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OpenSAFELY Service Restoration Observatory Monthly Dashboard: Eleven key measures for monitoring general practice clinical activity during COVID-19

Description
This report describing trends and variation in clinical activity codes using a set of key measures indicative of overall activity to evaluate NHS service restoration throughout the COVID-19 pandemic. This analysis is run on data for patients registered at a TPP practice. This covers 40% of the population of England. For details on the results presented here, please refer to the main report or to the accompanying preprint linked below.
Authors
Louis Fisher, Helen J. Curtis, Richard Croker, Milan Wiedemann, Victoria Speed, Christopher Wood, Andrew Brown, Lisa EM Hopcroft, Rose Higgins, Jon Massey, Peter Inglesby, Caroline E. Morton, Alex J. Walker, Jessica Morley, Amir Mehrkar, Seb Bacon, George Hickman, Orla Macdonald, Tom Lewis, Marion Wood, Martin Myers, Miriam Samuel, Robin Conibere, Wasim Baqir, Harpreet Sood, Charles Drury, Kiren Collison, Chris Bates, David Evans, Iain Dillingham, Tom Ward, Simon Davy, Rebecca M. Smith, William Hulme, Amelia Green, John Parry, Frank Hester, Sam Harper, Jonathan Cockburn, Shaun O'Hanlon, Alex Eavis, Richard Jarvis, Dima Avramov, Paul Griffiths, Aaron Fowles, Nasreen Parkes, Brian MacKenna, Ben Goldacre
Contact
Get in touch and tell us how you use this report or new features you'd like to see: team@opensafely.org
First published
25 Oct 2023
Last released
19 Feb 2024
Links

Summary of results

These key measures demonstrated substantial changes in clinical activity throughout the COVID-19 pandemic. Using our classification of activity change methods, six of the measures recovered to their pre-pandemic baseline within a year of the pandemic, showing a rapid, adaptive response by primary care in the midst of a global health pandemic. The remaining five measures showed a more sustained drop in activity; asthma and COPD reviews did not recover to their pre-pandemic baseline until around August 2021 and blood pressure monitoring, cardiovascular disease risk assessment and medication reviews had a sustained drop in activity that persisted up to December 2021. Since December 2021 activity rates for all measures have recovered and in some cases are now above the pre-pandemic baseline.

Findings in context

Discussion of the specific causes and reasons for the changes in narrow measures of clinical activity we have described is best addressed through quantitative analyses that identify practices in high and low deciles to approach for targeted qualitative interviews with patients and front line staff. However we believe the following broad points may help aid interpretation. Our measures reflect only a few areas of high volume clinical activity; decreases may reflect appropriate prioritisation of other clinical activity. For example NHS Health Checks, which are used to detect early signs of high blood pressure, heart disease or type 2 diabetes, were paused during the pandemic; this is likely to explain the sustained drop in activity in cardiovascular disease risk assessment and blood pressure monitoring. However, in specific cases this may reflect changes in the style of delivery of a clinical activity, rather than the volume: for example, where patients record their own blood pressure at home since, as we have previously highlighted, home monitoring of blood pressure may not be recorded completely or consistently in GP records. In addition, not all reductions should be interpreted as problematic: as part of the COVID-19 recovery, health systems are aiming to be more resilient, responsive and sustainable; complete recovery may not always be appropriate and reductions in clinical activity across some domains may reflect rational reprioritisation of activity. Where these changes in priority have not been nationally planned, data analyses such as ours may help to rapidly identify the pragmatic changes in prioritisation being made by individual dispersed organisations or people across the healthcare ecosystem before those changes are explicitly surfaced or discussed through other mechanisms. For more detail, please see our published manuscript here.

Blood Pressure Monitoring

The codes used for this measure are available in this codelist.

What is it and why does it matter?

A commonly-used assessment used to identify patients with hypertension or to ensure optimal treatment for those with known hypertension. This helps ensure appropriate treatment, with the aim of reducing long term risks of complications from hypertension such as stroke, myocardial infarction and kidney disease.

Caveats

We use codes which represent results reported to GPs so tests requested but not yet reported are not included. Only test results returned to GPs are included, which will usually exclude tests requested while a person is in hospital and other settings like a private clinic.

Practices included: 2559

Most Common Codes (Codelist)

Code Description Proportion of codes (%)
72313002 Systolic arterial pressure 94.94
413606001 Average home systolic blood pressure 3.92
407554009 Sitting systolic blood pressure 0.51
314449000 Average 24 hour systolic blood pressure 0.21
407556006 Lying systolic blood pressure 0.15

Total events: 68.86M

Cardiovascular Disease 10 year Risk Assessment

The codes used for this measure are available in this codelist.

What is it and why does it matter?

A commonly-used risk assessment used to identify patients with an increased risk of cardiovascular events in the next 10 years. This helps ensure appropriate treatment, with the aim of reducing long term risks of complications such as stroke or myocardial infarction.

Practices included: 2553

Most Common Codes (Codelist)

Code Description Proportion of codes (%)
718087004 QRISK2 cardiovascular disease 10 year risk score 98.6
763244005 QRISK cardiovascular disease 10 year risk calculator score 0.87
1085871000000105 QRISK3 cardiovascular disease 10 year risk calculator score 0.5
809311000000105 Joint British Societies cardiovascular disease risk score 0.02
752451000000100 Cardiovascular disease risk assessment by third party 0.01

Total events: 8.64M

Cholesterol Testing

The codes used this measure are available in Codelist.

What is it and why does it matter?

A commonly-used blood test used as part of a routine cardiovascular disease 10 year risk assessment and also to identify patients with lipid disorders (e.g. familial hypercholesterolaemia). This helps ensure appropriate treatment, with the aim of reducing long term risks of complications such as stroke or myocardial infarction.

Caveats

We use codes which represent results reported to GPs so tests requested but not yet reported are not included. Only test results returned to GPs are included, which will usually exclude tests requested while a person is in hospital and other settings like a private clinic.

Practices included: 2555

Most Common Codes (Codelist)

Code Description Proportion of codes (%)
1005671000000105 Serum cholesterol level 99.05
1017161000000104 Plasma total cholesterol level 0.72
850981000000101 Cholesterol level 0.23
395153009 Pre-treatment serum cholesterol level < 0.005

Total events: 31.37M

Liver Function Testing - Alanine Transferaminase (ALT)

The codes used for this measure are available in this codelist.

What is it and why does it matter?

An ALT blood test is one of a group of liver function tests (LFTs) which are used to detect problems with the function of the liver. It is often used to monitor patients on medications which may affect the liver or which rely on the liver to break them down within the body. They are also tested for patients with known or suspected liver dysfunction.

Caveats

In a small number of places, an ALT test may NOT be included within a liver function test. We use codes which represent results reported to GPs so tests requested but not yet reported are not included. Only test results returned to GPs are included, which will usually exclude tests requested while a person is in hospital and other settings like a private clinic.