International Classification Of Primary Care-2 Research Articles

Exposure to green spaces, cardiovascular risk biomarkers and incident cardiovascular disease in older adults: The Seniors-Enrica II cohort

IntroductionThe impact of residential green spaces on cardiovascular health in older adults remains uncertain. MethodsCohort study involving 2114 adults aged ≥ 65 years without cardiovascular disease (CVD), residing in five dense municipalities (Prince et al., 2015) of the Madrid region and with detailed characterization of their socioeconomic background, health behaviors, CVD biological risk factors, and mental, physical, and cognitive health. Greenness exposure was measured using the Normalized Difference Vegetation Index (NDVI) at varying distances from participants' homes. Traffic exposure, neighborhood environment, neighborhood walkability, and socioeconomic deprivation at the census level were also assessed. Serum N-terminal pro-B-type natriuretic peptide (NT-ProBNP), high-sensitivity troponin T (hs-TnT), interleukin 6 (IL-6), and Growth Differentiation Factor 15 (GDF‐15) were measured at baseline, and incident CVD events identified through electronic medical records (International Classification of Primary Care-2 codes K74, K75, K77, K90, and K92). ResultsAfter adjusting for sex, age, educational attainment, financial hardship and socioeconomic deprivation at the census level, an interquartile range (IQR) increase in NDVI at 250, 500, 750, and 1000 m around participants' homes was associated with mean differences in ProBNP of −5.56 % (95 %CI: −9.77; −1.35), −5.05 % (-9.58; −0.53), −4.24 % (-8.19, −0.19), and −4.16 % (-7.59; −0.74), respectively; and mean differences in hs-TnT among diabetic participants of −8.03 % (95 %CI: −13.30; −2.77), −9.52 % (-16.08; −2.96), −8.05 % (-13.94, −2.16) and −5.56 % (-10.75; −0.54), respectively. Of similar magnitude, although only statistically significant at 250 and 500 m, were the observed lower IL-6 levels with increasing greenness. GDF-15 levels were independent of NDVI. In prospective analyses (median follow-up 6.29 years), an IQR increase in residential greenness at 500, 750, and 1000 m was associated with a lower risk of incident CVD. The variables that contributed most to the apparent beneficial effects of greenness on CVD were lower exposure to traffic, improved cardiovascular risk factors, and enhanced physical performance. Additionally, neighborhood walkability and increased physical activity were notable contributors among individuals with diabetes. ConclusionIncreased exposure to residential green space was associated with a moderate reduction in CVD risk in older adults residing in densely populated areas.

Medicinal plants traditionally used in the health care practices by the indigenous communities of the Trans-Himalayan region of Ladakh, India

Ethnopharmacological relevanceLadakh, “the land of high-rising passes,” is a cold arid desert located in the India's northernmost part of the Trans-Himalayan region. Traditional knowledge of medicinal plants in this fragile ecosystem is an important part of the primary healthcare system, particularly in remote areas where modern medical facilities are not fully operational. There is a need to update the traditional information on medicinal plants from time to time to understand any addition of plants or uses to assist in developing new drugs through pharmacological and phytochemical studies. Aim of the studyThe study was conducted to document the traditional knowledge and current therapeutic practices of the indigenous communities of Ladakh. Besides, the study strives to evaluate previous studies from Ladakh to identify plants that have not been previously reported for medicinal use. Material and methodsEthnomedicinal information was collected from 350 local informants through open and semi-structured questionnaires and field surveys in 35 villages of 8 regions of Ladakh. The primary data were analyzed for use reports (UR) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants and unreported medicinal uses in this study were identified and compared to 36 prior studies conducted in Ladakh. ResultsIn the study, 176 medicinal plants belonging to 45 families and 131 genera were reported to treat 116 diseases of 16 (ICPC-2) groups with a total of 4841 use reports. Based on the highest use reports (UR), the most utilized species were Thymus linearis Benth. (134), followed by Aconitum heterophyllum Wall. (127) The highest informant consensus factor (ICF) was reported for Pregnancy, Childbearing, and Family Planning (ICF = 1) followed by respiratory (ICF = 0.91), and digestive (ICF = 0.90) disorders. Based on the comparative literature review, a total of 518 plant species (502 previously reported plus 16 newly cited) are being used in the Ladakh region. A total of 133 use reports for 16 newly cited plants using 30 diseases were recorded. The highest degree of overlapping of medicinal plants and uses for medicines was recorded in regions with comparable ethnicity, and shorter geographical distances. Based on the IUCN Red List, recorded medicinal plants include 7 critically endangered, 9 endangered, and 13 vulnerable species. ConclusionLadakh's indigenous populations use a diverse range of medicinal plants to treat a variety of illnesses. The introduction of species and medicinal uses not previously cited in the primary health care system demonstrates that shared knowledge of traditional medicine among Ladakhi is still rich. The medicinal value of preferred medicinal plants has already been validated, but some medicinal plants lack scientific validation. We recommend further scientific studies on Aconitum violaceum Jacquem. ex Stapf,Anaphalis nepalensis var. monocephala (DC.) Hand.-Mazz., Allardia nivea Hook. f. & Thomson ex C.B. Clarke, Atriplex hortensis L., Eriophyton tibeticum (Vatke) Ryding, Iris lactea Pall. and Rheum webbianum Royle.

