Health services research in general practice. A new approach

Competence networks in medicine, involving departments of general practice (www.kompetenznetze-medizin.de), as well as a large research support program "General Practice" funded by the German Federal Ministry of Education and Research (www.gesundheitsforschung-bmbf.de/de/439.php) mirror the increasing importance of academic general practice for health services research. The use and benefit of computerized medical records is exemplified by the classification of therapeutic measures and prevalence estimates of diseases. Computerized medical records from 134 practices could be extracted via the BDT (BehandlungsDatenTräger) interface. Using SQL (structured query language) queries, we identified patients with urinary tract infection (UTI), airway obstruction and chronic heart failure and the therapeutic management for these illnesses. Age and sex of the patients were nearly completely documented in the BDT data. Patients with UTI (6,239 consultations) received most often cotrimoxazole (69%) and fluoroquinolone (15%), less often trimethoprim (9%) and herbal UTI drugs (4%). About half of the 2,714 patients with asthma received inhaled steroids, to a somewhat lesser degree than patients suffering from chronic obstructive pulmonary disease (50 vs 53%). In a subsample of practices (n=44), we identified 4,120 patients with a diagnosis of chronic heart failure. Using refined analysis tools, computerized medical records from general practices may be helpful to answer relevant questions of health services research and contribute to quality assurance in ambulatory patient care.