value of the point was proportional to the square root of the prevalence.
There was one other factor which was largely ignored at the time. It was that any practice with a prevalence below 5% of the prevalence of the maximum was adjusted to have exactly that 5% prevalence. Those who want more detail can read the full guide.
This is where the Nightingale House practice comes in. It is a small practice attached to a nursing home and, as such, had a lot of patients with mental health problems - in fact a huge 35.4% of their patients had severe and enduring mental health problems. This was not entirely surprising with their particular population although this is vastly higher than the national average of 0.6%
Unfortunately, and I must emphasise again through no fault of the practice, this made chaos of the prevalence formula. 5% of 35.4 is 1.77 and 97% of practices had a prevalence of less 1.77%. The upshot was that the vast majority of practices were standardised to the same prevalence and all differentiation was lost. This could amount to several thousands of pounds in difference. Practices with low prevalence gained, most practices with high prevalence lost and the square root ensured that even Nightingale House got paid less per patient than anyone.
Mental health was the most prominent example but there is a similar, if smaller effect in stroke, thyroid disease and LVD. The rules are different for mental health this year as well so we shall see if the QOF payment of every GP in England still depend on a nursing home in London.
Labels: prevalence
