General practice recording of Adverse Childhood Experiences: A retrospective cohort study of GP records

Background: Adverse childhood experiences (ACEs) are linked to negative health outcomes in adulthood. Poor engagement with services may, in part, mediate the association between adverse outcomes and ACEs. While appointment recording is comprehensive, it is not yet known if or how ACEs are recorded in the GP clinical record (GPR). Aim: To investigate recording of ACEs in the GPR and assess associations between available ACE-related Read codes and missed appointments. Design & setting: Retrospective cohort study of 824 374 anonymised GPRs. Nationally representative sample of 136 Scottish general practices; data collected 2013-2016. Method: Read codes were mapped onto ACE questionnaire and wider ACE-related domains. Natural language processing (NLP) was used to augment capture of non-Read-coded ACEs. Frequency counts and proportions of mapped codes, and associations of these with defined levels of missing GP appointments, are reported. Results: In total, 0.4% of patients had a record of any code that mapped onto the ACE questionnaire, contrasting with survey-reported rates of 47% in population samples. This increased only modestly by including inferred ACEs that related to safeguarding children 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 rates of missing GP appointments. Conclusion: General practices would require substantial support to implement the recording of ACEs in the GPR. This study adds to the evidence that patients who often miss appointments are more likely to be socially vulnerable.