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Soler JK, Buono N, Cardillo E, Frese T, Vinker S, Ungan M. The fractured lens: a controversial revision of the International Classification of Primary Care. Front Med (Lausanne) 2024; 10:1230987. [PMID: 38274446 PMCID: PMC10808642 DOI: 10.3389/fmed.2023.1230987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Background 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. Objectives To formally describe and critically appraise the revision process of ICPC-3. Methods 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. Results 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. Conclusion 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.
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Affiliation(s)
| | - Nicola Buono
- Department of General Practice, ICPC Club Italia, Caserta, Italy
| | - Elena Cardillo
- Institute of Informatics and Telematics, National Research Council, Rende, Italy
| | - Thomas Frese
- Institute of General Practice and Family Medicine, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Shlomo Vinker
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Leumit Health Services, Tel Aviv, Israel
| | - Mehmet Ungan
- Department of Family Medicine, Ankara University School of Medicine, Ankara, Türkiye
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Mellanen E, Kauppila T, Kautiainen H, Lehto M, Rahkonen O, Pitkälä K, Laine MK. Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities. Scand J Prim Health Care 2023; 41:392-399. [PMID: 37706640 PMCID: PMC11001330 DOI: 10.1080/02813432.2023.2255062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities. DESIGN AND SETTING A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018. SUBJECTS PHC patients aged 60 years or more with a T2D were included. MAIN OUTCOME MEASURES Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR). RESULTS In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]). CONCLUSIONS In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.
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Affiliation(s)
- E. Mellanen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - T. Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - H. Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - M. Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- City of Vantaa, Vantaa, Finland
| | - O. Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - K. Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - M. K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
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Kang SY, Kim YS. Experience of Lifetime Health Maintenance Program: An Observational Study of a 30-Year Period of Outpatient Primary Care in a Tertiary Hospital. Korean J Fam Med 2023; 44:281-288. [PMID: 37582665 PMCID: PMC10522474 DOI: 10.4082/kjfm.23.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND This study aimed to identify the clinical content of patients registered with the Lifetime Health Maintenance Program (LHMP) under the care of a single family physician who introduced and operated the program in Korea at a tertiary hospital for over 30 years. METHODS We analyzed the electronic medical records of 745 patients who had registered for more than 3 times with the LHMP under the care of a single family physician between January 1, 2010 and December 31, 2019. We reviewed medical records from June 1989, when the hospital was established, to February 2022. The participants' age at the time of LHMP enrollment, sex, initial consultation date, final consultation date, and consultation content were evaluated. RESULTS Patients visited the LHMP for various reasons, including acute symptom management, chronic disease management, psychiatric consultation, counseling on health behaviors, health checkups, and vaccination. The top five diagnoses for acute symptom management were upper respiratory infection, abdominal pain, dizziness/vertigo, headache, and lower back pain, whereas those for chronic disease management were dyslipidemia, hypertension, osteoarthritis, osteoporosis/osteopenia, and diabetes. More than one in five patients received psychiatric consultation and counseling on health behaviors. As the duration of the program enrollment increased, the proportion of patients visiting the LHMP for acute symptoms, vaccinations, and health checkups also increased. Furthermore, the number of categories of consultation content increased for each patient. CONCLUSION The LHMP emphasized the need to systematize regular primary care physicians in Korea. Policy changes are necessary to strengthen primary care, and the LHMP serves as an intermediate step in organizing regular primary care physicians in Korea.
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Affiliation(s)
- Seo Young Kang
- Department of Family Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Young Sik Kim
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Lomans AM, Uijen AA, Akkermans RP, Lagro-Janssen TALM, Teunissen DAM. Help-seeking behaviour in primary care of men and women with a history of abuse: A Dutch cohort study. Eur J Gen Pract 2022; 28:40-47. [PMID: 35379063 PMCID: PMC8986289 DOI: 10.1080/13814788.2022.2054985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Previous studies show an association between a history of abuse and higher care demand. However, studies in general practice regarding help-seeking behaviour by patients (mainly male patients) with a history of abuse are scarce. Objectives To analyse help-seeking behaviour in general practice of men and women with a history of abuse. Methods A cohort study using data from a Dutch primary care registration network from 2015 to 2019. We included all patients aged ≥ 18 years who indicated on a questionnaire that they did or did not have a history of abuse. We analysed differences in contact frequency, types of contact, reason for encounter and diagnoses between men and women with or without a history of abuse. Results The questionnaire had a response rate of 59% and resulted in 11,140 patients, of which 1271 indicated a history of abuse. Men and women with a history of abuse contact the general practitioner (GP) 1.5 times (95% CI 1.42–1.60) more often than men and women without a history of abuse, especially for psychological (rate ratio 1.97, 95% CI 1.79–2.17) and social (rate ratio 1.93, 95% CI 1.68–2.22) problems. Moreover, when diagnosed with a psychological or social problem, patients with a history of abuse contact the GP twice more often for these problems. Conclusion Compared to men and women without a history of abuse, men and women with a history of abuse visit their GP more often, particularly for psychological and social problems.
