International Classification Of Primary Care Research Articles

Sex Differences in the Primary Prevention of Cardiovascular Diseases in a Dutch Primary Care Setting.

Sex differences in the primary prevention of cardiovascular diseases (CVD) have been shown, but the evidence is mixed and fragmented. In this study, we assessed sex differences in cardiovascular risk factors assessment, risk factor levels, treatment, and meeting of treatment targets, within a Dutch primary care setting. Data were obtained from individuals aged 40 to 70 years old, without prior CVD, registered during the entire year in 2018 at one of the 51 general practices participating in the Julius General Practitioner's Network (JGPN). History of CVD was defined based on the International Classification of Primary Care (ICPC). Linear and Poisson regressions were used to investigate sex differences in risk factor assessment, risk factor levels, treatment, and meeting of treatment targets. We included 83,903 individuals (50% women). With the exception of glycated hemoglobin (HbA1c), all risk factors for CVD were more often measured in women than in men. Lipid measurements and body mass index values were higher in women, while blood pressure (BP) and HbA1c levels were higher in men, along with estimated glomerular filtration rate (eGFR) levels. Among individuals with elevated BP or cholesterol levels, no sex difference was observed in the prescription of antihypertensive medications (RR 1.00, 95% CI: 0.94-1.06) but women were less likely than men to receive lipid-lowering medications (RR 0.87, 95% CI: 0.79-0.95). Among treated individuals, women were more likely than men to meet adequate levels of blood pressure (RR 1.17, 95% CI: 1.09-1.25) and less likely to meet target levels of cholesterol (RR 0.90, 95% CI: 0.83-0.98). While women were more likely to have their CVD risk factors measured, they were less likely to be prescribed lipid-lowering medications and to meet target levels. When treated, men were less likely to achieve adequate blood pressure control.

The fractured lens: a controversial revision of the International Classification of Primary Care.

The International Classification of Primary Care (ICPC) has represented the international standard reduction for measuring the content of primary care for over 30 years. In the process of its third revision, its authors, the Wonca International Classification Committee (WICC), delegated a major part of the technical work to a purposely formed Consortium. However, in the process of such revision, standard classification principles and rules have been inconsistently applied with the result that ICPC-3 has been published with major errors and an inconsistent structure. To formally describe and critically appraise the revision process of ICPC-3. The formal review of ICPC-3 performed by an expert group within WICC and commissioned by the Executive Council of Wonca Europe is presented in abridged form. ICPC-3 as currently presented introduces major departures from formal classification principles and rules, besides other major errors and inconsistencies, all of which are listed and described. Major changes in ICPC-3 defy categorisation and conceptualisation standards. ICPC-3 now represents an untested departure from international standard presentations, without a formal academic base. The direct inclusion of measures of functioning in a classification of reasons for encounter and health problems fails to address the dichotomy of these domains, the boundaries of and relationships between which are not satisfactorily resolved by the system. Analysis of ICPC-3 data will require the development and implementation of alternative, as yet undefined, models of the relationships between disease and health. By including different domains without resolving ambiguity, and by splitting function from other body systems, ICPC-3 becomes an internally fractured instrument.

Ethnobotanical study on medicinal plants used by the Yi people in Xiaoliangshan, Yunnan Province, SW China