Validation of diagnosis of acute myocardial infarction and stroke in electronic medical records: a primary care cross-sectional study in Madrid, Spain (the e-MADVEVA Study)

ObjectivesTo validate the diagnoses of acute myocardial infarction (AMI) and stroke recorded in electronic medical records (EMR) and to estimate the population prevalence of both diseases in people aged ≥18...

Post-intensive care syndrome in primary care: The development of new diseases and primary care services utilisation – a prospective cohort study

BackgroundPatients experience long-lasting health problems defined as post-intensive care syndrome (PICS) after Intensive Care Unit (ICU) admission. Little is known about PICS in primary care.ObjectivesTo investigate whether ICU survivors encounter more new International Classification of Primary Care-2 (ICPC-2) diagnoses and general practitioner (GP) contact compared to patients with similar comorbidity without ICU admission.MethodsProspective multicentre cohort study in three Dutch general practices. Numbers of disease-episodes and GP contacts of ICU survivors ≥ 16 years admitted between 2008 and 2017 were extracted from GPs’ information systems. A non-ICU reference cohort was matched 1:1 for age, sex, follow-up period and comorbidity groups from patients’ medical history. Negative binominal regression analysis was used to compare both cohorts 0–3, 3–6, 6–12 months, 1–2 and 2–5 years after ICU admission and 1 year prior to admission.ResultsICU survivors (n = 199) encountered more new disease-episodes 1 year before (mean 3.97 (95% confidence interval [CI] 3.50–4.52]]; reference 2.36 [1.28–3.17]) to 2–5 years after ICU admission (3.65 [3.15–4.26]; reference 2.86 [2.52–3.22]). ICU survivors also had more GP contacts 1 year before (mean 19.61 [17.31–22.17]; reference 10.02 [7.81–12.38]) to 2–5 years after ICU admission (18.53 [15.58–21.85]; reference 12.03 [10.33–13.91]). Patients with prior ICU admission did not encounter patterns in specific ICPC-2 chapters compared to non-ICU patients.ConclusionPatients admitted to the ICU encounter more new primary care disease-episodes and GP contacts. As patients present their symptoms to their GP first, it is therefore up to the GP to recognise these critical illness-related symptoms.

Ethnopharmacological survey of endemic plants used in ethnomedicinal knowledge of Soqotra Island

