ClinicalCodes.org
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Research article:
Identifying prior signals of bipolar disorder using primary care electronic health records
Reference:
Catharine Morgan, Darren M Ashcroft, Carolyn A Chew-Graham, Matthew Sperrin, Roger T Webb, Anya Francis, Jan Scott, Alison R Yung(2023) Identifying prior signals of bipolar disorder using primary care electronic health records. British Journal of General Practice, doi:
- Link to article
- Abstract
- Background: Bipolar disorders (BD) are serious mental illnesses yet evidence suggests that the diagnosis and treatment of BD can be delayed by around 6 years. Aim: To identify signals of undiagnosed BD using routinely collected electronic health records. Methods: A nested case-control study conducted using the Clinical Practice Research Datalink (CPRD) GOLD dataset, an anonymised electronic primary care patient database linked with hospital records. Cases were adult patients with incident BD diagnoses between 1st Jan. 2010 and 31st July 2017. These patients were matched by age, sex, and registered general practice to 20 controls without a recorded BD. Annual episode incidence rates were estimated and odds ratios from conditional logistic regression models were reported for recorded health events prior to index (diagnosis) date. Results: There were 2,366 patients with incident BD diagnoses and 47,138 matched control patients (median age 40 years; 60.5% females). Compared with controls, BD cases had higher incidence of diagnosed depressive, psychotic, anxiety and personality disorders recorded and escalating self-harm, up to 10 years before BD diagnosis. Sleep disturbance, substance misuse and mood swings were more frequent among cases than controls. Also, cases had more frequent face-to-face consultations and were more likely to miss multiple scheduled appointments and prescribed three different psychotropic medication classes in a given year. Conclusion: Psychiatric diagnoses, psychotropic prescriptions and health service use patterns might be signals of unreported BD. Recognition of these signals could prompt further investigation for undiagnosed significant psychopathology, leading to timely referral, assessment and initiation of appropriate treatments.
- Author for correspondence
- catharine Morgan
- Email for correspondence
- cathy.morgan@manchester.ac.uk
Code list: res201: Did not attend appointment
111 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| 68W2900 | Read | Bowel scope (flexi-sig) appointment: DNA | diagnostic | res201: Did not attend appointment | |||
| 9HB7.00 | Read | Did not attend learning disabilities annual health assessmnt | diagnostic | res201: Did not attend appointment | |||
| 9HB7.11 | Read | Did not attend learning disabilities annual health check | diagnostic | res201: Did not attend appointment | |||
| 9kh2.00 | Read | Did not attend extended hours clinic - ESA | diagnostic | res201: Did not attend appointment | |||
| 9kh2.11 | Read | Did not attend extended hours clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4..00 | Read | Failed encounter | diagnostic | res201: Did not attend appointment | |||
| 9N41.00 | Read | Did not attend - reason given | diagnostic | res201: Did not attend appointment | |||
| 9N42.00 | Read | Did not attend - no reason | diagnostic | res201: Did not attend appointment | |||
| 9N42.11 | Read | Patient defaulted from follow up | diagnostic | res201: Did not attend appointment | |||
| 9N43.00 | Read | Patient too late | diagnostic | res201: Did not attend appointment | |||
| 9N44.00 | Read | DNA - appointment mix-up | diagnostic | res201: Did not attend appointment | |||
| 9N45.00 | Read | Patient walked out | diagnostic | res201: Did not attend appointment | |||
| 9N47.00 | Read | Appt cancelled by patient | diagnostic | res201: Did not attend appointment | |||
| 9N4B.00 | Read | Poor attender | diagnostic | res201: Did not attend appointment | |||
| 9N4C.00 | Read | Failed encounter - no answer when rang back | diagnostic | res201: Did not attend appointment | |||
| 9N4D.00 | Read | Failed encounter - message left with work place | diagnostic | res201: Did not attend appointment | |||
| 9N4E.00 | Read | Failed encounter - message left with household member | diagnostic | res201: Did not attend appointment | |||
| 9N4f.00 | Read | DNA - Did not attend podiatry clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4F.00 | Read | Failed encounter - message left on answer machine | diagnostic | res201: Did not attend appointment | |||
| 9N4g.00 | Read | DNA - Did not attend psychiatry clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4G.00 | Read | Failed encounter - phone number unobtainable | diagnostic | res201: Did not attend appointment | |||