Ethnopharmacological relevanceThe Yi people in the Xiaoliangshan region in southwest China have a unique practice of combining ritual treatment and traditional medicine to care for patients. Despite increasing urbanization in the area, they have managed to preserve their distinctive lifestyle and extensive knowledge of traditional medicinal plants, setting them apart from other regions. However, there is a lack of systematic documentation on the knowledge of traditional medicinal plants used by the Yi people in Xiaoliangshan. Aim of the studyThis research aims to achieve the following objectives: 1. Document the diversity of medicinal plants used by the Yi people and explore their therapeutic usages. 2. Evaluate and analyze the main types of diseases with a high incidence in the local area and identify the types of medicinal plants used to treat these diseases. 3. Explore the underlying geographical and human factors influencing both disease prevalence and medicinal plant usage. MethodsEthnobotanical research methods were used to record and analyze the medicinal plants used by the Yi in Xiaoliangshan. Experts identified all plant specimens collected during ethnobotanical field surveys. The types of diseases treated by medicinal plants were classified according to the International Classification of Primary Care -2nd. ResultsA total of 125 medicinal plants were recorded after interviewing 193 participants. Of the medicinal plants identified, those with over 100 use reports were Paris polyphylla (202 use reports), Taxillus sutchuenensis (183), Artemisia indica (149), and Papaver somniferum (113). A total of 14 disease categories were recorded, with those related to the following categories having higher Informant Consensus factor values (ICF ≥0.85): Pregnancy, Childbearing, Family Planning, General and Unspecified, Urological, Respiratory, Musculoskeletal, and Skin. The highest quantity of medicinal plants is utilized to improve specific diseases and health problems, namely those related to Digestion, Skin, and Musculoskeletal. Fewer plant species were utilized for diseases or health issues associated with Eyes, Psychological, or Pregnancy, Childbearing, and Family Planning. The use reports from the informants also revealed how some medicinal plants are used to treat a variety of diseases or health issues. For instance, Malva pusilla is used for inducing abortion, treating postpartum hemorrhage, and joint sprains; Artemisia indica is used for treating malaria; Argentina lineata is used to remedy tuberculosis and malaria. Taxillus sutchuenensis is used for dealing with cold, pneumonia, and other ailments. ConclusionsThe Yi people in Xiaoliangshan have a rich knowledge of traditional medicinal plants. Decoction and wine brewing are the most common processing methods used for these plants, which are utilized to treat a wide range of diseases. The characteristics of the medicinal use of the Yi people reflects the alpine mountainous environment in which they live, and their medical practices are closely related to traditional healing culture. This study enhances our understanding of the Yi traditional medicine via documentation and offers a valuable reference for future research and the development of new drugs.

Validating and Improving Adjusted Clinical Group's Future Hospitalization and High-Cost Prediction Models for Dutch Primary Care.

The rise in health care costs, caused by older and more complex patient populations, requires Population Health Management approaches including risk stratification. With risk stratification, patients are assigned individual risk scores based on medical records. These patient stratifications focus on future high costs and expensive care utilization such as hospitalization, for which different models exist. With this study, the research team validated the accuracy of risk prediction scores for future hospitalization and high health care costs, calculated by the Adjusted Clinical Group (ACG)'s risk stratification models, using Dutch primary health care data registries. In addition, they aimed to adjust the US-based predictive models for Dutch primary care. The statistical validity of the existing models was assessed. In addition, the underlying prediction models were trained on 95,262 patients' data from de Zoetermeer region and externally validated on data of 48,780 patients from Zeist, Nijkerk, and Urk. Information on age, sex, number of general practitioner visits, International Classification of Primary Care coded information on the diagnosis and Anatomical Therapeutic Chemical Classification coded information on the prescribed medications, were incorporated in the model. C-statistics were used to validate the discriminatory ability of the models. Calibrating ability was assessed by visual inspection of calibration plots. Adjustment of the hospitalization model based on Dutch data improved C-statistics from 0.69 to 0.75, whereas adjustment of the high-cost model improved C-statistics from 0.78 to 0.85, indicating good discrimination of the models. The models also showed good calibration. In conclusion, the local adjustments of the ACG prediction models show great potential for use in Dutch primary care.

Male Urethritis in Primary Care: Real-World Evidence From a Portuguese Center.

