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author:("massey, Alan")
3.  The effectiveness and cost-effectiveness of opportunistic screening and stepped care interventions for older hazardous alcohol users in primary care (AESOPS) – A randomised control trial protocol 
There is a wealth of evidence regarding the detrimental impact of excessive alcohol consumption. In older populations excessive alcohol consumption is associated with increased risk of coronary heart disease, hypertension, stroke and a range of cancers. Alcohol consumption is also associated with an increased risk of falls, early onset of dementia and other cognitive deficits. Physiological changes that occur as part of the ageing process mean that older people experience alcohol related problems at lower consumption levels. There is a strong evidence base for the effectiveness of brief psychosocial interventions in reducing alcohol consumption in populations identified opportunistically in primary care settings. Stepped care interventions involve the delivery of more intensive interventions only to those in the population who fail to respond to less intensive interventions and provide a potentially resource efficient means of meeting the needs of this population.
The study design is a pragmatic prospective multi-centre two arm randomised controlled trial. The primary hypothesis is that stepped care interventions for older hazardous alcohol users reduce alcohol consumption compared with a minimal intervention at 12 months post randomisation. Potential participants are identified using the AUDIT questionnaire. Eligible and consenting participants are randomised with equal probability to either a minimal intervention or a three step treatment approach. The step treatment approach incorporates as step 1 behavioural change counselling, step 2 three sessions of motivational enhancement therapy and step 3 referral to specialist services. The primary outcome is measured using average standard drinks per day and secondary outcome measures include the Drinking Problems Index, health related quality of life and health utility. The study incorporates a comprehensive economic analysis to assess the relative cost-effectiveness of the interventions.
The paper presents a protocol for the first pragmatic randomised controlled trial evaluating the effectiveness and cost-effectiveness of stepped care interventions for older hazardous alcohol users in primary care.
Trial registration
PMCID: PMC2442836  PMID: 18549492
6.  Systematic review of scope and quality of electronic patient record data in primary care 
BMJ : British Medical Journal  2003;326(7398):1070.
Objective To systematically review measures of data quality in electronic patient records (EPRs) in primary care.
Design Systematic review of English language publications, 1980-2001.
Data sources Bibliographic searches of medical databases, specialist medical informatics databases, conference proceedings, and institutional contacts.
Study selection Studies selected according to a predefined framework for categorising review papers.
Data extraction Reference standards and measurements used to judge quality.
Results Bibliographic searches identified 4589 publications. After primary exclusions 174 articles were classified, 52 of which met the inclusion criteria for review. Selected studies were primarily descriptive surveys. Variability in methods prevented meta-analysis of results. Forty eight publications were concerned with diagnostic data, 37 studies measured data quality, and 15 scoped EPR quality. Reliability of data was assessed with rate comparison. Measures of sensitivity were highly dependent on the element of EPR data being investigated, while the positive predictive value was consistently high, indicating good validity. Prescribing data were generally of better quality than diagnostic or lifestyle data.
Conclusion The lack of standardised methods for assessment of quality of data in electronic patient records makes it difficult to compare results between studies. Studies should present data quality measures with clear numerators, denominators, and confidence intervals. Ambiguous terms such as “accuracy” should be avoided unless precisely defined.
PMCID: PMC155692  PMID: 12750210
8.  A survey of validity and utility of electronic patient records in a general practice 
BMJ : British Medical Journal  2001;322(7299):1401-1405.
To develop methods of measuring the validity and utility of electronic patient records in general practice.
A survey of the main functional areas of a practice and use of independent criteria to measure the validity of the practice database.
A fully computerised general practice in Skipton, north Yorkshire.
The records of all registered practice patients.
Main outcome measures
Validity of the main functional areas of the practice clinical system. Measures of the completeness, accuracy, validity, and utility of the morbidity data for 15 clinical diagnoses using recognised diagnostic standards to confirm diagnoses and identify further cases. Development of a method and statistical toolkit to validate clinical databases in general practice.
The practice electronic patient records were valid, complete, and accurate for prescribed items (99.7%), consultations (98.1%), laboratory tests (100%), hospital episodes (100%), and childhood immunisations (97%). The morbidity data for 15 clinical diagnoses were complete (mean sensitivity=87%) and accurate (mean positive predictive value=96%). The presence of the Read codes for the 15 diagnoses was strongly indicative of the true presence of those conditions (mean likelihood ratio=3917). New interpretations of descriptive statistics are described that can be used to estimate both the number of true cases that are unrecorded and quantify the benefits of validating a clinical database for coded entries.
This study has developed a method and toolkit for measuring the validity and utility of general practice electronic patient records.
What is already known on this topicDelivering the performance management agenda in the NHS will depend on the availability of high quality information in general practiceRecord entries in GP systems generally consist of a mixture of text and Read coded entriesSensitivity and positive predictive value have been used to measure the completeness and accuracy of data recording in electronic patient record systemsWhat this study addsThis study has developed a standard method and toolkit for measuring the validity and utility of electronic patient record systemsThe principal innovation in this study is to consider the Read codes in the records as tests for the true presence of the associated diagnosesThis study has developed a new approach to the validation of electronic patient record systems.
PMCID: PMC32256  PMID: 11397747

Results 1-8 (8)