The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

Sibo Oskam,Inge Okkes,Predrag Zivotic,Kes Van Boven,Milan Jevtic,Jean K Soler,Frank Dobbs,Henk Lamberts

doi:10.14236/jhi.v20i1.45

Abstract

This is a study of the relationships between common reasons for encounter (RfEs) and common diagnoses (episode titles) within episodes of care (EoCs) in family practice populations in four countries. Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the International Classification of Primary Care (ICPC), including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using Bayesian methods. The RfE 'cough' is a strong, reliable predictor for the diagnoses 'cough' (a symptom diagnosis), 'acute bronchitis', 'URTI' and 'acute laryngitis/tracheitis' and a less strong, but reliable predictor for 'sinusitis', 'pneumonia', 'influenza', 'asthma', 'other viral diseases (NOS)', 'whooping cough', 'chronic bronchitis', 'wheezing' and 'phlegm'. The absence of cough is a weak but reliable predictor to exclude a diagnosis of 'cough', 'acute bronchitis' and 'tracheitis'. Its presence allows strong and reliable exclusion of the diagnoses 'gastroenteritis', 'no disease' and 'health promotion/prevention', and less strong exclusion of 'adverse effects of medication'. The RfE 'sadness' is a strong, reliable predictor for the diagnoses 'feeling sad/depressed' and 'depressive disorder'. It is a less strong, but reliable predictor of a diagnosis of 'acute stress reaction'. The absence of sadness (as a symptom) is a weak but reliable predictor to exclude the symptom diagnosis 'feeling sad/depressed'. Its presence does not support the exclusion of any diagnosis. We describe clinically and statistically significant diagnostic associations observed between the RfEs 'cough' and 'sadness', presenting as a new problem in family practice, and all the episode titles in ICPC.

Highlights

The development of family medicine (FM, synonymous with general practice) as a clinical speciality and an academic discipline is informed and enhanced by the collection of empirical longitudinal data from routine clinical practice
Reasons for encounter presented by the patient, all family doctors (FDs) interventions and the diagnostic labels recorded for each encounter were classified as recommended with International Classification of Primary Care (ICPC) (ICPC-2-E in Malta and Serbia, ICPC-1 in the Netherlands and Japan)
The episode title (ICPC code), and incidence and prevalence rates expressed as episode of care (EoC) per 1000 patient years of observation in the four populations are given

Summary

Introduction

The development of family medicine (FM, synonymous with general practice) as a clinical speciality and an academic discipline is informed and enhanced by the collection of empirical longitudinal data from routine clinical practice. Use of the ICPC to study the epidemiology of FM has the advantage of allowing precise capture of reason for encounter data, often ignored in FM research,[2,11,12,13] and this allows further important perspectives into the process of diagnosis in FM. The study aims to exemplify how data such as those from the Transition Project may be used to explore the process of diagnosis from a symptom, rather than from a disease, perspective. This is a study of the relationships between common reasons for encounter (RfEs) and common diagnoses (episode titles) within episodes of care (EoCs) in family practice populations in four countries. The relationships between RfEs and episode titles were studied using Bayesian methods

Objectives

Methods

Results

Discussion

Conclusion