International Classification Of Primary Care Research Articles

Justifications nosologiques et fonctionnelles des arrêts maladie : une étude transversale dans le Rhône

BackgroundAlthough sick leave has significant medical and economic stakes, justifications for sick leave are poorly known in France. Our objective was to describe the medical justifications for sick leave, in nosological, functional and contextual terms. MethodsCross-sectional study, based on 1,143 sick leave certificates collected by the Health Insurance Fund of the Rhône district in February 2011. The medical justifications for sick leave were classified and coded in nosological terms according to the International Classification of Primary Care (ICPC-2) and in functional and contextual terms according to the “AT-CIF questionnaire”, derived from the International Classification of Functioning (ICF). ResultsAmong the 1,073 sick leaves containing a medical justification (93.9%), 757 (70.5%) could be classified only according to the ICPC-2 and 316 (29.5%) according to both the ICPC-2 and the AT-CIF questionnaires. The health problems most frequently reported in sick leave justifications concerned, in order of decreasing frequency: respiratory (26.9%), psychological (13.7%), or digestive (12.1%) systems; general problems (10.7%); pregnancy (3.5%); the neurological system (2.9%). Furthermore, 346 functional deficiencies, five restrictions of activity and one environmental barrier were identified. ConclusionSick leave certificates almost always provide justifications for sick leave in nosological terms, but in less than one third of certificates provide information in functional or contextual terms. Training practitioners to make functional and contextual assessments may allow them to more optimally decide on the indication and the duration of sick leave, and facilitate communication around the patient.

ICF or ICPC: what is missing for primary care?

The International Classification of Primary Care (ICPC) has often been confused with the International Classification of Functioning, Disability and Health (ICF) because it is a tool that indicates problems related to health, but which are not diseases. Although its importance be recognized in primary care, the ICPC points, for example, the reasons for contact with health services, clinical information and some interventions. In none of these respects, the ICPC addresses the issue of functioning and disability, either, the relationship of environmental factors on human performance. ICPC is a mere intermediary for the International Statistical Classification of Diseases and Related Health Problems (ICD), it does not include all information necessary for a diagnosis of health status or the health determinants. Thus, managers need to thoroughly know the ICF, since it is a reference classification of the World Health Organization and the real complement for the ICD to population data. The ICF contains the necessary tolls to stimulate a cross-sectoral work, but it has been done only for specialized care, what leave aside all the potential of its application in primary care.

Skin lesions suspected of malignancy: an increasing burden on general practice

BackgroundSkin cancer is believed to impose a heavy burden on healthcare services, but the burden of skin lesions suspected of malignancy on primary healthcare has never been evaluated. Therefore the aim of this study was to determine the demand for care in general practice due to these suspected skin lesions (i.e. lesions that are suspected of malignancy by either the patient or the GP).MethodsRegistry study based on data (2001–2010) from the Registration Network Groningen. This is a general practice registration network in the northern part of the Netherlands with an average annual population of approximately 30,000 patients. All patient contacts are coded according to the International Classification of Primary Care (ICPC). Consultations for skin lesions suspected of malignancy were selected according to the assigned ICPC codes. Subsequently, the number of consultations per year and the annual percent change in number of contacts (using the JoinPoint regression program) were calculated and analysed. Additionally, the percentage of patients referred to secondary care or receiving minor surgery within one year after the first contact were calculated.ResultsFrom 2001 onwards we found an annual increase in demand for care due to skin lesions suspected of malignancy of 7.3% (p < 0.01) and in 2010 the benign:malignant ratio was 10:1. In total 13.0% of the patients were referred and after 2006, minor surgery was performed on 31.2% of the patients. Most surgeries and referrals took place within 30 days.ConclusionsSuspected skin lesions impose an increasing burden on primary healthcare and most likely on healthcare costs as well. General practitioners should therefore be trained in diagnosing skin lesions suspected of malignancy, as a high diagnostic accuracy can save lives in the case of melanoma, and may also prevent unnecessary, costly, excisions and referrals to secondary healthcare.

