COVID-19 high risk patients for accessing lateral flow tests

COVID-19 high risk patients for accessing lateral flow tests

This letter required primary care to identify and contact certain groups of patients to make them aware of the ongoing provision of lateral flow tests.
This work appeared to be in tandem with secondary care as some of the criteria are possibly not identifiable by primary care.

Primary Care IT has produced some searches to help Practices identify their patients.

The main search is called CLF-001 Highest risk patients for LFTs. This search simply combines the result of a number of sub-searches (cohorts) to produce a single list of patients. It is possible to use the Check Patient feature to find out which cohort a patient has been identified in. Due to the combination of recurring search features it is possible that a patient may appear in more than one sub-search.
The list report should not be used without having first reviewed the list and removed patients who do not meet the criteria.

The sub-searches have been built primarily using clusters found in the PCD Refset. In testing we identified that a number of patients will erroneously appear in the searches due to:
  1. the way diagnoses have been coded
  2. newly registered patients with pre-existing conditions or prescriptions whose record has not transferred or filed via GP2GP
  3. new courses of the same drug being added (or changed type) where the patient was receiving the drug prior to 28th January 2022.
Of these the most common is likely to be found in patients with renal disease. Patients changing status, or even where the CKD stage (especially stage 3) has been recoded as a 'New' problem or no problem at all.
We recommend Practices use the reports on the cohorts to check all patients before finalising the list of patients who will receive the letter



CLF-02 Patients with solid cancer

This has been split into 2 searches as testing found this to be a large cohort.
  1. CLF-02a identifies patients with a new solid cancer diagnosis and those with an existing cancer diagnosis who have started a course of radiotherapy or chemotherapy in the past 3 months (but had not received similar treatment in the preceding 9 months) 
  2. CLF-02b will return a higher number of patients which is those who have had a diagnosis of a solid cancer in the past and there have been ongoing reviews or code entries relating to the cancer in the past 6 months. This cohort will require careful attention to determine whether they meet the criteria. Some may be receiving radiotherapy or chemotherapy, while others may be in a non-treatment phase or in remission.
For the reasons described above CLF-02b is not included in the final CLF-01 report. Practices are welcome to add it to the search if desired.

CLF-03 Patients with haematological diseases

This cohort combines those patients with a haematological cancer, recent stem cell transplant recipients (including those with a history of stem cell transplant but recent graft vs host disease) plus patients with specified non-malignant haematological disorders. Patients with a diagnosis of sickle cell disease or myelodysplastic syndrome (ever) are included.
Due to the cluster used for solid organ transplants patients may appear in both this search and CLF-08.

CLF-04 Patients with renal disease

Any patient with renal disease (including CKD stage 3) who were diagnosed or had a related procedure after or on 28th January, plus those who started immunosuppressants after the same date.
It is possible that patients switching immunosuppressant medications since 28th January will be picked up.

Due to the way CKD staging can be coded, it is possible that re-coding the same stage as 'New' rather than 'Review' will pull patients into the new diagnosis category. The search does not take into account eGFR values which are sometimes a better indicator than coding of a patient's true renal state! Separate searches may be useful to ensure that recent eGFR values match the coded diagnosis.

CLF-05 Patients with liver disease

Any patient with liver disease (including CKD stage 3) who were diagnosed or had a related procedure after or on 28th January, plus those who started immunosuppressants after the same date.
It is possible that patients switching immunosuppressant medications since 28th January will be picked up.

CLF-06 Patients with immune mediated inflammatory disorders (IMID)

IMID has been defined here as those patients with any of the following conditions: rheumatoid arthritis; systemic lupus erythematosus; psoriasis; autoimmune liver disease (primary biliary cholangitis, autoimmune hepatitis). It is possible that patients switching immunosuppressant medications since 28th January will be picked up.

CLF-07 Patients with immune deficiencies or HIV/AIDS

This search combines two separate cohorts listed in C1613 by taking the IMATRISK cluster found in pneumococcal eligibility.
The guidance also states that the invitation is to include "Any patient who has not listed their HIV status on GP records (if known)" which clearly cannot be found by a search. This would be 'ever' rather than since 28th January. Local GP knowledge may be required to think about any patients who might fit this description.

CLF-08 Solid organ transplant recipients

This search uses a PCD refset cluster to identify patients who had a code for a solid organ transplant added after 28th January 2022. Patients where the procedure has been reviewed (or coded against an incoming document) who received their transplant within the past 12 months but prior to 28th January will not be included. In testing we spotted some codes might cause patients to appear in both this search and CLF-03.

CLF-09 Patients with rare neurological conditions

This search simply looks for patients whose first ever entry for one of the four specified conditions was on or after 28th January 2022. Remember that newly registered patients who have been summarised manually may appear in this figure.

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