Test data collection. Follow-up of the project for the customer is carried out by the Directorate for Health and Social Affairs. The Ministry of Health and Care Services shall make a decision on any continuation or expansion of the project after they have received a final report.
Most of the tables are created at a national level, but one table will be published at a local level (Statistics Norway’s standard for municipal classification is used as a basis).
330 - Division for health statistics
Dispensation has been granted from the Health Personnel Act for the collection of data. Doctors take part on a voluntary basis. The data are de-identified.
Not relevant.
Not relevant.
SEDA - Central data from the General Practitioner service is a project financed by the Directorate for Health and Social Affairs, and executed by Statistics Norway. The project is a follow-up to a pilot project carried out in 2001/2002.
While the pilot project had a clear focus on method, the emphasis in the development of the project has been on data analysis and quality improvement.
The aim of the SEDA is to develop a system for establishing representative statistics for the whole of Norway. This is made up of a sample, and not all GPs are included.
The purpose of establishing SEDA statistics is to provide a basis for increased knowledge on the activity in the General Practitioner service and on the contact that patients have with their GPs.
The organisation of the project was initiated at the beginning of 2004, and is based on recommendations given in the report from the SEDA pilot project from 2001/2002. The Ministry of Health and Care Services within the Directorate for Health and Social Affairs also initiated the SEDA pilot project.
An extension and continuation of the project aimed at laying the foundation for ongoing data collection will provide central health authorities with control data and information for the follow up of the General Practitioner service. There are currently statistics for the nursing and care sector and for the specialist health service, but there are no official statistics for general practice.
The statistics will also greatly help the municipalities in achieving a better overview of the population’s health and the circumstances that affect health. This is a requirement of the Act relating to the municipal health services, but there have not been many tools to enable this to be complied with to date.
The capability to extract statistics on their own patients will give GPs an aggregate and uniform overview of their own practice. Extending the data basis to cover variations over the year will provide good possibilities for research in the field.
The data are obtained from 82 GPs’ patient journals. These are extracts from three months of patient journal data; from January, February and March 2005. The data cover 100,600 listed patients. A total of 52,000 patients have visited the doctor. Overall, they have been in contact with GPs 119,800 times. These patient contacts are the data basis for the statistics.
Primary data is obtained on the type of contact (telephone, personal attendance, consultation etc.), diagnoses, referrals, medical certificates and laboratory tests.
Electronic patient journal.
The Register of General Practitioners was the basis for the sampling, and the aim was to recruit 100 GPs. The sample of doctors was intentionally limited. Doctors were selected from all parts of the country and sorted according to the size of their medical practices. Consideration was given to the wish to achieve a sample that represented the use of the four patient journal systems: Profdoc Winmed, Infodoc, Profdoc Vision and System X. Importance were also attached to as many as possible being connected to Norsk Helsenett.
Around 100 doctors signed up for the project. There was a certain amount of withdrawals in the sample due to technical problems, time constraints, illness etc. A total of 86 doctors provided data, of which 82 data sets were complete.
Mediata AS was commissioned to program an extraction program for SEDA in accordance with the requirement specification of Statistics Norway. Mediata worked together with the journal suppliers Profdoc Norway, Infodoc and System X.
The doctors that consented to providing data to the project received the extraction program and guidelines. Mediata provided user support. Doctors who were connected to Norsk Helsenett sent the data electronically to Statistics Norway. Doctors who were not connected to the network downloaded the data on a disk, which was then sent to Statistics Norway in the post.
Response burden
The actual extraction of data took doctors a few minutes to carry out, but the installation of the program, automatic packing of files and downloading to disk took longer.
All extracts were checked by Statistics Norway. The control related to whether data from the selected areas in the patient journals was extracted, whether time delimitations were correct, and whether the data applied to the relevant doctors that had consented to take part. Various other controls of the material were also carried out, such as duplicate control.
Not relevant.
The data material will be processed further. In addition to compiling a final report with an analysis of the statistics, one or more articles are planned on the subject.
Definitions of the main concepts
Patient contact (Doctor contact): All contact between patient and doctor in connection with a health problem. Comprises individual patient contact, consultations and home visits.
Individual contact: Approach via enquiry, written advice, telephone contact, personal attendance or messenger.
Consultation: Approach, enquiry via personal attendance at the doctor’s premises, normally at the doctor’s place of work/office. A consultation comprises direct contact between doctor and patient, and the doctor giving an explanation.
Home visit: Approach, enquiry via the doctor visiting the patient at home or at a relevant or agreed meeting place. A home visit comprises direct contact between doctor and patient, and the doctor, as a minimum, giving an explanation.
Definitions of the main variables
The diagnosis code is an alphanumeric code from the ICPC-2 international code known as International Classification of Primary Care. The main diagnosis is the same as the first diagnosis given.
NOMESCO age and diagnosis groups. SEDA has primarily used the classifications in NOMESCO’s recommendations on Nordic comparable statistics as a basis for the presentation of data from the project. The diagnosis groups have been somewhat extended in relation to NOMESCO’s standard. This was carried out in collaboration with the doctors involved in the project.
There is some uncertainty in the data material, mainly because the data volume is intentionally limited, but also because the information in the journal systems is only partly standardised. Refer to the final report for further details of sources of error.
A technical fault in the extraction program resulted in System X not providing data on medical certificates. Infodoc reported all prescribed medicines as blue prescriptions. A solution was found whereby a distinction was subsequently made between white and blue prescriptions via the ATC codes. Another error that affected the doctors using Infodoc, is that the extracts of rates are incomplete. Statistics Norway has used the available data to develop a contact variable. In this regard, some patient contacts with and without attendance are merged together in the category “individual contact” so as to avoid incorrect registration. It has not been possible to separate home visits and interdisciplinary collaboration for Infodoc, but the number of contacts of this nature in the data material is low (approx. 1 per cent). This is not therefore very significant to the division of contacts.
Not relevant.
There are fewer solo practices than desired in the sample. There is also a potential geographic misalignment, since there are fewer doctors from western Norway than from other parts of the country. This is only a problem if the doctors in western Norway treat the patients considerably different to doctors in other parts of the country. The project cannot see that there is anything to indicate that this is the case. In order to reduce any misalignment, it has been decided to mainly publish data at a national level, and run tables with the patients and patient contacts as a starting point.
Non-sampling errors
The data in the patient journals varies somewhat between the journal systems.
First-time publishing.
The statistics may be regarded in context with the patient statistics, which give an overview of hospital patients.
Internet address: http://www.ssb.no/alegetj_en/
The documentation for the project is being compiled and will be issued in December 2006.
Survival data is stored in accordance with prevailing principles for Datadok.
Data is anonymised and may be used by researchers upon application to Statistics Norway.
Technical documentation (mainly internal documentation) from the project is being separated into a supplementary note, which will be completed during autumn 2006.
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