title: Empirical evidence of recall bias for primary health care visits.
abstract: BACKGROUND
  While it is common for an economic evaluation of health care to rely on trial participants for self-reported health service utilisation, there is variability in the accuracy of this data due to potential recall bias. The aim of this study was to quantify the level of recall bias in self-reported primary health care general practitioner (GP) visits following inpatient rehabilitation over a 12 month period.
  
  
  METHODS
  This report is a secondary analysis from a larger randomised control trial of an economic evaluation of additional Saturday inpatient rehabilitation. Participants were adults who had been discharged into the community following admission to an acute general rehabilitation hospital. Participants were asked to recall primary health care visits, including community GP visits, via a telephone questionnaire which was administered at 6 and 12 months following discharge from inpatient rehabilitation. Participants were asked to recall health service utilisation over each preceding 6 month period. The self-reported data were compared to equivalent claims data from the national insurer, over the same period.
  
  
  RESULTS
  751 participants (75% of the full trial) with a mean age of 74 years (SD 13) were included in this analysis. Over the 12 month period following discharge from rehabilitation there was an under-reporting of 14% in self-reported health service utilisation for GP visits compared to national insurer claims data over the same period. From 0 to 6 months following discharge from rehabilitation, there was an over-reporting of self-reported GP visits of 35% and from 7 to 12 months there was an under-reporting of self-reported GP visits of 36%, compared to national insurer claims data over the same period. 46% of patients reported the same or one number difference in self-reported GP visits between the 0 to 6 and the 7 to 12 month periods.
  
  
  CONCLUSIONS
  Based on these findings we recommend that an economic evaluation alongside a clinical trial for an elderly adult rehabilitation population include a sensitivity analysis that inflates self-reported GP visits by 16% over 12 months. However caution is required when utilising self-reported GP visits as the data may contain periods of both over and under reporting. Where general practitioner visits are expected to vary significantly between intervention and control groups we recommend that administrative data be included in the trial to accurately capture resources for an economic evaluation.
authors.affiliation: Physiotherapy Department, Faculty of Health Science, La Trobe University, Bundoora Campus, Melbourne, VIC, 3086, Australia. nbrusco@cabrini.com.au.|Physiotherapy Services, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia. nbrusco@cabrini.com.au.|Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia. nbrusco@cabrini.com.au.
authors.forename: Natasha Kareem
authors.initials: NK
authors.lastname: Brusco
authors.affiliation: Deakin Health Economics, Population Health Strategic Research Centre, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. j.watts@deakin.edu.au.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Watts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015982:Bias; D005260:Female; D058005:General Practitioners; D006296:Health Services; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008511:Medicine; D011939:Mental Recall; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011320:Primary Health Care; D057566:Self Report; D011795:Surveys and Questionnaires