This paper describes a personal experience in setting up a psychiatric record linkage system in an Eastern Ontario city. It discusses the rationale, background and methodology of the Kingston Psychiatric Record Linkage System and includes a detailed description of the practical issues encountered in its establishment and operation. The issues include funding, cooperation of local facilities, system start-up, operating costs, and data collection, linkage, entry, processing, storage and analysis. The limitations and uses of this system are discussed. Potential problems such as financial support and reliance on others have been resolved and the system has been functioning remarkably well since 1984. Published reports from other record linkage systems do not include such mundane details which would have been useful to know before planning this project. It is hoped that this paper will be beneficial to others who are interested in record linkage.
The aim of the circulating occupational medical record (COMR) is to coordinate activities and documents concerning the patient who has an occupational disease. This new case record belongs to the patient, which solves the problems concerning the professional secrecy of the involved authorities. The general practitioner, the trade union and amongst others the safety organisation of the work place all have their own schematic pages in the record. The number and use of COMRs were studied. Postal questionnaires were sent to the primary users of the COMRs. Altogether 345 COMRs were started over the two year period 1989-1991. Two hundred and ninety-eight COMRs were evaluable. The page of the general practitioner was used in 90% of the records, versus 64% in the case of the unionpage and 21% in the case of the safety organisation. In 78% there were documents from medical specialists, psychologists or physiotherapists. The majority of the documents were from the department of occupational medicine. In half of the COMRs there were documents from more than four different sources. Only 76% of the patients were referred to the department of occupational medicine. It is recommended that the COMR should be extended to the whole country.
A register has been built for planned epidemiological studies of sick-leave, containing all cases exceeding 6 days in a population of 184,000, over a period of 3 years. The diagnoses were coded from medical certificates. To assess the quality of this information this study reviews the medical certificates of 2,364 cases. In 299 cases the corresponding medical records are reviewed and independent diagnoses made. The coding and entering of data into the register is correct in 98% of cases. The independently-made diagnoses match exactly the ones registered in 50% of cases. When grouping the diagnoses into 39 groups, the match on group level is 72%. Ten percentage points of the mismatch are caused by specified overlaps between groups. The remaining 18% mismatch is caused mainly by different interpretations or unspecific labelling of the disease states, not so much by them being obscure in themselves or by doctor covering up unpleasant diagnoses.