GPs ‘under-record child maltreatment’
MedWire News: GPs under-record concerns that a child may be suffering maltreatment, UK researchers say.
Using two datasets for 2009-2010, one from 11 practices and another from 442 practices in The Health Improvement Network database, they found evidence of "considerable uncoded activity".
On average, maltreatment-related codes were recorded in 8.0-8.4 children per 1000 child years, with variation among practices. Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, although all had relevant free text, scanned documents, or codes.
GPs from the 11 practices were interviewed about their experience of recording suspected maltreatment, confirming that major disincentives included potentially harming the relationship with the family if concerns were visible on the computer screen, uncertainty over which codes to use and perceived legal barriers to recording third-party information about parent risk factors or maltreatment of a sibling.
Dr Ruth Gilbert (University College London) and colleagues then worked with GPs to develop a series of principles to guide coding. They recommend that, in line with guidance issued by NICE, GPs always (and as a minimum) use the code for 'Child is cause for concern' whenever maltreatment is 'considered'. This is 13lf for Read Codes Version 2 (5-byte) and XaMzr for Read Codes Clinical Terms Version 3, they note.
After that, further codes should be considered based on four key issues, namely: what the cause is for concern; if the family is a cause for concern; whether child protection/social services are involved; and what other professionals are involved.
The full list of recommended codes is available online (click here). Reporting their proposed coding pathway in the British Journal of General Practice, the authors comment: "Improved recording allows the GP to identify rapidly any previous maltreatment concerns during a consultation.
"At a practice level, searchers for children with maltreatment concerns can be used to ensure appropriate review in team meetings or early intervention (for example, targeted health visiting or parent training)."
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By Caroline Price