Introduction Early diagnosis and treatment of male urethritis are fundamental for preventing complications and further transmission. Primary healthcare services are the first point of contact for patients. This study aimed to assess the practice and compliance of Unidade Saúde Familiar Conde Lousã (USF CL) with best clinical practices. Materials and Methods A retrospective study was undertaken on male urethritis cases at USF CL from January 2018 to March 22, 2021, identified using the International Classification of Primary Care (ICPC) coding system. We established quality criteria encompassing treatment, diagnostics, and reporting. A "sufficiency index" was introduced as a performance metric, which was designed to offer a multiparametric assessment of adherence to these criteria. Results Of 77 cases, 60 were included, averaging 27 years of age. In all, 40.7% showed treatment adequacy, with a sufficiency index of 0.28 for epidemiological characterization and 0.52 for co-infection screening. Prevention measures indexed at 0.28, with 27.1% diagnostic notifications. Conclusion The study reveals gaps in managing male urethritis at USF CL, underscoring the need for standardized guidelines and better diagnostic tools in primary care. Based on these results, a new multicentric specialized sexually transmitted infections clinic was created within our unit in collaboration with a tertiary hospital [Centro Hospitalar Universitário Lisboa Central (CHULC), Lisbon, Portugal] and the national laboratory center [Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), Lisbon, Portugal].

Reasons for Encounter in Outpatient Clinic of a Tertiary Hospital in South Eastern Nigeria

Background: Reasons for Encounter (RFEs) are the main aim of a clinic visit that often goes unexplored by health practitioners especially when fixated on making a clinical diagnosis. Most patients present with one or more RFEs at the clinic visit. The traditional medical model unduly emphasizes the need for a biomedical diagnosis, hence the routine use of the traditional International Classification of Diseases (ICD-10), but with the recent introduction and adoption of International Classification of Primary Care (ICPC) by the World Health Organization, there is need for a paradigm shift by primary care physicians to embrace the use of ICPC. Considering the immense benefits and practicability of ICPC, we undertook this study to get a bird’s eye view of our patients RFEs to create the necessary awareness about the use of ICPC and also to use the result in making necessary health policy recommendation and training of resident doctors in our hospital.
 Objective: The aim of this study is to identify the reason for outpatient encounter in Federal University Teaching Hospital in Southern East Nigeria.
 Methods: A cross-section of patients aged 16 years and above presenting at our outpatient clinic was recruited consecutively until a sample size of 325 patients was attained. There was 100% response rate among the respondents. The reasons for encounter were assessed using an interviewer administered questionnaire where they were requested to “say” in their own words their reasons for coming to see the doctor.
 Results: The five commonest reason for encounter was A: general/unspecific(43.4%),  X:femalegenitalia(14.2%), M: musculoskeletal(8.5%), D: digestive(6.5%) and R: respiratory(6.5%); while the least are U:urogenital(0.9%) and Y:male genital(0.9%). Incidentally none of the patients presented with substance abuse or social problems. The geriatric age group accounted for less than 20% of the total number of patients seen within the period.
 Conclusion: This study identified the common reasons for encounter amongst our patients at the general outpatient. This will assist in the training of our medical students and resident doctors and effective planning of the general outpatient.
 Recommendation: This study also brings to the fore the need to look into the challenges of the elderly to improve their health seeking behavior.

