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Using Electronic Health Records to Describe the Sexual and Reproductive Health and Rights of Migrant Women Attending Primary Care in England

Pathak, Neha; (2022) Using Electronic Health Records to Describe the Sexual and Reproductive Health and Rights of Migrant Women Attending Primary Care in England. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background:Health equity for international migrants, including sexual and reproductive health and rights (SRHR), is a recognised public health priority. Primary care is an important setting for SRHR in England, particularly for women, however population level data of primary care SRHR for migrants is lacking. Electronic health records (EHRs) could resolve this research gap, but this requires establishing a migration variable within the data. EHR phenotype are reproducible clinical code algorithms that define study variables; there is no validated EHR phenotype for migration. Aim: To describe SRHR health resource utilisation by migrant versus non-migrant women in England using Clinical Practice Research Datalink (CPRD), a primary care EHR. Methods: A systematic review was completed to identify existing SRHR phenotypes (Chapter 2). A CPRD migration phenotype was developed and its suitability assessed for migration health research (Chapter 3). Using these phenotypes, two population-based cohort studies were completed describing primary care SRHR in CPRD by migrant versus non-migrant women. The first described consultation rates for all-causes and for six exemplar SRHR outcomes (Chapter 4). The second described prescription rates for long-acting reversible contraceptives (LARCs), a national health policy target (Chapter 5). Results: The systematic review identified 515 SRHR phenotypes. Migration status is under-recorded in CPRD; the CPRD migration phenotype resulted in a large cohort representative of migrants by sex and geographical region, but not ethnicity or age. Emergency contraception, cervical screening and all-cause consultation rates were lower in migrant versus non-migrant women; rates were higher for abortion and management of fertility problems. Prescribing rates were lower in migrant versus non-migrant women for hormonal LARCs, but higher for copper intra-uterine devices. Conclusions: This thesis generated a validated method for migration health research and described its limitations. It also generated new knowledge on migrant women’s SRHR. Strengths, limitations and implications of the findings are discussed.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Using Electronic Health Records to Describe the Sexual and Reproductive Health and Rights of Migrant Women Attending Primary Care in England
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10160991
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