Antibiotic use in Dutch primary care: relation between diagnosis, consultation and treatment

Countries generally present their overall use of antibiotics as an indicator of antibiotic prescribing quality. Additional insight is urgently needed for targeted improvement recommendations: first, data on specific clinical indications for which antibiotics are used, and second, on distinguishing whether changes in patient consultation or changes in physician prescribing drive changing antibiotic use for particular indications. The aim of this study was to describe the antibiotic management of infectious diseases in the clinical context, by analysing prescribing by physicians and patient consultation incidences per indication over time. A database with all contact data for infectious diseases from 45 primary care practices in the Netherlands (2007-10) was used. Consultation incidences, prescribing rates and choice of antibiotic were analysed per International Classification of Primary Care (ICPC) chapter and relevant ICPC codes. Antibiotics were prescribed in ∼25% of infectious disease episodes, mainly respiratory infections, urinary infections and ear and skin infections. Overall, this resulted in 300 prescribed courses of antibiotics per 1000 patient-years. Given a stable prescription rate, a 19% increase in the number of consultations explained the increased antibiotic prescribing for urinary tract infections. Given a stable consultation incidence, an 8% reduction in prescribing rate explained the decreased antibiotic prescribing for respiratory tract infections. Macrolides were predominantly prescribed for respiratory disease (∼66%), amoxicillin/clavulanate for respiratory disease (∼42%) and urinary illness (∼25%), and fluoroquinolones for urinary and genital indications. Insight into the reasons for the decreased prescribing for respiratory tract infections and the increased prescribing for urinary tract infections was provided by a detailed analysis of incidences and prescribing rates. For respiratory disease, the second- and third-choice antibiotics were overused. Complete data on infectious disease management, with respect to patient and physician behaviour, are crucial for understanding changes in antibiotic use, and in defining strategies to reduce inappropriate antibiotic use.

[Self-reported morbidity by workers in the Family Health Teams].

The health of primary care workers is still a poorly addressed area of study in Brazil. The scope of this study was to describe the standard of self-reported morbidity by workers in Family Health Teams (FHT) in the northeastern macro-region of the state of Minas Gerais. A cross-sectional study was conducted with self-applied questionnaires, including socio-demographical data, labor and health conditions, among all workers in FHT. Self-reported morbidity was categorized based on the International Classification of Primary Care, version 2. Information was collected from 1,731 workers in 204 primary health care units. The group was predominantly comprised of female community health workers. The prevalence of at least one health problem was 26.1% for women and 18.3% for men. The main health problems were related to circulatory, musculoskeletal, respiratory, endocrine-metabolic and nervous systems. After multiple analysis, the variables associated with health problems were related to being female, aged 30 years or more and being on the team for 5 years or longer. The morbidity reported by the FHT workers is similar to that observed for the population in general, highlighting the need for strategies to promote the health of these workers as well.

Die medizinische Versorgung in einer kassenärztlichen Bereitschaftsdienstzentrale – Eine deskriptive Studie aus dem CONTENT-Projekt

Little published research is available about the content of out of hours care (OOHC) in Germany. CONTENT is a project of the University Hospital Heidelberg to build up a morbidity registry for ambulatory health care. One of the participating practices of the network is a rural OOHC centre. The study reports exemplarily on the work of this practice. The design of the study is cross-sectional. One of the 2 available CONTENT practice-softwares was used for data retrieval. The softwares allow for classifying reasons for encounter (RFE), health problems (diagnoses) and processes of care with the International Classification of Primary Care (ICPC-2). Furthermore the softwares allow for pseudonymised data export. A 3-year period with 15 886 patient contacts of 9 542 patients (65.9% female) is described. Close to 8% of the population in the catchment area visited the practice at least once in a year. Medium age of the patients was 42 years (range 0-104). The groups of the 25-44-year-old and the 45-64-year-old patients formed together 43% of all contacts. The most frequent RFE were: fever (5.8%), sore throat (4.8%), cough (4.8%), earache (3.9%) and insect bites (3.6%). Frequencies of these RFEs differed considerably between the age groups. With the help of the data, resulting diagnoses and care processes can be described in detail. This study describes, for the first time in Germany, the work of an OOHC practice. Data capture to accomplish this was feasible within existing practice software and without much extra work. If more OOHC practices would participate in the CONTENT project a more representative picture of OOHC in Germany could be established.

ICF or ICPC: what is missing for primary care?