Ethnopharmacological relevanceDue to the long biogeographical isolation since ancient times, Soqotra Island (southern Yemen) is rich in medicinal endemic plants. However, information on their traditional therapeutic knowledge is scarce in scientific literature and still not completely documented. Aim of the study(1) Documentation and search the native traditional therapeutic knowledge focusing on the medicinal plants which are endemic to Soqotra (2) Identification of the important endemic plants treating diseases by quantitative analysis of the collected data. Materials and methodsEthnobotanical data were collected from 105 local informants through open interviews, semi-structured questionnaires and field survey in February 1990 to document the traditional medicinal plants in Soqotra Island. Of them we reported in this study the data of the endemic species, due to their wide biodiversity in the island. The quantitative data were analyzed for use reports (URs) and the informant consensus factor (ICF). The reported diseases were classified according to the International Classification of Primary Care-2 (ICPC-2). New reported medicinal plants in this study were identified compared to literature review. The level of traditional Soqotri knowledge among Islanders was observed during 1990–2003. ResultsIn the study, 86 medicinal endemic plants with 7654 therapeutic URs were explored for 69 ailments types belongs to 11 (ICPC-2) groups. The highest ICF value (0.99) were calculated for both eye and ear diseases categories, followed by general and unspecified ailments (0.98), digestive and skin (0.97 for each), and musculoskeletal ailments (0.96) among all diseases categories. While the highest URs (2276) were identified for skin diseases, followed by digestive diseases (URs = 2146). All the 86 recorded medicinal plant species were endemic to Soqotra, belonging to 57 genera and 29 families. Euphorbiaceae and Burseraceae were the dominant families, followed by Apocynaceae, Fabaceae and Asteraceae. Shrubs were the dominant growth form (41 species, 47.67%), followed by herbs (27; 31.4%), and trees (14; 16.28%). Leaves (45 species; 31.25%) were the most frequently used parts, followed by stems (34 species; 23.61%) and barks (species 23; 15.97%). The most cited preparation method was paste for 51 species followed by liquid exudates (48 species) and powder (26 species). Based on the comparative literature review, we recorded 36 new endemic medicinal plants and reported new traditional therapeutic uses for the remaining 50 endemic plants for the first time. On the other hand, all the reported endemic medicinal plants have been enlisted in the IUCN Red List of Threatened Species, of them 21 endemic species enlisted as highest threatened species. ConclusionAccording to the quantitative data analyzed, Soqotra Island has a valuable traditional knowledge in several medicinal endemic plants that used by local people in the primary health care until the study time at 1990. This study emphasizes the importance of early time in documenting traditional indigenous knowledge before losing and to protect and conserve the endemic plants against highly endangered. Consequently, these ethnomedicinal data could be used in the future as guide for pharmacological and phytochemical studies to discover new therapeutic drugs.

Diversity of medicinal plants and their therapeutic usages of Kachin people (Jinghpaw) in the central part of Kachin State, Myanmar

Ethnopharmacological relevanceThe traditional medical system plays a major role in healthcare in Kachin State, Myanmar, where long-term political instability persists and conventional healthcare facilities are inadequate. A knowledge of the traditional medicinal plants therefore benefits the Kachin people, yet documentation and records of the uses of these plants are rare. In this study, we attempt to answer the questions on what medicinal plants and how they are used by the Kachin people. Aim of the studyWe aimed to document knowledge of the traditional medicinal plants and to identify those most frequently used by the Kachin people. Materials and methodsEighty-two informants from eight villages in three townships were interviewed, and their knowledge of medicinal plants was recorded. The reported ailments were classified to the standard categories of the International Classification of Primary Care-2 (ICPC-2) system. Use reports (UR) were employed to evaluate the knowledge consensus of the informants. ResultsWe recorded a total of 117 species used as medicinal plants, of which 22 are newly recorded medicinal plant species for Myanmar. The plants belonged to 103 genera in 52 families, and were used to treat a total of 72 ailments from 17 ICPC-2 disease categories. Fabaceae and Lamiaceae were the most highly represented families of medicinal plants, with eleven and eight species used, respectively. The most cited species based on URs were Tinospora cordifolia (Willd.) Hook.f. & Thomson (URs = 39), Oroxylum indicum (L.) Kurz (URs = 28), Aquilaria malaccensis Lam. (URs = 26), Chromolaena odorata (L.) R.M.King & H.Rob. (URs = 24), and Chloranthus elatior Link. (URs = 22). Digestive system disorder was the most prevalent disease category, and was treated with 47 different medicinal plants (URs = 142). Leaves were the most commonly used plant part; decoction was the dominant method of preparation; and oral consumption was the most frequent method of administration. ConclusionOur study documented a list of 117 medicinal plants and their uses in traditional medicine based on the local knowledge of the Kachin people. The study also identified the five most frequently cited species and found that the plants investigated are used to treat a total of 72 diseases. The 642 therapeutic reports we collected showcase a rich and diverse living knowledge of medicinal plant use by the Kachin people. Moreover, we present 22 new medicinal records, enriching the list of known medicinal plants in Myanmar. This exploratory study has enabled us to assemble the local knowledge of the Kachin people into solid dataset that will allow further scientific validation and will potentially contribute to better integration of medicinal plants into the healthcare provision for Kachin people in Myanmar.