Transport Rates and Prehospital Intervals for an EMS Telemedicine Intervention

Introduction Emergency medical services (EMS) facilitated telemedicine encounters have been proposed as a strategy to reduce transports to hospitals for patients who access the 9-1-1 system. It is unclear which patient impressions are most likely able to be treated in place. It is also unknown if the increased time spent facilitating the telemedicine encounter is offset by the time saved from reducing the need for transport. The objective of this study was to determine the association between the impressions of EMS clinicians of the patients’ primary problems and transport avoidance, and to describe the effects of telemedicine encounters on prehospital intervals. Methods This was a retrospective review of EMS records from two commercial EMS agencies in New York and Tennessee. For each EMS call where a telemedicine encounter occurred, a matched pair was identified. Clinicians’ impressions were mapped to the corresponding category in the International Classification of Primary Care, 2nd edition (ICPC-2). Incidence and rates of transport avoidance for each category were determined. Prehospital interval was calculated as the difference between the time of ambulance dispatch and back-in-service time. Results Of the 463 prehospital telemedicine evaluations performed from March 2021 to April 2022, 312 (67%) avoided transports to the hospital. Respiratory calls were most likely to result in transport avoidance (p = 0.018); no other categories had statistically significant transport rates. Four hundred sixty-one (99.6%) had matched pairs identified and were included in the analysis. When compared to the matched pair, telemedicine without transport was associated with a prehospital interval reduction in 68% of the cases with a median reduction of 16 min; this is significantly higher than telemedicine with transport when compared to the matched pair with a median interval increase in 27 min. Regardless of transport status, the prehospital interval was a median of 4 min shorter for telemedicine encounters than non-telemedicine encounters (p = 0.08). Conclusion In this study, most telemedicine evaluations resulted in ED transport avoidance, particularly for respiratory issues. Telemedicine interventions were associated with a median four-minute decrease in prehospital interval per call. Future research should investigate the long-term effects of telemedicine on patient outcomes.

What is integrative medicine? Establishing the decision criteria for an operational definition of integrative medicine for general practice health services research in Australia

BackgroundOperational definitions outline how a conceptual definition will be measured for consistent, reproducible data collection and analysis. This article reports the decision criteria that will be used for an operational definition of integrative medicine (IM) in a secondary analysis of an Australian national survey of general practitioner activity. MethodsA multidisciplinary team applied an iterative approach, informed by expert knowledge and literature reviews to establish decision criteria for categorizing the terms in the Australian clinical interface terminology of the International Classification of Primary Care, second edition (ICPC-2 PLUS) and the Coding Atlas for Pharmaceutical Substances, according to whether they reflected IM, conventional/mainstream medicine (MM), or both IM and MM (IM/MM). ResultsThe final decision criteria categorized all terms for examinations, investigations, advice/counselling, and drugs with synthetic ingredients, and terms for referrals to secondary care services and healthcare practitioners that are not a traditional or complementary medicine practitioner as MM. Terms that could apply to both styles of clinical practice (e.g., preventive health, lifestyle medicine, psychosocial and some drugs with natural ingredients) were categorised as IM/MM. The remaining terms, that mostly reflected the World Health Organization's theoretical definitions of traditional and complementary medicine, were categorized as IM. ConclusionDifferentiating between integrative and conventional/mainstream medicine in general practice is context specific and not always possible. The category IM/MM proposes integrative medicine as an extension, rather than an alternative. The rationale for the integrative medicine operational definition has relevance for researchers and health services in Australia, and internationally.

Health Conditions in Older Adults Suspected of Being Maltreated: A 20-Year Real-World Study.

Older adult maltreatment (OAM) is a global problem that has attracted increasing attention due to the ageing population and its severe impact on victim health. Thus, this study aims to analyse the prevalence of certain health conditions in people ≥ 60 years old whom physicians from a local healthcare unit suspected to be victims of maltreatment. The specific objectives are to determine the prevalence rates of health-related risk factors, traumatic injuries and intoxications, mental disorders, and physical disorders. We conducted a real-world, retrospective, observational, and cross-sectional study based on secondary data analyses of electronic health records and healthcare registers of patients at the Local Healthcare Unit of Matosinhos (2001-2021). Information was obtained based on codes from the International Classification of Diseases, codes from the International Classification of Primary Care, and clinical notes (according to previously defined keywords). We identified 3092 suspected victims of OAM, representing 4.5% of the total population analysed. This prevalence is lower than the known rates. We also found that some health risk factors, traumatic injuries and intoxications, mental health disorders, and physical disorders presented higher rates in the suspected victims than among the total population. In this age group, we cannot assume that these health problems are only related to a possible current victimisation process; they could also be associated with adverse childhood experiences or intimate partner violence, among other forms of violence, all of which can lead to cumulative effects on the victim's health. This evidence increases healthcare providers' responsibility in detecting and reporting all cases of suspected maltreatment.