The International Classification of Primary Care (ICPC) has often been confused with the International Classification of Functioning, Disability and Health (ICF) because it is a tool that indicates problems related to health, but which are not diseases. Although its importance be recognized in primary care, the ICPC points, for example, the reasons for contact with health services, clinical information and some interventions. In none of these respects, the ICPC addresses the issue of functioning and disability, either, the relationship of environmental factors on human performance. ICPC is a mere intermediary for the International Statistical Classification of Diseases and Related Health Problems (ICD), it does not include all information necessary for a diagnosis of health status or the health determinants. Thus, managers need to thoroughly know the ICF, since it is a reference classification of the World Health Organization and the real complement for the ICD to population data. The ICF contains the necessary tolls to stimulate a cross-sectoral work, but it has been done only for specialized care, what leave aside all the potential of its application in primary care.

International classification of primary care: an Indian experience.

Background:India is in the process of transition to universal health coverage for Indian citizens. The focus is to strengthen the primary and secondary level services. Coupled with this national scenario, the development of Family medicine as a distinct discipline is in a crucial stage. There is a nation-wide urge to build family medicine training units and service centers across the country to fulfill the unmet health needs of the population.Objectives:This study aimed to bring out reasons for encounter (RFE) and morbidity pattern of patients seen in a family physician run urban health center in South India.Methods:The study was conducted in an urban health center of a tertiary care hospital. Clinicians entered the data using International Classification of Primary Care (ICPC) codes. Data included were demographics, 3 RFE, 3 diagnoses, 3 outcomes of care that include prescriptions, investigations, procedures, and referrals made.Results:During 47,590 patient encounters, 59,647 RFE, 62,283 diagnoses and 68269 outcomes of care were recorded. The majority of RFEs and diagnoses are in the following ICPC chapters: Endocrinology (38.6%), cardiovascular (35.91%), respiratory (20.26%), digestive (7.68% and musculo-skeletal (6.8%). The most frequent outcome of care was prescriptions, followed by counseling and nebulization.Conclusion:This study is the first to report on the RFE in India. This study demonstrated the breadth of clinical conditions seen by family physicians across all ages and in both genders. This study attempts to highlight the need for family physician based services as a training ground for trainees.

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

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

Cystitis: antibiotic prescribing, consultation, attitudes and opinions

Despite stable overall antibiotic use between 2007 and 2011 in The Netherlands, use of nitrofurantoin and trimethoprim increased by 32%. The background of this increased antibiotic use against uropathogens is unknown. To determine whether increased use of urinary tract infection antibiotics is caused by changes in patients' consultation or physicians' prescribing behaviour and to investigate attitudes and opinions of women with respect to cystitis management and antibiotics. Consultation and prescribing for International Classification of Primary Care (ICPC) codes U01 (dysuria), U02 (frequency), U05 (other urination problems), U70 (pyelonephritis) and U71 (cystitis) were determined from 2007 to 2010, using routinely collected primary health care data. Separately, behaviour of women with respect to managing cystitis, consultation and opinions towards (delayed) antibiotic treatment were studied using questionnaires in 2012. Consultation for U02 and U71 significantly increased from 93 to 114/1000 patient-years from 2007 to 2010; proportion of episodes in which an antibiotic was prescribed remained constant. Questionnaires revealed that urination problems and pain were dominant complaints of cystitis; pain medication, however, was not adequately used. One-third of women directly consult upon first symptoms, whereas the majority awaits an average of 4 days. Sixty-six per cent of women report to be willing to postpone antibiotic use. Increased use of urinary tract infection antibiotics may be caused by increased consultation for cystitis in primary care. Future research should focus on the outcomes of adequate pain medication, enhanced diagnostic procedures and of delaying antibiotic use in cystitis management.

Information Systems for Monitoring the Burden of Chronic Diseases in Public Reference Health Facilities in Central Africa

Background and purpose: Chronic diseases are an increasingly important cause of death in sub-Saharan Africa. Diseases such as cancer, diabetes and arterial hypertension remained for years in the background, in the shadow of pandemics such as malaria, HIV / AIDS and tuberculosis. Chronic disease incidence in the Central African region however, is poorly documented. This study explores to what extent secondary use of clinical information stored in hospital information systems can help to provide evidence related to the burden of diabetes, cancer and hypertension in DR Congo, Rwanda and Burundi. Methods: In the past 6 years, 4 reference hospitals of Kisangani, Bukavu, Kigali and Bujumbura implemented open source hospital information management tools integrating international classification systems such as ICD-10 and ICPC-2. Clinical and financial data from chronic disease treatments in the period 2006-2012 were merged into Diagnosis Related Groups (DRGs) for further analysis. Metrics related to case load, mortality load and financial burden have been calculated for diabetes, cancer and hypertension DRGs. Results : 89,765 out-patient visits and 59,434 admissions have been analyzed in this study. The results show a worrying growth of the 3 chronic diseases in the region. Costs related to the studied diseases are expected to increase by 10% (diabetes) to 70% (cancer & hypertension) between 2011 and 2015 in the studied reference hospitals. Conclusion : the study demonstrates that the problem of chronic diseases also grows rapidly in the Great Lakes region and therefore urgent steps must be taken, both by governments (Rwanda, DRC and Burundi), by the international donor community and by local hospital boards. Keywords : Information systems, Diagnosis-Related Groups, Chronic Disease, Sub-Saharan Africa, Neoplasms, Hypertension, Diabetes

