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Cited by 196Medical Coding and Health InformationElectronic Health Records SystemsSchizophrenia research and treatment

Accuracy of diagnosis of psychosis on general practice computer system.

Open access
Nazareth, I, King, M, Haines, A, Rangel, L, Myers, S·1993·BMJ
DOI 10.1136/bmj.307.6895.32
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Abstract

OBJECTIVES--To determine the accuracy of diagnoses of schizophrenia and non-affective psychosis entered by general practitioners on a computer system. To compare recording of clinical events on computer with written records. DESIGN--Examination of case notes of all patients with a computer diagnosis of psychosis. Search of 8000 randomly selected patient records to identify patients with psychosis not recorded on computer and comparison of 141 computer and written entries for prescribing and consultation in each practice. SETTING--13 London practices on the VAMP research bank. MAIN OUTCOME MEASURES--Accuracy of record of psychosis compared with ICD 9, American Psychiatric Association diagnostic manual, and syndrome checklist criteria. RESULTS--Computer search revealed 102 patients with schizophrenia, 78 with other psychoses, and 71 with non-affective psychosis who had adequate case notes. The sensitivity and positive predictive value of the computer diagnosis of schizophrenia were 88% (95% confidence interval 62% to 98%) and 71% (48% to 88%). For all non-organic psychoses sensitivity was 91% (74% to 97%) and positive predictive value was 91% (74% to 98%). On average 95% of all known prescriptions and 74% of all consultations were recorded on computer compared with 42% and 75% in written records. CONCLUSIONS--Recording of psychotic illness on the VAMP computer is accurate and complete. Prescribing was more fully recorded on the computer than on the written records. Computer databases of well motivated general practitioners could be used for research.

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  • Since the turn of the millennium, strategies aimed at reducing the mortality gap between people with SMI and the general population have been implemented in the UK.

    “Since the turn of the millennium, a number of strategies aimed at reducing the mortality gap between people with SMI and the general population have been implemented in the UK.10–17”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [11]

    The Introduction discusses UK general-practice computer records in 1989–1991, and the Discussion addresses the accuracy of psychosis diagnoses in those records. Neither section addresses strategies implemented since 2000 to reduce the mortality gap for people with severe mental illness; searches for mortality-gap strategies and UK interventions found no relevant passage. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Recording of a number of these CVD risk factors has been incentivised by the Quality and Outcomes Framework, and we have attempted to minimise 'missingness' by defining these as ever recorded during follow-up.

    “However, recording of a number of these CVD risk factors has been incentivised by the Quality and Outcomes Framework,11 and we have attempted to minimise ‘missingness’ by defining these as ever recorded during follow-up.”

    From Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000–2014 (2017) · cites this paper as [11]

    The citation is attached to the claim that the Quality and Outcomes Framework incentivised recording CVD risk factors; the missingness definition is the citing authors’ own method. The Introduction describes incentives for entering data into the VAMP system, and the Discussion addresses completeness of prescription records. Neither section addresses the Quality and Outcomes Framework or incentives to record CVD risk factors (searched for both). (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 3

  1. Mann RD, Hall G, Chukwujindu J. Research implications of computerised primary care. Post Marketing Surveillance 1992;5:259-68.
  2. Perry J, ed. Oxmis problem code for primary medical care. Oxford: Oxmis Publications, 1971.
  3. Wing JK, Cooper JE, Sartorius N. Derivation of syndromes: the syndrome check list in measuremenu and classification of psychiatric symptoms. Cambridge: Cambridge University Press, 1974:40-7.

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Related

Authors
Nazareth, I., King, M., Haines, A., Rangel, L., & Myers, S.
Affiliations
Whittington Hospital (GB)
ORCID
Venue
BMJ
Publisher
BMJ
Published
1993-07-03
Volume
307
Issue
6895
Pages
32-34
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.307.6895.32
OpenAlex
W2092369059
Cited by
196
References
6
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 1 · 2021: 2 · 2020: 4 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 6 · 2015: 2 · 2014: 4 · 2013: 6 · 2012: 7
FWCI
14.16
Type
journal article
Language
en
Open access
Licence
www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Sir Jules Thorn Charitable Trust
Topics
  • Health Sciences › Health Professions › Health Information Management › Medical Coding and Health Information
  • Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
psychosis, schizophrenia, non-affective psychosis, electronic health records, general practice, diagnostic accuracy, case law commentary, ICD-9, diagnostic sensitivity, positive predictive value
MeSH terms
Ambulatory Care Information Systems, Family Practice, Humans, London, Medical Records, Predictive Value of Tests, Psychotic Disorders, Random Allocation, Schizophrenia, Sensitivity and Specificity, Medical Records Systems, Computerized

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