Bookmarkers beware: Bookmarks to pages other than the home page may not work after we change our server in April Editor's Choice | This Week in BMJ | Press releases BMJ No 7129 Volume 316 Letters Saturday 7 February 1998 Electronic record linkage to create diabetes registers Registers constructed from primary care databases have advantages Editor, Morris et al report having joined those areas in Tayside that have developed diabetes registers and their use of electronic record linkage.(1) It is now clear from the literature that a comprehensive dataset can be collected by a variety of means, either centrally led or built up from primary care. The suggestion in Morris et al's paper that general practice diabetes registers are not comprehensive is not supported either by their own regional data or by comparisons with other areas. The sensitivity of general practice registers in their study was 0.91 compared with 0.96 for electronic linkage. This would seem comparable, given the cost and effort entailed in producing a register by means of electronic linkage. The prevalence of diabetes is increasing both through improved recognition and through increased morbidity. Comparison of point prevalence in Tayside in 1996 with point prevalence from previous studies is therefore invalid. Our own experience over 13 years of maintaining a district register has been of a steady increase in the prevalence of diabetes over time. Morris et al selectively cited the prevalence in North Tyneside in 1991 (1.18%) while omitting the prevalence in 1994 (1.8%) quoted in the same paper.(2) This has since risen to 2.2% in 1997, a figure that compares favourably with the prevalence in Tayside in 1996 (1.94%). Figures from South Glamorgan support a similar rise in the prevalence of diabetes over time based on a district register generated by general practices.(3) Other factors must also be taken into account. Although Morris et al claim to have shown 'how clinical information can be harnessed electronically and exploited for the benefit of patients,' they have failed to state what benefit patients with diabetes in Tayside have derived from their register. Since a variety of methods are equally effective in data collection, perhaps the choice of method should reflect the effect that the method itself has on the commitment of those involved, their feelings of ownership, and its usefulness. Diabetic registers constructed from primary care databases are not constrained by the problem of confidentiality associated with electronic linkage and are therefore free to fulfil the purpose for which they exist. They are therefore used extensively for patient recall, the gathering of clinical data, screening, audit, and research. Any presumed gain in sensitivity from electronic record linkage cannot compete with this overwhelming factor. David L Whitford General practitioner 381 West Farm Avenue, Longbenton, Newcastle upon Tyne NE12 8UT Susan H Roberts Consultant diabetologist North Tyneside General Hospital, North Shields, Tyne and Wear NE29 8NH References 1 Morris A D, Boyle D I R, MacAlpine R, Emslie-Smith A, Jung R T, Newton R W, et al for the DARTS/MEMO Collaboration. The diabetes audit and research in Tayside Scotland (DARTS) study: electronic record linkage to create a diabetic register. BMJ 1997;315:524-8. (30 August.) 2 Whifford D L, Southern A J, Braid E, Roberts S H. Comprehensive diabetes care in North Tyneside. Diabetic Med 1995;12:691-5. 3 Butler C, Smithers M, Stott N, Peters J. Audit-enhanced, district-wide primary care for people with diabetes mellitus. Eur J Gen Pract 1997;3:23-7. Home | Current issue | Past issues | Classified ads | Career Focus | Feedback Collections | About this site | About the BMJ | BMA | Medline