Quality of antibiotic prescription during office hours and out-of-hours in Flemish primary care, using European quality indicators

Background: European disease-specific antibiotic prescribing quality indicators (APQI) were proposed for seven acute indications (bronchitis, upper respiratory infection, cystitis, tonsillitis, sinusitis, otitis media and pneumonia): (a) the percentage of patients prescribed an antibiotic; (b) the percentage of patients receiving the guideline recommended antibiotic; (c) the percentage of patients receiving quinolones.Objectives: To assess the feasibility of calculating values for these 21 APQI using primary care databases; and to assess the quality of antibiotic prescribing in office hours and out-of-hours general practice.Methods: Data was extracted from a morbidity registration network (http://www.intego.be) and the out-of-hours service centre in Flanders. Within both databases diagnoses are labelled using the revised second edition of International Classification of Primary Care (ICPC-2-R) and antibiotic prescriptions using Anatomical Therapeutic Chemical (ATC) classification.Results: Both databases allow calculation of APQI values and results are similar. Only for cystitis was the percentage of patients prescribed an antibiotic within the proposed acceptable range. For all indications, the percentage of recommended antibiotics was below the proposed acceptable range (80–100%). The percentage of quinolones was within the proposed acceptable range (0–5%) for otitis media, upper respiratory infection and tonsillitis.Conclusion: Primary care databases can produce APQI values. These values revealed huge opportunities to improve the quality of antibiotic prescribing in office hours and out-of-hours Flemish general practice, especially the prescription of recommended antibiotics.

Motivos de consulta em Medicina Geral e Familiar no distrito de Coimbra no ano de 2010

Objectives: To characterize the reasons for consultation in primary care as coded by family physicians. Study design: Descriptive, cross-sectional. Setting: District of Coimbra, Portugal. Participants: Patients visiting health centres in the Coimbra district in 2010. Methods: This study examined 453,388 reasons for consultation recorded in primary care in the district of Coimbra during the year 2010. They were coded using the International Classification for Primary Care, second edition (ICPC-2). Descriptive statistics were obtained using PAWS v19 statistical software. Results: The most frequent reasons for consultation recorded were “general and unspecified” (39.8%), “musculoskeletal system” (9, 9%) and “circulatory system” (8.7%). The most commonly recorded components were “signs and symptoms” (30.8%), “diagnostic and preventive procedures” (20.0%) and “test results” (19.3%). The most frequent signs and symptoms symptoms recorded were “cough” (5.6%), “signs and symptoms in the lumbar region” (4.2%), “signs/symptoms of the throat” (3.5%) and “fever” (3.5%). Conclusions: General and unspecified conditions were found to be the most common reason for consultation in this population

A Study on the Integration of Coding Systems to Establish a Database of Clinical Data

AbstractTo facilitate comprehensive and easy retrieval of clinical data, common coding systems which are currently in use, such as the International Classification of Diseases (ICD), the International Classification of Primary Care (ICPC), the Systematized Nomenclature of Human and Veterinary Medicine (SNOMED), and the Logical Observation Identifiers Names and Codes (LOINC), were simply introduced and analyzed. The method and strategy used to establish a database of clinical data based on these coding systems were studied. Theprimary method was to choose useful codes of all coding systems to establish a code library, to prepare entry procedures and to input codes. The strategy was to start from a point and to make full use of the existing information systems, so as to gradually accumulate experience and reduce the workload. To establish a comprehensive database by using two coding systems for the terminology of human and veterinary medicine systems and the ICD, and to establish the database of clinical da...