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Affiliation(s)
- Anieck M Lomans
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Toine A L M Lagro-Janssen
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Doreth A M Teunissen
- Department of Primary and Community Care, Gender and Women's Health, Radboud University Medical Centre, Nijmegen, The Netherlands
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Buono N, Harris M, Farinaro C, Petrazzuoli F, Cavicchi A, D'Addio F, Scelsa A, Mirra B, Napolitano E, Soler JK. How are reasons for encounter associated with influenza-like illness and acute respiratory infection diagnoses and interventions? A cohort study in eight Italian general practice populations. BMC FAMILY PRACTICE 2021; 22:172. [PMID: 34454426 PMCID: PMC8401359 DOI: 10.1186/s12875-021-01519-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/13/2021] [Indexed: 12/02/2022]
Abstract
Background Influenza-like illness (ILI) and Acute Respiratory Infections (ARI) are a considerable health problem in Europe. Most diagnoses are made by family physicians (FPs) and based on symptoms and clinical signs rather than on diagnostic testing. The International Classification of Primary Care (ICPC) advocates that FPs record patients’ ‘Reasons for Encounters’ (RfEs) as they are presented to them. This study analyses the association of patients’ RfEs with FPs’ diagnoses of ILI and ARI diagnoses and FPs’ management of those patients. Methods Cohort study of practice populations. Over a 4-month period during the winter season 2013–14, eight FPs recorded ILI and ARI patients’ RfEs and how they were managed. FPs recorded details of their patients using the ICPC format, collecting data in an Episode of Care (EoC) structure. Results There were 688 patients diagnosed as having ILI; between them they presented with a total of 2,153 RfEs, most commonly fever (79.7%), cough (59.7%) and pain (33.0%). The 848 patients with ARI presented with a total of 1,647 RfEs, most commonly cough (50.4%), throat symptoms (25.9%) and fever (19.9%). For patients with ILI, 37.0% of actions were related to medication for respiratory symptoms; this figure was 38.4% for patients with ARI. FPs referred six patients to specialists or hospitals (0.39% of all patients diagnosed with ILI and ARI). Conclusions In this study of patients with ILI and ARI, less than half received a prescription from their FPs, and the illnesses were mainly managed in primary care, with few patients’ needing referral. The ICPC classification allowed a standardised data collection system, providing documentary evidence of the management of those diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01519-4.
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Affiliation(s)
- Nicola Buono
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy.
| | - Michael Harris
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Carmine Farinaro
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Ferdinando Petrazzuoli
- Center for Primary Health Care Research, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Angelo Cavicchi
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Filippo D'Addio
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Amedeo Scelsa
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Baldassarre Mirra
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Enrico Napolitano
- Department of General Practice, ICPC Club Italia Via Roosevelt 4, 81100, Caserta, Italy
| | - Jean K Soler
- Mediterranean Institute of Primary Care, Attard, Malta
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Sturgiss E, van Boven K. Datasets collected in general practice: an international comparison using the example of obesity. AUST HEALTH REV 2019; 42:563-567. [PMID: 29860968 DOI: 10.1071/ah17157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 03/28/2018] [Indexed: 11/23/2022]
Abstract
International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences.
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Affiliation(s)
- Elizabeth Sturgiss
- Academic Unit of General Practice, Australian National University, Canberra Hospital Campus, Building 4, Level 2, Garran, 2605, Canberra, ACT, Australia
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University, Nijmegen, 6500 HB, Netherlands. Email
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van den Broek J, van Boven K, Bor H, Uijen AA. Change in frequency of patient requests for diagnostic screening and interventions during primary care encounters from 1985 to 2014. Fam Pract 2018; 35:724-730. [PMID: 29701780 DOI: 10.1093/fampra/cmy031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The reason why patients contact a care provider, the reason for encounter (RFE), reflects patients' personal needs and expectations regarding medical care. RFEs can be symptoms or complaints, but can also be requests for diagnostic or therapeutic interventions. OBJECTIVES Over the past 30 years, we aim to analyse the frequency with which patients consult a GP to request an intervention, and to analyse the impact of these requests on the subsequent diagnostic process. METHODS We included all patients with a request for diagnostics, medication prescription or referral from 1985 to 2014. We analysed the number of requests, granted requests and interventions originating from a request. We compared the final diagnosis (symptom or disease diagnosis) between patients with and without a request. DESIGN AND SETTING This is a retrospective cohort study with data from Family Medicine Network, a Dutch primary healthcare registration network. RESULTS Over time, patients more often present to their GP with a request for intervention. GPs are increasingly compliant with these requests. Patients presenting with a request for intervention are more likely to be diagnosed with a symptom rather than a disease. CONCLUSION This study provides insight into the changes in patients' and GPs' behaviour and patients' influence on the medical process, and confirms the clinical relevance of the RFE. This study could support GPs in daily practice when deciding whether or not to grant a request.