| 9N4h.00 | Read | DNA - Did not attend peripheral vascular disease clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4H.00 | Read | DNA hospital appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4i.00 | Read | DNA - Did not attend substance misuse clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4I.00 | Read | DNA - Did not attend diabetic clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4j.00 | Read | DNA - Did not attend community psychiatric nurse review | diagnostic | res201: Did not attend appointment | |||
| 9N4J.00 | Read | DNA - Did not attend cardiac clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4k.00 | Read | Failed encounter - practitioner access denied | diagnostic | res201: Did not attend appointment | |||
| 9N4K.00 | Read | DNA - Did not attend cholesterol clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4l.00 | Read | Did not attend dietetic clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4L.00 | Read | DNA - Did not attend hypertension clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4m.00 | Read | Did not attend vaginal swab | diagnostic | res201: Did not attend appointment | |||
| 9N4M.00 | Read | DNA - Did not attend smoking cessation clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4N.00 | Read | Did not attend mental health appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4N000 | Read | DNA child and adolescent mental health service appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4N100 | Read | Did not attend CAMHS choice appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4N200 | Read | Did not attend CAMHS partnership appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4N300 | Read | Did not attend CAMHS return appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4o.00 | Read | Did not attend blood test | diagnostic | res201: Did not attend appointment | |||
| 9N4p.00 | Read | Did not attend diabetic retinopathy clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4Q.00 | Read | DNA - Did not attend asthma clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4r.00 | Read | Did not attend cognitive behaviour therapy | diagnostic | res201: Did not attend appointment | |||
| 9N4R.00 | Read | DNA - Did not attend cryotherapy clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4s.00 | Read | Did not attend practice nurse heart failure clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4S.00 | Read | DNA - Did not attend cancer clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4t.00 | Read | DNA - Did not attend mental health review | diagnostic | res201: Did not attend appointment | |||
| 9N4T.00 | Read | DNA - Did not attend hyperthyroidism clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4u.00 | Read | Did not attend community anticoagulation clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4v.00 | Read | Did not attend weight monitoring clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4V.00 | Read | DNA - Did not attend epilepsy clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4w.00 | Read | Did not attend heart failure clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4W.00 | Read | DNA - Did not attend COPD clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4x.00 | Read | Did not attend GP chronic disease monitoring clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4X.00 | Read | DNA - Did not attend stroke clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4y.00 | Read | Did not attend breast screening clinic | diagnostic | res201: Did not attend appointment | |||
| 9N4Y.00 | Read | Did not attend physiotherapy appointment | diagnostic | res201: Did not attend appointment | |||
| 9N4Z.00 | Read | Failed encounter NOS | diagnostic | res201: Did not attend appointment | |||
| 9N4z200 | Read | DNA diphtheria, tetanus, acellular pertussis and polio vaccn | diagnostic | res201: Did not attend appointment | |||
| 9N8C.00 | Read | Number of appointments missed | diagnostic | res201: Did not attend appointment | |||
| 9NC3200 | Read | Letter sent about missed general practitioner appointment | diagnostic | res201: Did not attend appointment | |||
| 9NFb100 | Read | DNA health visitor 3 to 4 month contact with family | diagnostic | res201: Did not attend appointment | |||
| 9NFC.00 | Read | Home visit - no reply | diagnostic | res201: Did not attend appointment | |||
| 9Ni..00 | Read | Did not attend | diagnostic | res201: Did not attend appointment | |||
| 9Ni0.00 | Read | Did not attend retinal screening | diagnostic | res201: Did not attend appointment | |||
| 9Ni1.00 | Read | Did not attend renal clinic | diagnostic | res201: Did not attend appointment | |||
| 9Ni2.00 | Read | Did not attend bowel cancer screening programme nurse clinic | diagnostic | res201: Did not attend appointment | |||
| 9Ni3.00 | Read | Did not attend bowel cancer screening | diagnostic | res201: Did not attend appointment | |||
| 9Ni8.00 | Read | DNA cardiology spec interest general practitioner clinic | diagnostic | res201: Did not attend appointment | |||
| 9Ni9.00 | Read | Did not attend chronic kidney disease monitoring clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nia.00 | Read | Did not attend psychotherapy appointment | diagnostic | res201: Did not attend appointment | |||
