We updated the title of this post to reflect the fact that our aim is to promote healthy living - physically, psychologically, and socially - and not just to diagnose and treat illness. Thanks to Anonymous for pointing this out to us in the comments section.
Many of our patients will already have noticed that we are constantly talking about 'registers'. One of the first things I look at when I open a patient's chart is the box in the top left of the screen. It's the 'disease register' list (Chronic Issues Registers). These are chronic issues that we want to prevent, screen for, and treat aggressively when we find them. For example, diabetes and asthma. Some registers are supportive - for example the Carers' Register is a list of patients who care for relatives or friends with serious health problems.
We use these registers to call patients back - usually to see our Practice Nurses for review on a regular basis. We have guidelines for each one - a series of questions, tests, or goals which will help keep our patients healthy (and, hopefully, out of the emergency department!).
The registers also help us track the quality of the care we provide to our patients. In fact, setting up chronic issues registers is the first step in any quality system. Unless we know how many diabetics we have and who they are, we can't check if we are getting their care right.
Knowing what percentage of patients we have with a disease also helps us plan our care. This is called 'prevalence data'. Every night, our computer system (EMR) counts up how many patients we have in each register and divides it by our total number of patients.
Here are our current prevalence figures for Sherwood:
You can compare them with the prevalence of illnesses in our Scottish practice here.
In Scotland, you will see from the link that you are able to compare our prevalence with that of our neighboring practices and a national average. Unfortunately, we can't show you any comparison data for our Canadian practice because we can't find any. Either no-one else is collecting this data in Canada, or they are not publishing it online. (If you know where we can get hold of this data, let us know.)
When comparing prevalences between our Canadian and Scottish patients, some points should be borne in mind. 1. The average age in our Scottish practice is unusually high. 2. We have not reviewed all of our Canadian patients yet, and in many cases are relying on self-reporting on the online registration form. For example, we only have recorded weights in our database from just over half of our patients. So the actual rate of obesity is likely to be around 25% once all our patients have been weighed.
7 comments:
I really enjoy the posts on your web page. The stats are interesting but I would say the average age for your PEI patients must be unusually low given the low prevalence of older peoples' diseases. This probably occurred because the people without a family Dr., when you started your practice, tended to be younger.
What is "carers"?
Yes, we do have a young practice - I just ran a quick query on the database and 36 is the average age.
(I agree with your reasoning as to why our practice is young. We also have a lot of immigrant families who are usually younger too.)
The carer's register is a register of patients that are the main carer for a person with a long term illness. For example, someone who looks after a parent with dementia.
(Ooops. That should, of course, be carers' register. Apologies to the punctuation conscious.)
Is this information that every family practice on Prince Edward Island maintains, or is it unique to yours?
Currently it is unique to us.
Our medical practice is the first in Prince Edward Island to use what is called a 'high architecture' electronic medical record.
This is different from hospital EMRs (such as the one used by the QEH) or older primary care systems.
High architecture systems such as ours allows doctors to provide a completely new level of care.
OSCAR (our system) is developed by the University of McMaster in Hamilton, and is free.
Friendly Pharmacy is installing it for their doctors, and other doctors have visited us to look at installing OSCAR in their practices.
So, hopefully, we will see more such data in the future.
More info at:
http://blog.oscarpei.net
I understand that knowing if your patient is a "carer" might be important information to chart but I would suggest that it doesn't need to be listed with the diseases. Although care giving can be difficult, it can also be very rewarding. Carers can grow in confidence as they learn the necessary new tasks and information. Most importantly, being a carer means the person that you love is still with you.
I can see your point, Anon. We certainly don't want to give the impression that being a carer is a negative thing or a disease!
However, I would say that this holds true for many of the 'diseases' that we have registers for. Chronic Kidney Disease is a classic example. Most of the people with CKD are not ill (ie: they have no symptoms), but we want to prevent them from becoming ill in the future.
Hypertension is another example of 'medicalization' of a health issue. High blood pressure is normal - it's just that it is not good for your health in the long term. It is not an illness.
Carers are at high risk of problems such as loneliness, isolation, burnout, depression, anxiety. They also tend to put their loved ones first, and so their health can suffer from lack of attention (so to speak).
We want to support a healthy life in all of our patients, and the registers help us to do this.
I think medicine needs to change the language it uses to make this clearer, but at the same time we also need patients to take the risks seriously so we can support and help them to live as long and healthy a life as is possible.
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