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Affiliation(s)
- Jenny van den Broek
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Bor
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
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Bösner S, Schwarm S, Grevenrath P, Schmidt L, Hörner K, Beidatsch D, Bergmann M, Viniol A, Becker A, Haasenritter J. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care - a systematic review. BMC FAMILY PRACTICE 2018; 19:33. [PMID: 29458336 PMCID: PMC5819275 DOI: 10.1186/s12875-017-0695-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/12/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Dizziness is a common reason for consulting a general practitioner and there is a broad range of possible underlying aetiologies. There are few evidence-based data about prevalence, aetiology and prognosis in primary care. We aimed to conduct a systematic review of symptom-evaluating studies on prevalence, aetiology or prognosis of dizziness in primary care. METHODS We systematically searched MEDLINE and EMBASE. Two independent researchers screened titles and abstracts according to predefined criteria. We included all studies evaluating the symptoms 'dizziness' or 'vertigo' as a reason for consultation in primary care. We extracted data about study population and methodology and prevalence, aetiology and prognosis. Two raters independently judged study quality and risk of bias. We investigated the variation across studies using forest plots, I2 and prediction intervals. Since we anticipated a great amount of clinical and unexplained statistical heterogeneity, we provided qualitative syntheses instead of pooled estimates. RESULTS We identified 31 studies (22 on prevalence, 14 on aetiology and 8 on prognosis). Consultation prevalence differs between 1,0 and 15,5%. The most common aetiologies are vestibular/peripheral (5,4-42,1%), benign peripheral positional vertigo (4,3-39,5%), vestibular neuritis (0,6-24,0%), Menière's disease (1,4-2,7%), cardiovascular disease (3,8-56,8%), neurological disease (1,4-11,4%), psychogenic (1,8-21,6%), no clear diagnosis (0,0-80,2%). While studies based on subjective patient assessment reported improvement rates from 37 to 77%, these findings could not be confirmed when applying instruments that measure symptom severity or quality of life. CONCLUSION There is a broad variety of possible underlying diseases for the symptom dizziness. There exist only few methodologically sound studies concerning aetiology and prognosis of dizziness.
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Affiliation(s)
- Stefan Bösner
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Sonja Schwarm
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Paula Grevenrath
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Laura Schmidt
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Kaja Hörner
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Dominik Beidatsch
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Milena Bergmann
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Annika Viniol
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Annette Becker
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
| | - Jörg Haasenritter
- Department of General Practice / Family Medicine, University of Marburg, Karl-von-Frisch-Str, 435043 Marburg, Germany
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Schrans D, Boeckxstaens P, De Sutter A, Willems S, Avonts D, Christiaens T, Matthys J, Kühlein T. Is it possible to register the ideas, concerns and expectations behind the reason for encounter as a means of classifying patient preferences with ICPC-2? Prim Health Care Res Dev 2018; 19:1-6. [PMID: 28899448 PMCID: PMC6452976 DOI: 10.1017/s1463423617000391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/14/2017] [Accepted: 06/25/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Family practice aims to recognize the health problems and needs expressed by the person rather than only focusing on the disease. Documenting person-related information will facilitate both the understanding and delivery of person-focused care. Aim To explore if the patients' ideas, concerns and expectations (ICE) behind the reason for encounter (RFE) can be coded with the International Classification of Primary Care, version 2 (ICPC-2) and what kinds of codes are missing to be able to do so. METHODS In total, 613 consultations were observed, and patients' expressions of ICE were narratively recorded. These descriptions were consequently translated to ICPC codes by two researchers. Descriptions that could not be translated were qualitatively analysed in order to identify gaps in ICPC-2. RESULTS In all, 613 consultations yielded 672 ICE expressions. Within the 123 that could not be coded with ICPC-2, eight categories could be defined: concern about the duration/time frame; concern about the evolution/severity; concern of being contagious or a danger to others; patient has no concern, but others do; expects a confirmation of something; expects a solution for the symptoms without specification of what it should be; expects a specific procedure; and expects that something is not done. Discussion Although many ICE can be registered with ICPC-2, adding eight new categories would capture almost all ICE.
