¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria? / Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?

OBJETIVO: Analizar si la utilización de códigos Z en la historia clínica electrónica (HCE) se correlaciona con la realidad socioeconómica de la población atendida en Atención Primaria (AP). DISEÑO: Estudio observacional, descriptivo, transversal, de tipo ecológico. Emplazamiento: 90 centros de salud de dos Direcciones Asistenciales de AP, Comunidad de Madrid. PARTICIPANTES: El total de pacientes atendidos durante el año 2016 fue de 1.920.124 (54,33% mujeres, 45,67% hombres). El 7,15% recibió algún código Z (67,29% mujeres, 32,71% hombres). Mediciones principales: Como variable dependiente se estableció la proporción de pacientes con registros de códigos Z en su HCE. Como variables independientes se seleccionaron dos indicadores socioeconómicos que reflejan de forma objetiva las diferencias entre zonas básicas de salud: renta media disponible per cápita y proporción de inmigrantes económicos. Para evaluar la correlación entre variable dependiente e independientes se recurrió a análisis multivariante de correlación-regresión. RESULTADOS: Se observó que a mayor renta disponible, menor proporción de registros de episodios Z en las HCE (coeficiente de correlación de Pearson: -0,56). Sin embargo, existe una gran variabilidad de registro de códigos Z y la codificación no consigue visibilizar las realidades socioeconómicas de las poblaciones atendidas (odds ratio diagnóstica: 0,12 [IC: 0,05-0,32]). CONCLUSIONES: Resulta relevante para una orientación comunitaria de la AP la utilización de distintas herramientas que faciliten visibilizar el impacto en la salud de las desigualdades sociales, así como su evaluación a través de diversas metodologías de investigación. Los códigos Z no visibilizan en la zona estudiada los determinantes sociales de la salud de la población atendida

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended

[Does the Electronic Health Record reflect the social determinants of health from Primary Health Care?] / ¿Refleja la historia clínica electrónica los determinantes sociales de la salud desde Atención Primaria?

OBJECTIVE: Analyze whether the use of Z codes in the Electronic Health Record (EHR) correlates with the socioeconomic reality of the population attended. DESIGN: Observational, descriptive, cross-sectional, ecological study. LOCATION: 90 health centres of two Primary Health Care (PHC) Departments of the Community of Madrid. PARTICIPANTS: The total number of patients treated during 2016: 1,920,124 (54.33% women, 45.67% men). The 7.15% received some Z code (67.29% women, 32.71% men). MAIN MEASUREMENTS: As a dependent variable, the proportion of patients with Z code records in their EHRs was established. As independent variable, two socioeconomic indicators were selected that objectively reflect the differences between Basic Health Areas: Average Income Available per capita and Proportion of Economic Immigrants. To evaluate the correlation between dependent and independent variables, a multivariate correlation-regression analysis was used. RESULTS: It was observed that the higher the disposable income, the lower the proportion of Z code records in the EHRs (Pearson correlation coefficient: -0.56). However, there is a great variability in the registration of Z codes and the coding fails to make visible the socio-economic realities of the populations covered (Diagnostic Odds Ratio: 0.12. CI: 0.05-0.32). CONCLUSIONS: The use of different tools that facilitate the visualization of the health impact of social inequalities, as well as their evaluation through various research methodologies, is relevant for a community orientation of the PHC. The Z codes do not make visible in the studied area the social determinants of health of the population attended.