Ethnobotanical study of traditionally used plants in the municipality of Zavidovići, BiH

Ethnopharmacological relevanceBosnia and Herzegovina (BiH) is a country with a highly diverse ecosystem, containing over 5000 confirmed taxa of vascular plants. The traditional medicinal use of plants has always played a crucial role and gained in importance in the time of war in the 1990s due to a lack of medical facilities. Still nowadays, the health care system is poorly developed, which altogether makes the region interesting for ethnopharmacological researches. Aim of the studyFocusing on the area of Zavidovići Municipality in the central part of the country, we aimed to document the diversity of the used medicinal plants and the knowledge of their therapeutic usages. Material and methodsData was collected in individual open and semi-structured interviews. Therapeutic uses were classified into 14 disease categories following the International Classification of Primary Care-2 (ICPC-2), a classification system recognized by the World Health Organization's Family of International Classifications (WHO-FIC). Use reports have been used to evaluate the acquired knowledge. ResultsThe findings revealed a total of 113 species belonging to 46 families. 14 informants well respected for their knowledge in the area listed 77 therapeutic uses for the indicated plants. Based on a comparison with other ethnobotanical surveys of BiH and to other important relating literature, three taxa have not been previously reported in BiH and for 19 species, new medicinal uses were stated. Based on use reports, oral application of remedies is far more common (76,7%) than external application (23,3%), the dominant mode of preparation thereby is an infusion. Usages of most concern were digestive, urological and respiratory diseases, their consensus factor ranging between 0,63 and 0,71. ConclusionThese results summarize the usage of traditional plants among people who are highly valued in their community of Zavidovići Municipality for their knowledge and thereby aim to preserve the indigenous knowledge associated with the medicinal plants of the area.

Comparison between the International Classification of Primary Care and the International Classification of Diseases Classifications in Primary Care in Korea.

BackgroundThe International Classification of Primary Care-2 (ICPC-2) is a classification method designed for primary care. Although previous studies have found that ICPC-2 is a useful tool for demonstrating the relationship between patients’ expectations and health providers’ diagnoses, its utility of ICPC-2 has yet to be fully studied in Korea. This study aimed to evaluate the practicality of ICPC-2 in Korean primary care.MethodsThe study was conducted at primary care clinics in Seoul and Gyeonggi areas from October to November 2015. Third-year family medicine residents examined and analyzed the medical records of patients who visited primary care physicians using ICPC-2, and the results were compared with those obtained using the International Classification of Diseases-10 (ICD-10) (Korean version: Korean Standard Classification of Diseases-7).ResultsA total of 26 primary care physicians from 23 primary care clinics participated in the study. Furthermore, 2,458 ICD-10 codes and 6,091 ICPC-2 codes were recorded from the data of 1,099 patients. The common disease codes were vasomotor and allergic rhinitis (J30), according to ICD-10, and acute upper respiratory infection (R74) in ICPC-2. Comparing disease status by body systems, the proportion of gastrointestinal disease with ICD-10 codes was significantly higher than that with ICPC-2 codes (P<0.001). Furthermore, patients with >4 diagnoses accounted for 36% of the ICD-10 classifications, whereas those with >4 diagnoses accounted for 4% of the ICPC-2 classifications.ConclusionIntroducing ICPC as a complementary means for diagnosing common diseases could be a practical approach in Korean primary care.

Distribution of health problems at the general outpatients' clinic of the University of Hong Kong-Shenzhen Hospital: A cross-sectional study.

