General practice recording of Adverse Childhood Experiences

Andrea Williamson, Ross McQueenie, David Ellis, Alex McConnachie, Philip Wilson

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Background: Adverse childhood experiences (ACEs) are linked to negative healthoutcomes in adulthood. Poor engagement with services may in part mediate theassociation between adverse outcomes and ACEs. While appointment recording iscomprehensive, it is not yet known if or how ACEs are recorded in the GP clinicalrecord.Aim: To investigate recording of ACEs in the GP clinical record and assess associationsbetween available ACEs related Read codes and missed appointments.Design and Setting Retrospective cohort study of 824,374 anonymised GP patientrecords. Nationally representative sample of 136 Scottish GP practice data, 2013-2016.Method: Read codes were mapped onto ACE questionnaire and wider ACE-relateddomains. Natural language processing (NLP) was used to augment capture of nonRead-coded ACEs. Frequency counts and proportions of mapped codes, andassociations of these with defined levels of missing GP appointments, are reported.Results: 0.4% of patients had a record of any code that mapped onto the ACEquestionnaire, contrasting with survey reported rates of 47% in population samples.This increased only modestly by including inferred ACEs that related to safeguardingchildren concerns, wider aspects of ACEs and adult consequences of ACEs.Augmentation via NLP did not substantially increase capture. Despite poor recording,there was an association between ever having an ACE code recorded and higher ratesof missing GP appointments.Conclusion: GP practices would require substantial support to implement therecording of ACEs in the patient record. This paper adds to the evidence thatpatients who often miss appointments are more likely to be socially vulnerable.
Original languageEnglish
JournalBritish Journal of General Practice Open
Publication statusPublished - 19 Feb 2020


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