Insomnia management in Dutch general practice: a routine care database study

Objective To explore insomnia management in general practice, with a focus on sleep medication prescription. Design Descriptive analysis of anonymized routine general practice care data extracted from electronic medical records (EMRs), including demographics, free text annotations from sleep consultations and sleep medication prescriptions covering one year before up to two years after the registration of the International Classification for Primary Care (ICPC) code P06 ‘Sleep disturbance’. Setting Twenty-one general practices in an urban area of the Netherlands. Patients Adults (18–85 year) with a first sleep consultation with their GP. Outcomes Documented non-pharmacological and sleep medication treatment. Results Of the 1,089 patients who consulted their general practitioner (GP) for sleep disturbance for the first time, about 50% had one more sleep consultation during the two years follow-up. Over two years including the first consultation, GPs documented a non-pharmacological intervention for 48.4% of the patients and prescribed sleep medication to 77.0%. 64.6% of the patients received a sleep medication prescription in the first consultation. Among patients receiving medication (N = 838); 59.6% received more than one prescription; 76.8% received one or more short-acting benzodiazepine receptor agonist (BZRA), 39.5% one or more unrecommended drugs and 14.7% >180 pills of BZRAs in two years. Conclusion Although the guidelines advocate non-pharmacological treatment and warn against unwarranted sleep medication, it is still very common in Dutch general practice to prescribe medication, even at the first sleep consultation. Prescriptions frequently include unrecommended and off-label drugs or repeated BZRA prescriptions.

Descriptive Study of Patients Treated in a Psychosomatic Internal Medicine Declared by Japanese Family Medicine Clinic.

Psychosomatic internal medicine (PSIM) assesses psychosocial factors and provides holistic consideration. In Japan, PSIM physicians seem to be recognized as providers of mental health services, but family medicine did not so. When family physicians confront with psychological problems, high dropout rate is reported so it is needed to reveal factors related to dropouts, The purpose of this study is to describe characteristics of patients, treatment dropouts and its related factors in PSIM practice by family physician. This cross-sectional study used data from the medical records of the Kitaibaraki Center of Family Medicine located in Kitaibaraki City, Ibaraki, Japan. The study included all new patients who made an appointment and visited the PSIM in this clinic from January 2020 to December 2022.Chief complaints and diagnoses were coded based on the International Classification of Primary Care, version 2 (ICPC-2). In total, 377 new patients were included in this study. The mean age was 39.9 ± 20.2 years. We found that 69.2% of patients who visited the clinic had a psychological chief complaint and 84.1% of primary diagnoses consisted of a psychological problem. One hundred sixty-five patients (43.8%) were still receiving treatment 6 months after the initial visit. Of the patients who ended treatment within 6 months after the initial visit, 84 patients (39.2%) dropped out. In multivariate analysis, the dropouts were less likely to occur patients with primary diagnosis of psychological problem (odds ratio (OR): 0.35, 95% confidence interval (CI): 0.19 - 0.67). Patients who visited a PSIM wanted consultation about psychological problems. Patients with a diagnosis of a psychological problem at the initial visit were less likely to drop out.

Reasons for Provider-to-Provider Synchronous Teleconsultations Between Nurses in Primary Care: A Cross-Sectional Study of TelessaúdeRS-UFRGS Service.

