Boston Collaborative Drug Surveillance ProgramThe General Practice Research Database
The characteristics of the United Kingdom health system, requiring general practitioners to be the gatekeepers and coordinators of health care, make it an ideal setting to conduct epidemiologic research.
In the late 1980s the availability of computers in doctors' offices began to change the medical record from a paper-based system to a computer-based system. At this time VAMP Health designed software for the office of the general practitioner. General practitioners (GPs) who chose to participate in the GPRD were provided with a computer and VAMP software. These GPs have a 12-month training period during which VAMP personnel work together with GPs and their staff to learn the routine, standardized procedures for the proper entering (and retrieval) of information on the computer. At the end of the 12-month training period, the computerized data are reviewed to determine whether the required information has been entered in a systematic, standardized manner. If the practice data are considered satisfactory, the information from that practice can be used for clinical research purposes. If the standards are not met the practice is informed and further instruction is given to improve performance.
The computer record replaces the manual record for recording patient visits and includes information such as patient characteristics, drugs prescribed, clinical diagnoses, referrals to consultants, hospitalizations, and additional patient care information such as immunizations, laboratory results, certain historical information (e.g. medical history), and other findings (e.g. smoking status, blood pressure, height, and weight). Referral letters from consultants and hospitalizations are kept in a manual file at the GPs office, and are available to researchers (after all identifying information is removed). Prescriptions for patients are generated directly from the computer and so are automatically part of the patient computer record. The details of each prescription, including dosage, instructions, and quantity are also automatically recorded on computer. The GPs also record the indication for each new course of drug therapy.
The General Practice Research Database (GPRD) is currently administerd by the UK Medicines and Healthcare products Regulatory Agency (MHRA). The UK Department of Health (DoH) collects the information from GPs and routinely checks the data for accuracy and validity. In addition, before the data was used for research purposes, the BCDSP conducted extensive validation of the data (1,2). The concordance between information on referrals and hospitalizations recorded on computer and information present in the practice paper medical record was greater than 90% in the first study (1) and greater than 95% in the second (2). Each subsequent study conducted by the BCDSP using GPRD data has confirmed these findings (see publications).
The BCDSP is licensed to receive updated information from the GPRD and to use it for research purposes. Anonymized information from the GPRD on demographics, outpatient visits, hospitalizations and prescriptions dispensed is available to the researchers at the BCDSP. Validation of diagnoses, reports of lab tests and anonymized notes from hospitalizations and referrals can be obtained from the general practitioner upon request. The GPRD has over four millions subjects and over 25 million person-years of data. The BCDSP has worked with the GPRD for 15 years and has published over 150 studies (see publications) using the GPRD resource.
Click on the text below to download a pdf fulltext version of the BCDSP publications on validity of the GPRD: