International Classification Of Primary Care Research Articles

Bidirectionality of antiseizure and antipsychotic treatment: A population-based study

PurposeTo study the prevalence and directionality of comorbid epilepsy and psychosis in Norway. MethodsThe Norwegian Prescription Database (NorPD) provided individual-based information on all antiseizure medications (ASMs) and antipsychotic drugs (APDs) dispensed during 2004–2017. Subjects were ≥18 years of age at the end of the study period. Diagnosis-specific reimbursement codes from the 10th revision of the International Classification of Diseases/2nd edition of the International Classification of Primary Care (ICD-10/ICPC-2) combined with ATC codes were used as indicators of diagnosis. Subjects had collected ASMs for epilepsy or APDs for psychosis at least four times, at least once issued with an ICD-10 code from the specialist healthcare service. Directionality was analyzed in subjects receiving both treatments. To reduce prevalent comorbidity bias, we employed a four-year comorbidity-free period (2004–2007). The use of specific ASMs and APDs was analyzed. ResultsA total of 31,289 subjects had collected an ASM for epilepsy at least four times, 28,889 an APD for psychosis. Both the prevalence of treatment for epilepsy and of treatment for psychosis was 0.8%. Further, 891 subjects had been treated for both conditions; 2.8% with epilepsy had been treated for psychosis, and 3.1% with psychosis had been treated for epilepsy. Among 558 subjects included in the analyses of directionality, 56% had collected the first APD before an ASM, whereas 41% had collected an ASM first. During the last year prior to comorbidity onset, levetiracetam, topiramate, or zonisamide had been used for epilepsy by approximately 40%, whereas olanzapine and quetiapine were most used in patients with psychosis, and clozapine in 13%. ConclusionThe proportion of patients with prior antipsychotic treatment at onset of epilepsy is higher than previously acknowledged, as demonstrated in this nation-wide study. Apart from a shared neurobiological susceptibility, the bidirectionality of epilepsy and psychosis may be influenced by various environmental factors, including the interaction of pharmacodynamic effects. APDs may facilitate seizures; ASMs may induce psychiatric symptoms. In patients with combined treatment, these potential drug effects should receive ample attention, along with the psychosocial consequences of the disorders. A prudent multi-professional approach is required.

Why Do Community-Dwelling Persons with Spinal Cord Injury Visit General Practitioners: A Cross-Sectional Study of Reasons for Encounter in Swiss General Practice.

PurposeIn a country of free selection of providers, general practitioners (GPs) remain the most visited health-care professionals by the vast majority of persons with spinal cord injury (SCI) in Switzerland; yet, little is known about these contacts. The study aims to explore reasons for encounters (RFEs) in general practice, and their relationships to first-contact of care (GP or specialist) and GP’s competence in managing SCI-specific problems.Patients and MethodsCross-sectional study from baseline data of non-randomized controlled trial. Persons with SCI in the chronic phase and living in Swiss rural communities were invited. Participants were asked about RFEs (reasons and health problems) of their last visit to a GP. RFEs were coded according to the International Classification of Primary Care (ICPC-2), and analyzed according to first-contact and participants’ ratings of GPs’ competence in managing SCI-specific problems.ResultsOut of 395, 226 (57%) persons participated, of which 89% have reported 2.1 (SD ±1.4) RFEs and 2.4 (±1.7) health problems per GP visit, on average. Participants visited GPs for medications (49%), urgent medical problems (33%) and follow-up (30%). Most RFEs were related to general/unspecified problems (65%). Persons whose first contact was a specialist were more likely to visit GPs for medications (Specialist = 60% vs GP = 42%). There were no associations between RFEs and the perceived GP’s competence at P < 0.05.ConclusionIrrespective of first contact of care, persons with SCI visit GPs for medication, urgent issues, and follow-up care, and more often for general problems than for secondary health conditions. Strengthening collaboration between GPs in rural communities and specialized centers is recommended; promoting such a connection potentially aids GPs in meeting their information needs for managing secondary health conditions and improving the quality of SCI care for this population.

Commentary: From Mixtapes to Playlists - Evolving Options for Capturing Diagnoses in Canadian Physicians' Data.

Physician billing claims are rich sources of administrative health data. However, diagnostic codes in billing claims are drawn from the International Classification of Diseases, Ninth Revision (WHO & International Conference for the Ninth Revision of the International Classification of Diseases 1977), which has not been updated by the World Health Organization in three decades. With its updated and expanded content and its digital tooling, the International Classification of Diseases 11th Revision (ICD-11) (WHO n.d.a.) could be considered for this purpose. Primary care practitioners have always found the ICD inadequate for their needs. This may change with ICD-11, with which the International Classification of Primary Care (ICPC) (van Boven and Ten Napel 2021) is more closely aligned. ICD-11, ICPC and the Systematized Nomenclature of Medicine Clinical Terms present evolving options for capturing diagnoses in physician data.

Ethnopharmacological preparations used for digestive system disorders in Talassemtane National Park (North of Morocco)

Background: The present ethnobotanical-ethnopharmacological study of plants used to treat ailments of the digestive system was carried out in the north of Morocco. The study aims to collect data on the plants used, their vernacular names, the parts used, and their modes of preparation and administration. Methods: Surveys and interviews were carried between 2014 and 2017 in Talassemtane National Park, North of Morocco. Data were collected through open semi structured interviews with the informants. A sample of 200 people aged from 20 to 60 years, including 24 herbalists and 28 traditional healers were included. Results: We identified 96 taxa belonging to 33 botanical families. With a total of 3270 use reports, we have identified 20 medicinal uses to treat 174 conditions or symptoms classified in digestive diseases according to the international classification of primary care (ICPC-2). The main families used in this pathological group are: Lamiaceae (24 species), Asteraceae (13 species), Apiaceae (11 species), Fabaceae (8 species). Most remedies are prepared as a decoction (48%), the most used parts of the plant are: leaves (29%), fruits (16%), seeds (11%) and the most common mode of administration is oral (84%). Conclusion: Knowledge of medicinal plants used to treat acute digestive system problems was common. All the local population used medicinal plants as a first choice to deal with the illness. This study represents a useful inventory to preserve and spread this knowledge. Keywords: Ethnobotanical survey; Digestive system problems; Medicinal plants; Talassemtane National Park.

Epidemiology and management of hepatitis B and C in primary care in the Netherlands: data from the Rijnmond Primary Care database.

The Dutch guideline for general practitioners (GPs) advises biannual surveillance of hepatitis B (HBV) patients and referral of every hepatitis C (HCV) patient. We aimed to study the prevalence, incidence, and the management of hepatitis B and C in primary care. This is a retrospective cohort study using the Rijnmond Primary Care database (RPCD), including health care data of medical records of GPs of approximately 200,000 patients in the area of Rotterdam, the Netherlands. Patient records were selected based on laboratory results, International Classification of Primary Care (ICPC) codes, and free-text words. In total, 977 patients were included: 717 HBV, 252 HCV, and 8 HBV/HCV coinfected patients. Between 2013 and 2019, the prevalence of HBV and HCV declined from 5.21 to 2.99/1,000 person-years (PYs) and 1.50 to 0.70/1,000 PYs, respectively. We observed that the majority of the patients had been referred to a medical specialist at least once (71% HBV and 89% HCV patients). However, among chronic patients, we observed that 36.2% of the HBV patients did not receive adequate surveillance by their GP (≥2 alanine aminotransferase checks within 3 years) or a medical specialist. In addition, 44.4% of the HCV patients had no record about successful antiviral treatment. This study demonstrated a declining prevalence in viral hepatitis B and C in primary care in the Netherlands. However, a substantial part of the patients did not receive adequate surveillance or antiviral therapy. It is therefore crucial to involve GPs in case finding and in follow-up after treatment.

Improving Primary Health Care Data With ICPC-3: From a Medical to a Person-Centered Perspective.

The World Organization of Family Doctors (WONCA) developed the third edition of the International Classification of Primary Care (ICPC-3) to support the shift from a medical perspective to a person-centered perspective in primary health care. The previous editions (ICPC-1 and ICPC-2) allowed description of 3 important elements of health care encounters: the reason for the encounter, the diagnosis and/or health problem, and the process of care. The ICPC-3 adds function-related information as a fourth element, thereby capturing most parts of the encounter in a single practical and concise classification. ICPC-3 thus has the potential to give more insight on patients' activities and functioning, supporting physicians in shifting from a strict medical/disease-based approach to care to a more person-centered approach. The ICPC-3 is also expanded with a new chapter for visits pertaining to immunizations and for coding of special screening examinations and public health promotion; in addition, it contains classes for programs related to reported conditions (eg, a cardiovascular program, a heart failure program) and can accommodate relevant national or regional classes. Classes are selected based on what is truly and frequently occurring in daily practice. Each class has its own codes. Less frequently used concepts pertaining to morbidity are captured as inclusions within the main classes. Implementation of the ICPC-3 in an electronic health record allows provision of meaningful feedback to primary care, and supports the exchange of information within teams and between primary and secondary care. It also gives policy makers and funders insight into what is happening in primary care and thus has the potential to improve provision of care.

Morbidity Patterns in Primary Care in Hong Kong: Protocol for a Practice-Based Morbidity Survey.

BackgroundUp-to-date and accurate information about the health problems encountered by primary care doctors is essential to understanding the morbidity pattern of the community to better inform health care policy and practice. Morbidity surveys of doctors allow documentation of actual consultations, reflecting the patient’s reason for seeking care as well as the doctor’s diagnostic interpretation of the illness and management approach. Such surveys are particularly critical in the absence of a centralized primary care electronic medical record database.ObjectiveWith the changing sociodemographic profile of the population and implementation of health care initiatives in the past 10 years, the aim of this study is to determine the morbidity and management patterns in Hong Kong primary care during a pandemic and compare the results with the last survey conducted in 2007-2008.MethodsThis will be a prospective, practice-based survey of Hong Kong primary care doctors. Participants will be recruited by convenience and targeted sampling from both public and private sectors. Participating doctors will record the health problems and corresponding management activities for consecutive patient encounters during one designated week in each season of the year. Coding of health problems will follow the International Classification of Primary Care, Second Edition. Descriptive statistics will be used to calculate the prevalence of health problems and diseases as well as the rates of management activities (referral, investigation, prescription, preventive care). Nonlinear mixed effects models will assess the differences between the private and public sectors as well as factors associated with morbidity and management patterns in primary care.ResultsThe data collection will last from March 1, 2021, to August 31, 2022. As of April 2022, 176 doctor-weeks of data have been collected.ConclusionsThe results will provide information about the health of the community and inform the planning and allocation of health care resources.Trial RegistrationClinicalTrials.gov NCT04736992; https://clinicaltrials.gov/ct2/show/NCT04736992International Registered Report Identifier (IRRID)DERR1-10.2196/37334

Health status assessment of a population of asylum seekers in Northern Italy

BackgroundSince 2011 Italy has faced an extraordinary increase in migrants arrivals, mainly from the Mediterranean route, one of the world’s most dangerous journeys. The purpose of the present article is to provide a comprehensive picture of the migrants' health status in the "T. Fenoglio" centre, Settimo Torinese (Turin, Italy).MethodsA retrospective cross-sectional study was conducted using data collected from June 2016 to May 2018 on adult migrants (over 18 years old) from Africa, Middle East and South East Asia (Bangladesh, Cambodia, India, Nepal). Data was collected through the migrants' medical records. Descriptive statistics were performed on socio-demographic variables. The diagnosed diseases were anonymously registered and classified according to the International Classification of Primary Care (ICPC-2).Conditional Inference Trees were used to perform a descriptive analysis of the sample and to detect the covariates with the strongest association with the variables Disease on arrival, Disease after arrival, ICPC on arrival and ICPC after arrival.ResultsAnalyzed observations were 9 857. 81.8% were men, median age was 23 (Interquartile range: 20.0–27.4). 70.3% of the sample came from Sub-Saharan Africa. 2 365 individuals (24%) arrived at the centre with at least one disease. On arrival, skin (27.71%), respiratory (14.46%), digestive (14.73%) and generic diseases (20.88%) were the most frequent. During the stay respiratory diseases were the most common (25.70%). The highest probability of arriving with a disease occurred in 2018 and during the period September–November 2016, in particular for people from the Horn of Africa. During this period and also in the first half of 2017, skin diseases were the most reported. In seasons with lower prevalence of diseases on arrival the most common disease code was generic for both men and women (usually fever or trauma).ConclusionsThis study provides information on the diverse diseases that affect the asylum seekers population. In our sample, the Horn of Africa was the most troubled area of arrival, with severe conditions frequently reported regarding skin diseases, in particular scabies. 2018 was the most critical year, especially for migrants from the Horn of Africa and Sub-Saharan Africa. During the stay at the camp, the prevalence of respiratory diseases increased. However, skin diseases remained the main issue for people from the Horn of Africa. Overall, the most reported diseases in the sample were dermatological, respiratory, digestive and generic diseases, both on arrival and during the stay.A better understanding of the health status of asylum seekers is an important factor to determine a more efficient reception and integration process and a better allocation of economic resources in the context of migrants' health care.

Traditional Plants Used for Medicinal Purposes in Güroymak (Bitlis/Turkey) District

This study, which was conducted between 2020 and 2021 to record the traditional medicinal plant usage culture of the inhabitants of Güroymak (Bitlis), was the first to be conducted in the district. Face-to-face interviews with individuals with advanced ethnobotanical knowledge were conducted in the villages (29) of the district, and the medicinal plants which were used were gathered and identified. The information gathered as a result of the interviews with 120 participants was recorded for this purpose. As a result of the study, it was observed that 60 taxa from 26 families were used to treat 30 different diseases. The most used medicinal plants were from the family “Asteraceae” (13 taxa), followed by “Lamiaceae” (8 taxa), “Rosaceae” (7 taxa) and “Polygonaceae (3 taxa)”. The usage value (UV) was calculated for each species. Malva neglecta, Rosa canina, Crataegus pseudoheterophylla, Crataegus monogyna, Juglans regia, Crataegus orientalis, Rumex scutatus, Celtis tournefortii, Alcea setosa, and Taraxacum kurdiciforme were the most commonly used taxa in the study area. Furthermore, diseases for which medicinal plants were used were classified using The International Classification of Primary Care (ICPC), accepted by the WHO, and the Informant Consensus Factor (ICF) values for each disease category were calculated. Diseases with high ICF values are digestive problems (27 taxa). This is followed by the respiratory and skin disease categories (11 taxa for each).

Predicting COVID-19 Symptoms From Free Text in Medical Records Using Artificial Intelligence: Feasibility Study.

BackgroundElectronic medical records have opened opportunities to analyze clinical practice at large scale. Structured registries and coding procedures such as the International Classification of Primary Care further improved these procedures. However, a large part of the information about the state of patient and the doctors’ observations is still entered in free text fields. The main function of those fields is to report the doctor’s line of thought, to remind oneself and his or her colleagues on follow-up actions, and to be accountable for clinical decisions. These fields contain rich information that can be complementary to that in coded fields, and until now, they have been hardly used for analysis.ObjectiveThis study aims to develop a prediction model to convert the free text information on COVID-19–related symptoms from out of hours care electronic medical records into usable symptom-based data that can be analyzed at large scale.MethodsThe design was a feasibility study in which we examined the content of the raw data, steps and methods for modelling, as well as the precision and accuracy of the models. A data prediction model for 27 preidentified COVID-19–relevant symptoms was developed for a data set derived from the database of primary-care out-of-hours consultations in Flanders. A multiclass, multilabel categorization classifier was developed. We tested two approaches, which were (1) a classical machine learning–based text categorization approach, Binary Relevance, and (2) a deep neural network learning approach with BERTje, including a domain-adapted version. Ethical approval was acquired through the Institutional Review Board of the Institute of Tropical Medicine and the ethics committee of the University Hospital of Antwerpen (ref 20/50/693).ResultsThe sample set comprised 3957 fields. After cleaning, 2313 could be used for the experiments. Of the 2313 fields, 85% (n=1966) were used to train the model, and 15% (n=347) for testing. The normal BERTje model performed the best on the data. It reached a weighted F1 score of 0.70 and an exact match ratio or accuracy score of 0.38, indicating the instances for which the model has identified all correct codes. The other models achieved respectable results as well, ranging from 0.59 to 0.70 weighted F1. The Binary Relevance method performed the best on the data without a frequency threshold. As for the individual codes, the domain-adapted version of BERTje performs better on several of the less common objective codes, while BERTje reaches higher F1 scores for the least common labels especially, and for most other codes in general.ConclusionsThe artificial intelligence model BERTje can reliably predict COVID-19–related information from medical records using text mining from the free text fields generated in primary care settings. This feasibility study invites researchers to examine further possibilities to use primary care routine data.

Construction and validation of a morbidity index based on the International Classification of Primary Care

Objectives In epidemiological studies it is often necessary to describe morbidity. The aim of the present study is to construct and validate a morbidity index based on the International Classification of Primary Care (ICPC-2). Design and Setting This is a cohort study based on linked data from national registries. An ICPC morbidity index was constructed based on a list of longstanding health problems in earlier published Scottish data from general practice and adapted to diagnostic ICPC-2 codes recorded in Norwegian general practice 2015 − 2017. Subjects The index was constructed among Norwegian born people only (N = 4 509 382) and validated in a different population, foreign-born people living in Norway (N = 959 496). Main outcome measures Predictive ability for death in 2018 in these populations was compared with the Charlson index. Multiple logistic regression was used to identify morbidities with the highest odds ratios (OR) for death and predictive ability for different combinations of morbidities was estimated by the area under receiver operating characteristic curves (AUC). Results An index based on 18 morbidities was found to be optimal, predicting mortality with an AUC of 0.78, slightly better than the Charlson index (AUC 0.77). External validation in a foreign-born population yielded an AUC of 0.76 for the ICPC morbidity index and 0.77 for the Charlson index. Conclusions The ICPC morbidity index performs equal to the Charlson index and can be recommended for use in data materials collected in primary health care. Key points This is the first morbidity index based on the International Classification of Primary Care, 2nd edition (ICPC-2) It predicted mortality equal to the Charlson index and validated acceptably in a different population The ICPC morbidity index can be used as an adjustment variable in epidemiological research in primary care databases

Occurrence and Timing of Advance Care Planning in Persons With Dementia in General Practice: Analysis of Linked Electronic Health Records and Administrative Data.

BackgroundAdvance care planning (ACP) is a process of communication in which patients and family caregivers discuss preferences for future care with the healthcare team. For persons with dementia, it is crucial to timely engage in ACP. Therefore, we study ACP in dementia using electronic health record data. This study aims to determine how often ACP conversations are recorded, analyze time from dementia diagnosis until the first recorded conversation and time from the first recorded conversation to death, and analyze which factors are associated with the timing of ACP.MethodsElectronic records of 15,493 persons with dementia in Dutch general practice between 2008 and 2016 were linked to national administrative databases. ACP conversations and indicators of health deficits to determine frailty were obtained from electronic records coded with the International Classification of Primary Care. Socio-demographic characteristics were derived from the national population registry managed by Statistics Netherlands. Date of death was derived from the Personal Records Database (2008–2018).ResultsACP was recorded as such as 22 (95% CI, 20–23) first conversations per 1,000 person-years of follow-up. The hazard ratio (HR) for the first conversation increased every year after dementia diagnosis, from 0.01 in the first year to 0.07 in the 7th and 8th year after diagnosis. Median time from a first conversation to death was 2.57 years (95% CI, 2.31–2.82). Migrant status [non-Western vs. Western (HR 0.31, 95% CI, 0.15–0.65)] was significantly associated with a longer time from dementia diagnosis to the first conversation. Being pre-frail (HR 2.06, 95% CI, 1.58–2.69) or frail (HR 1.40, 95% CI, 1.13–1.73) vs. non-frail was significantly associated with a shorter time from dementia diagnosis to the first ACP conversation.ConclusionACP conversations in Dutch general practice were rare for persons with dementia, or was rarely recorded as such. In particular among persons with a non-Western migration background and those who are non-frail, it started long after diagnosis. We advise further research into public health and practical strategies to engage persons with dementia with a non-Western migration background and non-frail persons early in the disease trajectory in ACP.

Direct Medical Costs of Four Vaccine-Preventable Infectious Diseases in Older Adults in Spain.

ObjectiveProtection against vaccine-preventable diseases is especially relevant in older adults due to age-related decline in immunity (immunosenescence). However, adult vaccination remains a challenge with overall low coverage rates, which has an impact on both the patients who have these diseases and the health care system in terms of resource use and costs derived. This study aimed to estimate the direct economic impact of herpes zoster, pneumococcal disease, influenza and pertussis in Spanish adults 45 years and older.MethodsData from 2015 were extracted from two Spanish public databases: the Minimum Basic Data Set for Hospitalisations and the Clinical Database of Primary Care. Codes from the International Classification of Diseases and the International Classification of Primary Care were used to identify and classify the diseases analysed. The variables extracted and calculated were hospitalisation (cases, percentage, length of stay, costs, mortality), primary care (cases, percentage, costs) and referrals (cases, percentage, costs). Results were presented for the age groups 45–64 years, 65–74 years, > 74 years and all ages.ResultsIn adults 45 years and older, total costs amounted to €134.1 million in 2015 (i.e. 63.9% of the total direct costs for all age groups): 44.4% due to pneumococcal disease, 39.5% due to influenza, 16.0% due to herpes zoster and 0.1% due to pertussis. Hospitalisations represented 58.1% (€77.9 million) of the total costs, with 15,910 admissions, 144,752 days of hospitalisation and 1170 deaths. Primary care registered 566,556 visits with a cost of €35.0 million, and 269,186 referrals with a cost of €21.1 million.ConclusionThe direct economic burden of herpes zoster, pneumococcal disease, influenza and pertussis in adults 45 years and older was high in Spain, and may be underestimated as it only considered medical assistance and not other applicable direct or indirect costs. Increasing vaccination rates in adults may potentially reduce the economic burden derived from these diseases, although future cost-effectiveness analysis including other disease-related costs, vaccination costs and vaccination effectiveness would be needed.Graphical

Interrupted Time Series Analysis of Pediatric Infectious Diseases and the Consumption of Antibiotics in an Atlantic European Region during the SARS-CoV-2 Pandemic.

The increasing concern about bacterial resistance has made the rational prescription of antibiotics even more urgent. The non-pharmacological measures established to reduce the impact of the SARS-CoV-2 pandemic have modified the epidemiology of pediatric infections and, consequently, the use of antibiotics. Interrupted time series (ITS) analyses are quasi-experimental studies that allow for the estimation of causal effects with observational data in “natural experiments”, such as changes in health policies or pandemics. The effect of the SARS-CoV-2 pandemic on the incidence of infectious diseases and the use of antibiotics between 2018 and 2020 in the Health Area of Vigo (Galicia, Spain) was quantified and analyzed. This paper outlines a real-world data study with administrative records from primary care services provided for the pediatric population. The records were related to episodes classified as infectious by the International Classification of Primary Care (ICPC-2) and oral medication in the therapeutic subgroup J01, corresponding to antibiotics for systemic use, according to the World Health Organization’s Anatomical Therapeutic Chemical (ATC) classification system. The records were classified according to incident episodes, age, dose per inhabitant, and year. Segmented regression models were applied using an algorithm that automatically identifies the number and position of the change points. During the SARS-CoV-2 pandemic, the number of infectious diseases being transmitted between individuals, through the air and through the fecal–oral route, significantly decreased, and a slight decrease in infections transmitted via other mechanisms (urinary tract infections) was also found. In parallel, during the months of the pandemic, there has been a marked and significant reduction in antibacterial agent utilization, mainly of penicillins, cephalosporins, and macrolides.

Anxiety problems in children and adolescents: a population-based cohort study on incidence and management in Dutch primary care.

BackgroundDue to a large strain on youth mental health care, general practice is suggested as an alternative treatment setting for children and adolescents with anxiety problems. However, research on the current management of these children and adolescents within general practice is scarce.AimTo investigate the incidence of coded anxiety in general practice using the International Classification of Primary Care (ICPC), and GPs’ management of children and adolescents presenting with anxiety problems.Design and settingPopulation-based cohort study using electronic medical records of 51 212 children (aged 0–17 years) in primary care in the Rotterdam region between 1 January 2012 and 31 December 2018.MethodIncidence of ICPC codes for anxiety were calculated, then the characteristics of children and adolescents consulting their GP with anxiety and the GPs’ management were assessed qualitatively using quantitative content analysis.ResultsIncidence of ICPC codes for anxiety in children and adolescents was 5.36 (95% confidence interval [CI] = 5.02 to 5.71) per 1000 person–years. Adolescent females had the highest incidence with 14.01 (95% CI = 12.55 to 15.58) per 1000 person–years. Of the 381 children and adolescents consulting their GP with an initial anxiety problem (median age 13.3 years, 40.4% male), GPs referred 59.3% to mental health care in the first year while 26.5% of children and adolescents were managed by a specialised practice nurse within general practice. Of the 381 children and adolescents, 10.5% received psychiatric medication during the first year, with the trend being for increased prescriptions during adolescence.ConclusionIn general practice children and adolescents frequently received one of two ICPC codes for anxiety, especially adolescent females. Most presenting to their GP with anxiety problems are referred externally or seen by a specialised practice nurse within general practice.

To which non-physician health professionals do French general practitioners refer their patients to and what factors are associated with these referrals? Secondary analysis of the French national cross-sectional ECOGEN study

BackgroundMultiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors.MethodsThis is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines.ResultsFrench GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003).ConclusionsReferral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.

User embracement in the Family Health Strategy in a city in the north of Minas Gerais, Brazil: a descriptive study, 2019-2020.

To analyze the user embracement records of the Family Health Strategy (FHS) teams in a city in the North of Minas Gerais, Brazil. This was a cross-sectional and descriptive study based on secondary data. We analyzed FHS nurse and pharmacist service user embracement records for the period from March 2019 to February 2020. The total number of user embracement records and total number of records per service user were calculated according to the codes used by the International Classification of Primary Care (ICPC-2). A total of 20,513 user embracement records were identified, the majority for female health service users (63.5%), those aged between 20 and 59 years (52.5%) and related to the ICPC-2 Procedure chapter (18.5%). User embracement activities were carried out for only 31.1% of the population resident in the FHS territories. Having knowledge about user embracement in the FHS and the main reasons for it highlights the importance of interventions targeting prevalent groups, in addition to contributing to the organization of health care.

Diagnostic codes for low back pain, nomenclature or noise? A descriptive study of disease classification system coding of low back pain

To compare and contrast the diagnostic codes for spinal causes of low back pain (LBP) in 3 disease classification systems (International Classification of Diseases [ICD]-10, International Classification of Primary Care [ICPC]-2 PLUS and Systematized Nomenclature of Medicine Clinical Terms - Australia [SNOMED CT-AU]) and consider how well they are aligned with the diagnostic approach recommended in contemporary clinical practice guidelines for LBP. This was a descriptive study which included 3 disease classification systems: ICD-10, ICPC-2 PLUS and SNOMED CT-AU. Two independent authors extracted relevant LBP codes from each system and mapped the codes to 3 guideline-endorsed categories of spine-related diagnoses for LBP (specific spinal pathology, radicular syndromes, and non-specific LBP) and the various clinical conditions (sub-categories) within each of the 3 categories. ICD-10, ICPC-2 PLUS, and SNOMED CT-AU had 126, 118 and 100 codes for LBP, respectively. All systems provided codes that would cover the 3 guideline-endorsed categories of spine-related diagnoses for LBP. On the basis of contemporary guidelines, the authors developed lists of discrete sub-categories of specific spinal pathology (56 sub-categories), radicular syndromes (7 sub-categories), and non-specific LBP (10 sub-categories). Each of the classification systems was then mapped against these sub-categories to tally redundancy and determine exhaustiveness. However, no system covered all 73 sub-categories of LBP, and within each system, there was substantial redundancy with up to 22 codes for the same clinical condition. LBP diagnostic codes used in popular disease classification systems are out of touch with current approaches to diagnosis, as reflected in contemporary LBP guidelines. Our findings suggest these disease classification systems need revision, but precisely how they should be revised is unclear.

Detecting young people with mental disorders: a cluster-randomised trial of multidisciplinary health teams at the GP office

BackgroundYoung people with mental health challenges present a major global challenge. More than half of adults with mental disorders experience their onset before age 14, but early detection and intervention...

Unaccompanied minors' consultation reasons for encounter and health problems managed in a permanence of access to health care

To describe the unaccompanied minors' reasons for consulting and their health problems managed in a permanence of access to health care (PASS) at the Hospices civils de Lyon. Consultation data of the unaccompanied minors cared for in 2016 and 2017 at the Edouard Herriot Hospital PASS, Lyon, were collected and coded according to the International Classification of Primary Care (CISP-2). The majority of unaccompanied minors were male adolescents from French-speaking sub-Saharan African countries. Each consultation included an average of 1.6 reason for encounter (95%CI: 1.5-1.8) and 2.0 health problems diagnosed (95%CI: 1.9-2.1). Apart from the discussion of test results, the most frequent reasons for consultation were physical symptoms, particularly generalized abdominal pain (8.7%), headache (6.6%) or pruritus (6.5%). Health problems diagnosed were mainly digestive (11.4%), cutaneous (11.0%) and osteoarticular (7.0%) problems, psychic diagnoses being rare. Unaccompanied minors seems to be apparently in good health, which probably results from under-diagnosing infectious diseases and psychic disorders. We recommend the implementation in the PASS of a common protocol for screening infectious conditions and detecting psychic disorders.