OP0138-PC High Presence of Chronic Diseases at the Onset of Inflammatory Arthritis: Results from a Population-Based Study

BackgroundSeveral cross- sectional studies report the prevalence of additional chronic diseases in patients with inflammatory arthritis (IA), but only in established disease.[1,2] Most studies include newly diagnosed IA patients without...

Identification of acute myocardial infarction from electronic healthcare records using different disease coding systems: a validation study in three European countries

ObjectiveTo evaluate positive predictive value (PPV) of different disease codes and free text in identifying acute myocardial infarction (AMI) from electronic healthcare records (EHRs).DesignValidation study of cases of AMI identified...

OP0187-PC Potentially harmful prescription of NSAIDS in a primary care population with musculoskeletal complaints

BackgroundTo reduce adverse drug events (ADEs), clinical guidelines recommend cautious prescription of non-steroidal anti-inflammatory drugs (NSAIDs) in patients known to be at a high risk of developing a serious ADE....

OP0276-PC High Risk for Anaemia, Osteoporosis and Copd After the Onset of Inflammatory Arthritis: Results from a Population-Based Study

BackgroundSeveral chronic diseases such as cardiovascular diseases, pulmonary diseases, and gastrointestinal diseases are known to be increased in inflammatory arthritis (IA) patients.[1-3] Longitudinal studies in community-based settings about the development...

Uma proposta metodológica para pesquisar as demandas dos pacientes e probabilidades pré-teste através de formulários em papel na atenção primária

Objective: The purpose of this study is to present a methodology for assessing patients’ demands and calculating pre-test probabilities using paper forms in Primary Care. Method: Most developing countries do not use Electronic Health Records (EHR) in primary care settings. This makes it difficult to access information regarding what occurs within the health center working process. Basically, there are two methodologies to assess patients’ demands and problems or diagnosis stated by doctors. The first is based on single attendance at each appointment, while the second is based on episodes of care; the latter deals with each problem in a longitudinal manner. The methodology developed in this article followed the approach of confronting the ‘reason for the appointment’ and ‘the problem registered’ by doctors. Paper forms were developed taking this concept as central. All appointments were classified by the International Classification of Primary Care (ICPC). Discussion: Even in paper form, confrontation between ‘reason for the appointment’ and ‘problem registered’ is useful for measuring the pre-test probabilities of each problem-based appointment. This approach can be easily reproduced in any health center and enables a better understanding of population profile. Prevalence of many illnesses and diseases are not known in each reality, and studies conducted in other settings, such as secondary and tertiary care, are not adequate for primary health care. Conclusion: This study offers adequate technology for primary health care workers that have potential to transform each health center into a research-led practice, contributing directly to patient care.

Avaliação da probabilidade pré-teste em Atenção Primária à Saúde usando a Classificação Internacional de Atenção Primária 2 (CIAP-2)

Introduction: The assessment of the patient’s reason for encounter using the International Classification of Primary Care (ICPC) is not common in countries without a strong primary health care system. Objective: This study aimed to evaluate the main reasons for encounter and to calculate the pre-test probabilities for frequent problems. Method: A questionnaire was created to study, in each appointment, the reasons for encounter and the clinical problems (or diagnosis). In total, 26 general practitioners of the Family Health Strategy from the municipality of Florianópolis filled the form after appointments, for four weeks over a year. Results: 5,698 encounters were evaluated, with regular distribution among seasons. There were 1,625 reasons for encounter and 1,475 clinical problems per appointment. The 30 most common clinical problems represented 50% of all appointments, covering 13 different chapters of ICPC-2. Patients with fever as symptom had diagnosis of acute upper respiratory infection (37.7%), acute tonsillitis (17.8%) or fever (11%), while patients who received the diagnosis of acute upper respiratory infection had complained of cough (24.2%), fever (22%) or of a throat symptom/complaint (9.8%). Discussion: Episode of care is the best methodology to assess pre-test probability longitudinally. However, it was possible to estimate the pre-test probability by using the data of each encounter, as demonstrated in the case of fever and acute upper respiratory infection, in spite of its follow up limitation, as it was based on encounters. Conclusion: This study shows that plans for continuing professional development should be focused on common symptoms and diagnosis, in order to improve the clinical reasoning guided by studies of pre-test probabilities. Hence, the ICPC-2 as a classification system is a great contribution to transform any health center in a research center, even those in rural areas of low-income countries.