ObjectiveThe study aimed to understand the distribution of health problems of a general practice clinic to provide guidance on how to develop primary care in Shenzhen, China.Study designThis is a cross-sectional study.MethodsPatients' sociodemographic data and diagnoses were recorded from the electronic medical record system of the University of Hong Kong-Shenzhen Hospital from Jan 2014 to Dec 2020 and coded using the International Classification of Primary Care-2. Descriptive statistics were used to describe the distribution of health problems.ResultsA total of 368,167 health problems were recorded. Respiratory, digestive, musculoskeletal, general, and cardiovascular were the top five categories, which accounted for 67.71% of the total in this study. Acute upper respiratory tract infection (AURTI) was the most common health problem (6.67%). Chronic diseases, including hypertension and diabetes mellitus, accounted for about 7% of all health problems. The proportion of cardiovascular problems increased significantly with age (r = 0.96, P < 0.05). The proportion of consultations for mental health problems was low in all age groups.ConclusionsThe results represent an understanding of the common health problems of patients in Shenzhen city, which can provide a reference for preventing diseases and developing primary care.

The impact of an intensive care unit admission on the health status of relatives of intensive care survivors: A prospective cohort study in primary care

Background Relatives of intensive care unit (ICU) survivors may suffer from various symptoms after ICU admittance of their relative, known as post-intensive care syndrome-family (PICS-F). Studies regarding PICS-F have been performed but its impact in primary care is unknown. Objectives To explore health problems of relatives of ICU survivors in primary care. Methods This is an exploratory prospective cohort study in which we combined data from two hospitals and a primary care research network in the Netherlands. ICU survivors who had been admitted between January 2005 and July 2017 were identified and matched by sex and age with up to four chronically ill (e.g. COPD, cardiovascular disease) patients. In both groups, relatives living in the same household were identified and included in this study. Primary outcome was the number of new episodes of care (International Classification of Primary Care-2) for up to five years. Hazard ratios (HRs) for the total number of new episodes were calculated. Results Relatives of ICU survivors (n = 267, mean age 38.1 years, 41.0% male) had significantly more new care episodes compared to the reference group (n = 705, mean age 36.3 years, 41.1% male) 1–2 years (median 0.11 vs. 0.08, HR 1.26; 95% confidence interval (CI) 1.03–1.54) and 2–5 years (median 0.18 vs. 0.13, HR 1.28; 95%CI 1.06–1.56) after ICU discharge. No differences were found in the period before ICU admission. Conclusion Relatives of ICU survivors present more morbidity in primary care than relatives of chronically ill patients up to five years after ICU discharge.

Ethnobotanical study of plants used by the Munda ethnic group living around the Sundarbans, the world's largest mangrove forest in southwestern Bangladesh

Ethnopharmacological relevanceIndigenous knowledge of medicinal plants is an integral part of the primary health care (PHC) system in almost every society. For more than two centuries, Munda, a small ethnic group in Bangladesh, has lived around the Sundarbans, the world's largest mangrove forest. This mangrove is rich in biodiversity but is threatened by global climate change. Information on the therapeutic use of plants by Munda ethnic minorities remains completely unknown. Therefore, it needs urgent documentation. Aim of the studyThe purpose of the study is (1) to search and compile data on the diversity of medicinal plants used by the Munda people for PHC needs, and (2) Quantitative analysis of these data to identify important medicinal plants and diseases related to treatment by this species. Material and methodsWe conducted repeated field surveys and interviews among 79 Munda informants to collect ethnobotanical data. Informants were selected through random sampling techniques and interviewed using an open and semi-structured questionnaire. We reported the primary (absolute) data as use reports (URs) with frequency citation (FC). The International Classification of Primary Care-2 (ICPC-2) was followed to categorize the therapeutic use of medicinal plants, and quantitative analysis was performed using the FC and informant consensus factor (ICF). ResultsThe present study explored and compiled a total of 3199 medicinal URs for 98 medicinal plant species to treat 132 ailment conditions under sixteen (16) ICPC-2 pathological groups. The highest URs (948) were noted for the digestive (D) group treated by 69 plant species, where the highest ICF value was measured for the social problem (Z) disease category (ICF: 1.00). Of the recorded medicinal plants, 17 were identified as true Mangrove (MNG), 24 as Mangrove Associates (MNA), and 57 as Non-Mangrove (NMG) species. Fabaceae (13 species) represented the leading family, followed by Lamiaceae and Compositae (5 species). Herbs (43%) have shown dominant life forms, and the leaves (41%) were frequently used plant parts. The most commonly cited preparation method was juice (24%), and the prevalent mode of administration was oral (62%). Azadirachta indica A. Juss. was the most widely used therapeutic plant species based on FC (39) values. The comparative literature review study reveals that the practices of 15 plants and their ethnomedicinal use by the Munda people are still entirely unexplored and newly reported in Bangladesh. Additionally, therapeutic use of 2 species, Brownlowia tersa (L.) Kosterm., and Dalbergia candenatensis (Dennst.) Prain has not been previously reported worldwide. In addition, 51 plant species (52%) of the total plants studied enlisted on the IUCN Red List of Threatened Species. ConclusionTo our knowledge, this is the first ethnobotanical study on the Munda ethnic group in Bangladesh. This study indicates that Munda people still rely on medicinal plants for PHC and have a rich and varied traditional knowledge about the therapeutic use of plants. This study also warns of the high risk of the current availability status of plants in the study area. Therefore, this study calls for urgent steps to protect and conserve high-risk plants that can be done by taking both in-situ and ex-situ measures. In addition, further phytochemical and pharmacological investigations of the important medicinal plants cited in the study have been suggested.