Introduction: Nurses have proven to be fundamental for the expansion and consolidation of primary health care (PHC), as well as the development of digital health strategies. We explored the results of a synchronous telephone teleconsultations service between professionals for nurses in Brazil. Methods: This is a cross-sectional study. We retrieved data from teleconsultations registry. All teleconsultations answered by the team of nurses between September 2018 and July 2021 were analyzed regarding the reasons (according to International Classification of Primary Care, 2nd edition-ICPC-2) and decisions of the teleconsultation. Results: There were 9,273 phone teleconsultations registered in the period, requested by 3,125 nurses from all states throughout the country, of which 56.9% called once and 15.9% used the teleconsultations at least 4 times. We found 362 different reasons for solicitations, which were classified according to the ICPC-2 chapters. The most frequent codes were respiratory (25.9%), general and unspecified (21.2%), and skin (21.2%), which corresponded to 68% of the total sample. Most teleconsultations (66.9%) had as outcome the maintenance of the case at PHC. Conclusion: Teleconsultations are widely used and address a broad number of situations. This service may improve the quality of Brazilian PHC and promote the development of clinical reasoning and critical thinking by nurses.

Patient-centredness in primary care walk-in clinics for refugees in Hamburg

BackgroundThe huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg.MethodsVideotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients’ reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations.ResultsPatient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores.ConclusionsThe level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness.Practice implicationsWe recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages.

Impact of comorbidity on symptomatology in various types of environmental intolerance in a general Swedish and Finnish adult population

Comorbidity with various health conditions is common in environmental intolerances (EIs), which restricts understanding for what symptoms that are associated with the intolerance per se. The present objectives were to study (i) prevalence of a broad range of specific symptoms in chemical, building-related, electromagnetic field- (EMF) related, and sound EI, irrespective of comorbidity, (ii) prevalence of symptoms in body systems in exclusive EIs, and (iii) increased risk of symptoms in body systems in exclusive EIs that cannot be referred to functional somatic syndromes, inflammatory diseases or mental disorders. Cross-sectional data (n = 4941) were used from two combined population-based surveys, the Västerbotten (Sweden) and Österbotten (Finland) Environmental Health Studies. Categorization of EI cases and controls were based on self-reports. Symptoms were assessed with the Environmental Hypersensitivity Symptom Inventory, and these were converted to 27 symptoms of the International Classification of Primary Care, 2nd edition, in eight chapters of body systems. The results showed, with few exceptions, that all assessed specific symptoms were significantly more prevalent in all four EIs than in referents. Although a large overlap between EIs, characteristic body system symptoms were eye and respiratory symptoms in chemical and building-related intolerance, skin symptoms in EMF-related intolerance, and general and unspecified, digestive, eye, cardiovascular, neurological, and psychological symptoms in sound intolerance. After controlling for various comorbidities, all studied body system symptoms were positively associated with chemical intolerance, fewer with sound intolerance, only one with building-related intolerance, and none with EMF-related EI. In conclusion, a broad range of symptoms are reported in all four EIs implying common mechanisms, but symptoms of certain body systems are more likely to be reported in a certain EI that cannot be explained by comorbidity.

Morbidity Pattern Among Adult Patients at the National Health Insurance Scheme Clinic of a Tertiary Hospital, Southwest Nigeria.

For adequate planning of healthcare services, agood knowledge of the burden and pattern of morbidity and mortality in the community is a key requirement. This study aimed at describing the morbidity pattern among patients at a National Health Insurance Scheme (NHIS) clinic in Southwestern Nigeria. This was a cross-sectional study. Secondary data was extracted from case notes of 5,108 patients who visited the NHIS Clinic in a tertiary health facility in Southwestern Nigeria, from 2014 to 2018, using the International Classification of Primary Care (ICPC-2) to categorize the diseases. Data analysis was done using IBM SPSS Statistics for Windows, Version 25.0 (Released 2018; IBM Corp., Armonk, NY, USA). Females were 2,741 (53.7%), males were 2367 (46.3%), and the mean age was 36.7±9.5 years. General and unspecified diseases were the commonest presentations. Malaria (1,268; 45.5%) was the commonest disease among the patients. Sex and age were associated with disease distribution (p-value = 0.001). Public health preventive strategies and measures should be undertaken to address the priority diseases as shown in this study.

