Identifying markers of health-seeking behaviour and healthcare access in UK electronic health records

Abstract

AbstractObjectiveTo assess the feasibility of identifying markers of health-seeking behaviour and healthcare access in UK electronic health records (EHR), for identifying populations at risk of poor health outcomes, and adjusting for confounding in epidemiological studies.DesignCross sectional observational study using the Clinical Practice Research Datalink (CPRD) Aurum pre-linked to Hospital Episode Statistics.SettingIndividual-level routine clinical data from 13 million patients across general practices (GPs) and secondary data in England.ParticipantsIndividuals aged ≥66 years on 01/09/2019.Main outcome measuresWe used the Theory of Planned Behaviour (TPB) model and the literature to iteratively develop criteria for markers selection. Based on this we selected 15 markers: those that represented uptake of public health interventions, markers of active healthcare access/use and markers of lack of access/underuse. We calculated the prevalence of each marker using relevant lookback periods prior to index date (01/09/2019) and compared to national estimates. We assessed the correlation coefficients (phi) between markers with inferred hierarchical clustering.ResultsWe included 1,991,284 individuals (mean age: 75.9 and 54.0% females). The prevalence of markers ranged from <0.1% (low-value prescriptions) to 92.6% (GP visits), and most were in line with national estimates; e.g., 73.3% for influenza vaccination in the 2018/2019 season, compared to 72.4% in national estimates. Screening markers e.g., abdominal aortic aneurysm screening were under-recorded even in age-eligible groups (54.3% in 65–69 year-olds vs 76.1% in national estimates in men). Overall, marker correlations were low (<0.5) and clustered into groups according to underlying determinants from the TPB model.ConclusionOverall, markers of health-seeking behaviour and healthcare access can be identified in UK EHRs. The generally low correlations between different markers of health-seeking behaviour and healthcare access suggest a range of variables are needed to capture different determinants of healthcare use.Strengths and limitations of this studyThis is the first known study in the UK that has identified proxies or markers of health-seeking behaviour or healthcare access.We utilised linked electronic health records from primary and secondary care so that a range of different health utilisation markers could be identified.We identified a large population of over 2 million individuals.For some of the markers (e.g., bone density scans), health need could not be entirely separated from health behaviour and access.Marker prevalences showed different patterns by age, and these findings might not be generalisable to younger age groups (<65 years).