Classificação Internacional de Atenção Primária: capturando e ordenando a informação clínica

The International Classification of Primary Care-2 (ICPC-2) is the result of forty years of continuous development. It originates in the second half of the twentieth century after the concern of general practitioners about the need to record and encode data specifically related to primary care, both in the reasons for encounter and procedures and conditions or diagnoses. The World Health Organization endorsed the classification, as did the developer committee after the Alma Ata meeting, since it also identified specific needs. Two forms of use are employed now in gathering information: by encounter or by an episode of care. The latter is more complex and controversial. Recently, an eleventh version of the International Classification of Diseases has been released, and the third edition of ICPC is being developed. One cannot predict how new technologies, classifications, and international organizations will interact. The role of front line health professionals and patients will define the course.

Family practitioners' top medical priorities when managing patients with multimorbidity: a cross-sectional study.

BackgroundManaging multiple chronic and acute conditions in patients with multimorbidity requires setting medical priorities. How family practitioners (FPs) rank medical priorities between highly, moderately, or rarely prevalent chronic conditions (CCs) has never been described. The authors hypothesised that there was no relationship between the prevalence of CCs and their medical priority ranking in individual patients with multimorbidity.AimTo describe FPs’ medical priority ranking of conditions relative to their prevalence in patients with multimorbidity.Design & settingThis cross-sectional study of 100 FPs in Switzerland included patients with ≥3 CCs on a predefined list of 75 items from the International Classification of Primary Care 2 (ICPC-2); other conditions could be added. FPs ranked all conditions by their medical priority.MethodPriority ranking and distribution were calculated for each condition separately and for the top three priorities together.ResultsThe sample contained 888 patients aged 28–98 years (mean 73), of which 48.2% were male. Included patients had 3–19 conditions (median 7; interquantile range [IQR] 6–9). FPs used 74/75 CCs from the predefined list, of which 27 were highly prevalent (>5%). In total, 336 different conditions were recorded. Highly prevalent CCs were only the top medical priority in 66%, and the first three priorities in 33%, of cases. No correlation was found between prevalence and the ranking of medical priorities.ConclusionFPs faced a great diversity of different conditions in their patients with multimorbidity, with nearly every condition being found at nearly every rank of medical priority, depending on the patient. Medical priority ranking was independent of the prevalence of CCs.

Design of a study evaluating the effects, health economics, and stakeholder perspectives of a multi-component occupational rehabilitation program with an added workplace intervention - a\xa0 study protocol

