Severity of episodes of care assessed by family physicians and patients: the DUSOI/WONCA as an extension of the International Classification of Primary Care (ICPC).

Abstract

The DUSOI/WONCA is included in the second edition of the International Classification of Primary Care (ICPC-2), as an extension to assess the severity of episodes of care. We studied (i) family physician's (FPs') assessment of three DUSOI/WONCA parameters per episode of care; (ii) how these relate to patient and episode of care characteristics, and to the interventions that occur; and (iii) how FPs' and patients' assessment of severity compare. Twelve FPs participated and coded patient and encounter data with ICPC. Also, they answered three DUSOI/WONCA questions, that were also answered (after the consultation) by 300 patients. Odds ratios were calculated for the relationships of the severity elements to patient and episode characteristics, and interventions. The relative agreement between FPs' and patients' ratings of severity was assessed. In 2033 consultations, 2860 episodes of care were documented, with a subset of 411 with a paired assessment by patient and FP. Patients appeared to be less hindered by symptoms/ complaints than the FPs thought, and less optimistic about the prognosis without care than the FP. Clear relationships existed between the FPs' assessment of severity and the patient, encounter and episode of care characteristics. Substantial agreement existed between FPs' and patients' assessment of severity. This study confirms the feasibility for FPs routinely to code the separate elements of severity for episodes of care, simultaneously using ICPC and DUSOI/WONCA. The studied elements of severity all provide relevant information: the interventions that occurred all related to them in a logical fashion. The FP-patient agreement on severity is satisfactory, also in the sense that it seems realistic to include these elements of severity as a topic in the communication with the patient.