| 9NiA.00 | Read | Did not attend diabetes structured education programme | diagnostic | res201: Did not attend appointment | |||
| 9Nib.00 | Read | Did not attend walk in centre | diagnostic | res201: Did not attend appointment | |||
| 9Nic.00 | Read | Did not attend fast track suspected cancer clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiC.00 | Read | Did not attend DAFNE diabetes structured education programme | diagnostic | res201: Did not attend appointment | |||
| 9Nic000 | Read | DNA fast track suspected gynaecological cancer clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nid.00 | Read | Did not attend abdominal aortic aneurysm screening | diagnostic | res201: Did not attend appointment | |||
| 9NiD.00 | Read | Did not attend DESMOND diabetes structured education program | diagnostic | res201: Did not attend appointment | |||
| 9Nie.00 | Read | Did not attend NHS Health Check annual review | diagnostic | res201: Did not attend appointment | |||
| 9NiE.00 | Read | Did not attend XPERT diabetes structured education programme | diagnostic | res201: Did not attend appointment | |||
| 9NiF.00 | Read | Did not attend expert patients programme | diagnostic | res201: Did not attend appointment | |||
| 9NiG.00 | Read | Did not attend minor surgery clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiH.00 | Read | Did not attend hospital anticoagulation clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nij.00 | Read | Did not attend postnatal examination | diagnostic | res201: Did not attend appointment | |||
| 9NiJ.00 | Read | Did not attend general practitioner anticoagulant clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nik.00 | Read | Did not attend counselling appointment | diagnostic | res201: Did not attend appointment | |||
| 9NiK.00 | Read | DNA hospital DMARD monitoring clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nil.00 | Read | Did not attend antenatal appointment | diagnostic | res201: Did not attend appointment | |||
| 9NiL.00 | Read | DNA GP disease modifying antirheumatic drug monitor clinic | diagnostic | res201: Did not attend appointment | |||
| 9Nim.00 | Read | Did not attend nurse appointment | diagnostic | res201: Did not attend appointment | |||
| 9NiM.00 | Read | Did not attend cardiovascular disease risk assessment | diagnostic | res201: Did not attend appointment | |||
| 9Nin.00 | Read | Did not attend general practitioner appointment | diagnostic | res201: Did not attend appointment | |||
| 9NiN.00 | Read | DNA cardiovascular disease primary prevention programme | diagnostic | res201: Did not attend appointment | |||
| 9Nio.00 | Read | Did not attend contraceptive clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiP.00 | Read | Did not attend genitourinary medicine clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiS.00 | Read | Did not attend NHS Health Check | diagnostic | res201: Did not attend appointment | |||
| 9NiT.00 | Read | Did not attend cervical smear | diagnostic | res201: Did not attend appointment | |||
| 9NiV.00 | Read | Did not attend spirometry clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiW.00 | Read | Did not attend colposcopy clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiY.00 | Read | Did not attend congenital heart disease clinic | diagnostic | res201: Did not attend appointment | |||
| 9NiZ.00 | Read | Did not attend diabetes foot screening | diagnostic | res201: Did not attend appointment | |||
| 9Nj..00 | Read | Other failed encounter | diagnostic | res201: Did not attend appointment | |||
| 9Nj8.00 | Read | Failed encounter - SMS text message delivery failure | diagnostic | res201: Did not attend appointment | |||
| 9Nj8.11 | Read | Failed encounter - SMS text message delivery failure | diagnostic | res201: Did not attend appointment | |||
| 9NjA.00 | Read | Failed encounter - hospital appointment | diagnostic | res201: Did not attend appointment | |||
| 9Oe3.00 | Read | Did not attend for community DMARD monitoring | diagnostic | res201: Did not attend appointment | |||
| 9Oe3.11 | Read | DNA community DMARD monitoring | diagnostic | res201: Did not attend appointment | |||
| 9Oq9700 | Read | NHSP incomplete as did not attend appointment | diagnostic | res201: Did not attend appointment | |||
| 9OqH000 | Read | NAAASP initial screening incomplete, did not attend | diagnostic | res201: Did not attend appointment | |||
| 9OqH900 | Read | NAAASP surveillance screening incomplete, did not attend | diagnostic | res201: Did not attend appointment | |||
| 9OWA.00 | Read | Did not attend new patient screening | diagnostic | res201: Did not attend appointment | |||
| 9Q11.00 | Read | MRC coronary screen DNA | diagnostic | res201: Did not attend appointment |
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The ClinicalCodes project is funded by the National Institute for Health Research (NIHR) School for Primary Care Research (SPCR)