BackgroundRecent research has suggested that interventions at the workplace might be the most potent ingredient in return to work interventions, but few studies have investigated the different effects of workplace interventions as part of occupational rehabilitation programs. The comprehensive design described in this article includes effect (on return to work and health outcomes), and health economic evaluations of a workplace intervention added to a multicomponent rehabilitation program. Qualitative and mixed method studies will investigate sick-listed persons’, rehabilitation therapists’ and employers’ perspectives on the usability and outcomes of the rehabilitation program and the workplace intervention. The program and intervention are provided to patients with musculoskeletal, psychological or general and unspecified diagnoses. The program is multi-component and includes Acceptance and Commitment Therapy, physical exercise, patient education and creating a plan for increased work participation.MethodsPersons who are employed, aged from 18 to 60 years, with a current sick leave status of 50% or more and a diagnosis within the musculoskeletal, psychological or general and unspecified chapters of International Classification of Primary Care-2 (ICPC-2) will be recruited to a researcher-blinded parallel-group randomized controlled trial. All participants take part in an in-patient occupational rehabilitation program, while the intervention group also takes part in an intervention at the workplace. The effect and economic evaluation will investigate the effect of the added workplace intervention. The primary outcome measures will be time until full sustainable return to work and total number of sickness absence days in the 12 months after inclusion. Health economic evaluations will investigate the cost-effectiveness and cost-utility. Qualitative studies will investigate rehabilitation therapists’ experiences with working towards return to work within an ACT-approach and stakeholders’ experiences with the workplace intervention. A mixed methods study will combine quantitative and qualitative findings on the participants’ expectations and motivation for return to work.DiscussionThe outline of this comprehensive study could represent an important addition to the standard designs of return to work evaluation. The mixed methods design, with qualitative approaches as well as a rigorous randomized controlled trial, might prove useful to shed light on contextual factors.Trial registrationClinicalTrials.gov: NCT02541890. September 4, 2015.

Reasons for encounters and psychiatric comorbidity in an urban Bavarian primary care out-of-hour service - results of a cross sectional study

BackgroundInternational studies have shown a contribution of psychiatric comorbidity to high utilization rates in out-of-hour primary care (OOHC). Up to now, the impact of psychiatric comorbidity in German OOHC remains unclear. Therefore, we aimed to investigate reasons for encounter (RFE), possible psychiatric comorbidity, utilization rates, and a possible association between utilization rate and psychiatric comorbidity among patients of an urban OOHC unit.MethodsIn a cross-sectional, prospective, naturalistic study five hundred self-referred patients completed a self-designed questionnaire addressing RFE, past office visits and personal information. Additionally, we employed three validated questionnaires (PHQ-9, PHQ-15 and GAD-7) to screen for mental disorders. We collected information about past visits through computerized patients’ charts. Diagnoses were classified according to the International Classification of Primary Care-2.ResultsThe most frequent RFE were musculoskeletal complaints (36%), followed by respiratory diseases (13%), gastrointestinal problems (10%), skin conditions (8%) and urologic ailments (6%). Of the included patients 58% were working fulltime and 61% had greater than or equal to 10 years of education. The mean age was 37.3 in females and 40.5 years in males. Prevalence of psychiatric comorbidity was 27%. Only 3% visited the office more than twice over a 12 months period. We could not find an association between high utilization and psychiatric comorbidity.ConclusionIn this study, musculoskeletal complaints were the most frequent RFE. Patients were predominantly young, employed and educated. The prevalence of psychiatric comorbidity was similar to the prevalence in common general practitioner offices and showed no significant relation to frequent attendance. This information might help to prepare physicians better for patient care in OOHC.

Morbidity pattern of traditional Chinese medicine primary care in the Hong Kong population

Primary care manages >90% of illnesses requiring medical services in Hong Kong, in which 9,513 registered Chinese medicine practitioners (CMPs) provide 8.2% of the consultations. This is the first study aimed to determine the morbidity pattern in different Traditional Chinese Medicine (TCM) primary care settings in Chinese population. 55,312 patients’ encounters were classified by the International Classification of Primary Care-2 (ICPC-2) from 260 of CMPs. Mean patient age was 50.5 years, with more females than males (67.0% vs 33.0%). Most patients consulted CMPs for chronic (64% vs 33.7%) rather than acute conditions. Among the 30% of patients, hypertension (49.5%) or diabetes (18.5%) were the most common co-morbidity. The most common problems presenting to CMP were respiratory (24.9%), musculoskeletal complaints (22.7%), cough (11.7%), and lower back pain (6.6%). To our knowledge, this was the first study permitting direct comparison with that presenting to Western medicine (WM) primary care by ICPC-2 systems. The results confirmed the role of CMP in primary care for musculoskeletal or chronic illnesses that they may have also received conventional WM treatment. We recommend greater effort and more resources should be invested to promote interdisciplinary communication to ensure safety and synergy of TCM and WM in primary care.