International Classification of Primary Care: in line with the future of family medicine

International Classification of Primary Care: in line with the future of family medicine

Prevalence of heart failure phenotypes and current use of therapies in primary care: results from a nationwide study.

Heart failure (HF) is an increasing concern worldwide. A rising HF burden is expected due to the prospected future demographic changes with aging populations. Consequently, the long-term follow-up and treatment will be performed increasingly by primary care physicians in the future. Contemporary data on HF patients in primary care are needed to plan and ensure an effective and safe follow-up of future patients. The electronic patient journals of 148 primary care clinics in Denmark were searched in a standardized manner to identify patients with HF [code K77 of the International Classification of Primary Care, Second Edition]. Prespecified variables including demographic information, clinical variables, co-morbidities, prescribed medications, and setting of follow-up were recorded. In total, 1111 patients were included in the study. The mean timepoint for the HF diagnosis was August 2018. In 95% of cases, the diagnosis of HF was made in a specialized setting. The echocardiogram data used for phenotyping were available in 1042 (94%) of the 1111 patients. HF with reduced ejection fraction (HFrEF) was present in 43%, recovered HFrEF in 31%, and HF with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF) in 26%. In patients with HFrEF or recovered HFrEF, fundamental treatments were prescribed in 86% for angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or angiotensin receptor neprilysin inhibitor (ARNI), in 82% for beta-blocker, in 38% for mineralocorticoid receptor antagonist (MRA), and in 12% for sodium-glucose co-transporter-2 inhibitor (SGLT2i). Older patients were treated to a significantly lesser extent than young patients for all drug classes [odds ratio (OR) point estimates 0.50 to 0.69, all P-values<0.05]. In patients with HFmrEF or HFpEF, an ACEI, ARB, or ARNI was prescribed in 67%, beta-blocker in 67%, MRA in 22%, and SGLT2i in 7.4% with significantly lower probability of treatment compared to patients with HFrEF or recovered HFrEF [OR point estimates 0.33 to 0.57, all P-values<0.05]. The setting of follow-up was available in 96% of patients. Irrespective of HF phenotype, follow-up was performed solely in primary care in 64%. These patients were generally treated to a lesser extent with HF therapies compared with patients where follow-up included specialized care, yet differences were generally small. HFrEF is the most common phenotype of HF in primary care followed by recovered HFrEF and fundamental therapies are markedly underutilized. Initiatives to increase the use of recommended therapies are needed to improve the future care of patients with HF.

Multimorbidity Patterns in Older Adults: the Role of Social Variables and Lifestyle Behaviors

Introduction: While some condition clusters represent the chance co-occurrence of common individual conditions, others may represent shared causal factors. The aims of this study were to identify multimorbidity patterns in older adults and to explore the relationship between social variables, lifestyle behaviors, and the multimorbidity patterns identified. Methods: This was a cross-sectional design. Data came from 3,273 individuals aged ≥65 from the Seniors-ENRICA-2 cohort; information on 60 chronic disease categories, categorized according to the 2nd edition of the International Classification of Primary Care and the 10th edition of the International Classification of Diseases, was obtained from clinical record linkage. To identify multimorbidity patterns, an exploratory factor analysis was conducted over chronic disease categories with a prevalence >5%, using Oblimin rotation and Kaiser’s eigenvalues-greater-than-one rule. The association between multimorbidity patterns and their potential determinants was assessed with multivariable linear regression. Results: The three-factor solution (Musculoskeletal diseases and mental disorders, Cardiometabolic diseases, and Cardiopulmonary diseases) explained 64.5% of the total variance. Being older, lower occupational category, higher levels of loneliness, lower levels of physical activity, and higher body mass index were associated with higher scores in the multimorbidity patterns identified. Female sex was linked to the Musculoskeletal diseases and mental disorders pattern, while being male was revealed to the two remaining multimorbidity patterns. A high diet quality was inversely related to Cardiometabolic diseases, while optimal sleep duration was inversely related to Cardiopulmonary diseases. Conclusion: Three multimorbidity patterns were identified in older adults. Multimorbidity patterns were differently associated with social variables and lifestyles behavioral factors.

