title: Variability in the detection and monitoring of chronic patients in primary care according to what is registered in the electronic health record.
abstract: BACKGROUND
  The electronic health record (EHR) allows a detailed study of the primary care consultations and assessment of variability among physicians regarding the implementation of practices for prevention, detection and monitoring of chronic diseases.
  
  
  OBJECTIVE
  To describe the variability in the detection and surveillance of chronic conditions in primary care.
  
  
  METHODS
  Review of the medical records maintained by 1685 primary care physicians in the Basque Health Service. Estimation of age and sex standardized rates of compliance with evidence-based recommendations and the systematic component of variation (SCV).
  
  
  RESULTS
  Compliance with screening recommendations varied from 14.2% for chronic obstructive pulmonary disease (COPD) to 37.2% for hypercholesterolaemia of the at-risk populations. Variability between Primary Care Units (PCUs) was low (SCV(5) (-95) < 0.10) for high blood pressure, hypercholesterolaemia and diabetes and high (SCV(5) (-95) ≥ 0.20) for COPD. Based on the EHR registries, recommendations were followed to in at least 50% of relevant patients according to only 10 of the 44 good care practice (GCP) criteria. For 16 of the GCP criteria, the EHR data indicated compliance to the recommendations in <25% of patients diagnosed.
  
  
  CONCLUSIONS
  EHR data indicate that some of the preventative care practices recommended to detect chronic problems in primary care are unevenly implemented across PCUs. Notably, there is less variation in the case of conditions for which evidence-based clinical practice guidelines have been published. The level of monitoring is inadequate for all the conditions studied; particularly in those in which it is less evident that primary care is the right level of the health service to provide this care.
authors.affiliation: Araba Research Unit-Osakidetza-Basque Health Service, Vitoria-Gasteiz, Spain. felipeesteban.aizpurubarandiaran@osakidetza.net
authors.forename: Felipe
authors.initials: F
authors.lastname: Aizpuru
authors.forename: Amaia
authors.initials: A
authors.lastname: Latorre
authors.forename: Berta
authors.initials: B
authors.lastname: Ibáñez
authors.forename: Kepa Latorre
authors.initials: KL
authors.lastname: Garcia
authors.forename: Itziar
authors.initials: I
authors.lastname: Vergara
authors.forename: Joseba
authors.initials: J
authors.lastname: Pz de Arriba
authors.forename: Ricardo
authors.initials: R
authors.lastname: Samper
authors.forename: Amanda
authors.initials: A
authors.lastname: López-Picado
authors.forename: Antxon
authors.initials: A
authors.lastname: Apiñaniz
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Bilbao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D058006:General Practice; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011787:Quality of Health Care; D055815:Young Adult