Multimorbidity and patterns of chronic conditions in a primary care population in Switzerland: a cross-sectional study

ObjectiveTo characterise in details a random sample of multimorbid patients in Switzerland and to evaluate the clustering of chronic conditions in that sample.Methods100 general practitioners (GPs) each enrolled 10 randomly...

A chart review of morbidity patterns among adult patients attending primary care setting in urban Odisha, India: An International Classification of Primary Care experience.

Introduction:Disease burden estimations based on sound epidemiological research provide the foundation for designing health services. Patients visiting a primary care often present with symptoms and signs. Understanding the burden is crucial for developing countries including India. The project aimed to record the reasons for encounter (RFE) at primary care settings for estimating the burden at the health-care facility.Methodology:This cross-sectional study was undertaken at four urban health dispensaries of Bhubaneswar, Odisha, with the aim to explore the prevailing patterns of diseases among patients attending these facilities. Data collection spanned from May to October 2012. At each center, patients' information on age, sex, religion, and presenting illness was extracted from the outpatient records over these time period. Data were entered and analyzed in SPSS version 20, and the International Classification of Primary Care-2 was used for coding the illnesses.Results:In total, 2249 patient's records were extracted over 12 weeks. Out of them, 1241 (55.2%) were male with mean age of 41.8 (±15.8) years vis-à -vis 38.2 (±14.1) years for females. Around 151 (6.7%) had 2 or more symptoms or conditions. Overall, the most common categories were general and unspecified followed by digestive-related symptoms in both sexes. The most common symptoms among males were fever (11.4%), heart burn (8.1%), and vertigo or dizziness (3.6%). Similar pattern was seen among females. Respiratory (17.0%) and cardiovascular (10.2%) problems were the most common RFEs among males and females. The most common RFEs for acute care among males and females were fever, allergic rhinitis, upper respiratory tract infection, and acute bronchitis. Leading RFEs for chronic care among males were hypertension uncomplicated, heart burn, low back pain, whereas among females, hypertension and heartburn were mostly seen.Conclusion:Primary care settings are experiencing both communicable and non-communicable diseases along with injuries. Understanding the distribution of the diseases are essential to design appropriate service package at primary care.

The acute sick and injured patients

There is a lack of knowledge of the emergency department (ED) population in Norway; hence, the aim of this study was to describe the ED patient population at a Norwegian University Hospital. Prospective data of all ED patients admitted to the main ED over a period of 2 months were collected. The patients' presenting complaint was registered using the International Classification of Primary Care-2 (ICPC-2). A total of 3163 patients arrived in the ED during the study period. The majority (71%) of patients presented with a complaint that was defined as a symptom in ICPC-2. The most common symptoms were abdominal pain (13%), chest pain (13%), and dyspnea (9%). The complaints of the remaining patients (29%) were primarily traumas, infections, and other diagnoses. ED patients have a diverse spectrum of presenting complaints and the majority of patients present with symptoms rather than a defined medical diagnosis.

Primary care morbidity in Eastern Cape Province

Primary health care in rural South Africa is predominantly provided by remote clinics and health centres. In 1994, health centres were upgraded and new health centres developed to serve as a health care filter between community clinics and district hospitals. To describe the spectrum of clinical problems encountered at a new health centre in an area of high economic deprivation and compare this with an adjacent community clinic and district hospital. Cross-sectional survey. A rural clinic, health centre and district hospital in Eastern Cape Province, South Africa. The International Classification of Primary Care-2 (ICPC-2) was used to code data collected over a 13-week period from patients presenting at a community clinic, health centre and district hospital. Altogether, 4 383 patient encounters were recorded across all three sites in 2001. Most contacts at the clinic (97%) and the health centre (80%) were with a nurse. Females over 15 years of age comprised over half of all contacts at health facilities (53%). The most common diagnosis category was respiratory (23%). Cough was the most common symptom. Thirty per cent of children up to 5 years of age were seen for immunisations. Most childhood immunisations (79%) were carried out at the health centre. Of all the health care facilities surveyed, the health centre had the highest throughput of patients, indicating that the health centre is an efficient filter between the community and hospital. The ICPC-2 can be successfully used to monitor encounters at similar African health care facilities.