Immediate release fentanyl in general practices: Mostly off-label prescribing

BackgroundThe immediacy of the onset of opioids may be associated with the risk of dependency and accidental overdose. Nasal and oromucosal fentanyl dosage forms are so called immediate release fentanyl (IRF). These IRFs have been approved to treat breakthrough pain in patients with cancer who are on chronic opioid treatment only. There are signals of increased off-label prescribing of IRFs in general practices.ObjectivesThis study aims to provide insight into the frequency of IRF prescription in Dutch general practices and the extent to which IRF is prescribed off-label.MethodsRoutinely collected electronic health records of general practices (GPs) participating in Nivel Primary Care Database were used. Adult patients with IRF prescriptions in 2019 were selected from whom dispensing data on 2018 and 2019 was available. Diagnoses were recorded by GPs using International Classification of Primary Care. Descriptive analyses were performed.ResultsThis study included 342 GPs with a patient population of 1,297,942 patients, 1,368 patients received at least one IRF prescription in 2019, which is equal to 1.1 patients per 1,000 registered patients. Most patients (74.9%) with an IRF prescription received an off-label prescription. A slight majority had a cancer diagnosis but nearly 65.2% did not have a maintenance therapy and 14% were opioid-naive before receiving their first IRF prescription.ConclusionIRFs are not prescribed frequently in Dutch general practices. However, when prescribed, a relatively large portion of patients received an off-label prescription.

The Diagnostic Value of the Patient's Reason for Encounter in Primary Care: A Retrospective Cohort Study.

Context Knowledge of incidence, prevalence and trends in morbidity support the diagnostic process of general practitioners (GPs). GPs use estimated probabilities of probable diagnoses to guide their policy on testing and referral. However, GPs estimations often are implicit and imprecise. The International Classification of Primary Care (ICPC) has the potential to incorporate the doctor and patient's perspective within a clinical encounter. The patient perspective is reflected in the Reason for encounter (RFE) which is the 'literal uttered reason' of the patient to contact the GP and comprises the patient's priority for seeking care. Previous research showed the predictive value of some RFEs in diagnosing cancer. Objective Our aim is to analyze the predictive value of the RFE for the final diagnosis, taking into account patient's age and sex. Study Design and Analysis In this cohort study, we determined the relationship between RFE, age, sex and the final diagnosis with multilevel analysis and distribution analysis. We focused on the top 10 most common RFEs. Dataset FaMe-Net database, containing coded routine health data from GP registration network (7 GP practices; 40.000 patients). GPs code the RFE and diagnosis of all contacts with patients, using the ICPC-2 within an episode of care (EoC) structure. An EoC is defined as a health problem in an individual from the first encounter until completion in the last encounter. Population Studied We used data from 1989-2020 and selected all patients with a RFE in the top 10 most common RFEs and the corresponding final diagnoses. Outcome Measures The predictive value is shown in odds risk and frequencies. Results We included 162,315 contacts from 37,194 patients. Multilevel analysis showed significant impact of the additional RFE on the final diagnosis (p<0.05). For example, patients presenting with RFE cough had a 5.6% chance of pneumonia, while it rose to 16.4%, when cough and fever were mentioned as RFE. Age and sex were also of significant impact on the final diagnosis(p<0.05), except for sex in case of fever(p 0.332) and throat symptoms(p 0.616). Conclusions Additional RFE, age and sex are of significant impact on the final diagnosis. Other patient factors might also have relevant predictive value. Artificial intelligence can be beneficial to add more variables to build a diagnostic prediction model. This model can support GPs in the diagnostic process and can help students and residents in training.