1. Clinical coding of long COVID in English primary care: a federated analysis of 58 million patient records in situ using OpenSAFELY
- Author
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William J Hulme, Rosalind M Eggo, George Hickman, Ian J. Douglas, David M. Evans, Alex Eavis, Ben Goldacre, Angel Y S Wong, Chris Bates, Simon Davy, Laurie A. Tomlinson, John Tazare, Anna Schultze, Elizabeth A. Williamson, Nasreen Parkes, Richard Jarvis, John Parry, Krishnan Bhaskaran, Frank Hester, Helen Mcdonald, Liam Smeeth, Christopher T Rentsch, Rohini Mathur, Alex J Walker, Paul D. Griffiths, Amir Mehrkar, Stephen J. W. Evans, Richard Croker, Helen J Curtis, Caroline E Morton, Peter Inglesby, Jessica Morley, Tom Ward, Jonathan Cockburn, Sam Harper, Aaron Fowles, Kevin Wing, Brian MacKenna, Shaun O'Hanlon, Harriet Forbes, Sebastian Bacon, and Dima Avramov
- Subjects
Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Population ,Coding (therapy) ,Primary care ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,Post-Acute COVID-19 Syndrome ,0302 clinical medicine ,Electronic health record ,medicine ,Humans ,Letters ,030212 general & internal medicine ,long COVID ,education ,general practice ,education.field_of_study ,SARS-CoV-2 ,business.industry ,Research ,Clinical Coding ,COVID-19 ,Confidence interval ,primary health care ,electronic health records ,England ,Family medicine ,General practice ,Female ,Diagnosis code ,Family Practice ,business ,Demography ,Cohort study ,Coding (social sciences) - Abstract
BackgroundLong COVID describes new or persistent symptoms at least 4 weeks after onset of acute COVID-19. Clinical codes to describe this phenomenon were recently created.AimTo describe the use of long-COVID codes, and variation of use by general practice, demographic variables, and over time.Design and settingPopulation-based cohort study in English primary care.MethodWorking on behalf of NHS England, OpenSAFELY data were used encompassing 96% of the English population between 1 February 2020 and 25 May 2021. The proportion of people with a recorded code for long COVID was measured overall and by demographic factors, electronic health record software system (EMIS or TPP), and week.ResultsLong COVID was recorded for 23 273 people. Coding was unevenly distributed among practices, with 26.7% of practices having never used the codes. Regional variation ranged between 20.3 per 100 000 people for East of England (95% confidence interval [CI] = 19.3 to 21.4) and 55.6 per 100 000 people in London (95% CI = 54.1 to 57.1). Coding was higher among females (52.1, 95% CI = 51.3 to 52.9) than males (28.1, 95% CI = 27.5 to 28.7), and higher among practices using EMIS (53.7, 95% CI = 52.9 to 54.4) than those using TPP (20.9, 95% CI = 20.3 to 21.4).ConclusionCurrent recording of long COVID in primary care is very low, and variable between practices. This may reflect patients not presenting; clinicians and patients holding different diagnostic thresholds; or challenges with the design and communication of diagnostic codes. Increased awareness of diagnostic codes is recommended to facilitate research and planning of services, and also surveys with qualitative work to better evaluate clinicians’ understanding of the diagnosis.
- Published
- 2021
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