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Affiliation(s)
- Diego Schrans
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Pauline Boeckxstaens
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Dirk Avonts
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Thierry Christiaens
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Jan Matthys
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
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Liu Y, Chen C, Jin G, Zhao Y, Chen L, Du J, Lu X. Reasons for encounter and health problems managed by general practitioners in the rural areas of Beijing, China: A cross-sectional study. PLoS One 2017; 12:e0190036. [PMID: 29267362 PMCID: PMC5739459 DOI: 10.1371/journal.pone.0190036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 12/04/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to describe the patients' reasons for encounter (RFE) and health problems managed by general practitioners (GPs) in the rural areas of Beijing to provide evidences for health services planning and GPs training. METHODS This study was conducted at 14 community health service centers (CHSCs) in 6 suburban districts of Beijing, using a multistage sampling method. A total of 100 GPs was selected from the study sites. A self-designed data collection form was developed on the basis of Subjective-Objective-Assessment-Plan (SOAP), including patient characteristics, RFEs, health problems, interventions, and consultation length. Each GP recorded and coded their 100 consecutive patients' RFEs and health problems with the International Classification of Primary Care, 2nd version (ICPC-2). Descriptive statistics were employed to describe the distribution of RFE and health problems. Student t-test and analysis of variance were used to compare the differences of mean number of RFE or health problems per encounter by patient characteristics. RESULTS A total of 10,000 patient encounters with 13,705 RFEs and 15,460 health problems were recorded. The RFEs and health problems were mainly distributed in respiratory, circulatory, musculoskeletal, endocrine, metabolic and nutritional, and digestive systems. Cough and hypertension were the most common RFE and health problem, respectively. With increased ages, the mean number of RFEs decreased and the mean number of health problems increased. Patients with Beijing medical insurance had less RFEs and more health problems than those in other cities (p<0.001). Patients who had visited the CHSC previously and signed contracts with the GP team had more health problems than those who had not (p<0.001). CONCLUSIONS These findings present a view of patients' demands and work contents of GPs in Beijing rural areas and can provide reference for health services planning and GPs training.
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Affiliation(s)
- Yanli Liu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China
| | - Chao Chen
- Department of Education, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Guanghui Jin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China
| | - Yali Zhao
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China
| | - Lifen Chen
- Department of Education, Xuanwu Hospital, Capital Medical University, Beijing, P.R. China
| | - Juan Du
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China
| | - Xiaoqin Lu
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, P.R. China
- * E-mail:
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11
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Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care. Prim Health Care Res Dev 2017; 19:176-188. [PMID: 29249206 DOI: 10.1017/s146342361700069x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on 'international data', at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.
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Wangmo T, Hauri S, Meyer AH, Elger BS. Patterns of older and younger prisoners' primary healthcare utilization in Switzerland. Int J Prison Health 2017; 12:173-84. [PMID: 27548019 DOI: 10.1108/ijph-03-2016-0006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to identify primary health concerns prompting older and younger prisoners in Switzerland to consult a nurse or a general practitioner (GP) within the prison healthcare setting, and explores if these reasons for visits differ by age group (49 years and younger vs 50 years and older). The authors used 50 years and older as the benchmark for older prisoners in light of literature indicating accelerated aging among prisoners. Design/methodology/approach Retrospective information from medical records of 406 prisoners were collected for a period of six months. This study analyzed the reasons for which prisoners visited the nurses and GPs available to them through the prison healthcare service. These reasons were coded using the International Classification of Primary Care-version 2. Data were analyzed descriptively and four generalized linear models were built to examine whether there was an age group difference in reasons for visiting nurses and GPs. Findings The health reasons for visiting nurses and GPs by 380 male prisoners from 13 Swiss prisons are presented. In the six month period, a total of 3,309 reasons for visiting nurses and 1,648 reasons for visiting GPs were recorded. Prisoner participants' most common reasons for both visits were for general and unspecified complaints and musculoskeletal problems. Older prisoners sought significantly more consultations for cardiovascular and endocrine problems than younger prisoners. Research limitations/implications Nurses play an important role in addressing healthcare demands of prisoners and coordinating care in Swiss prisons. In light of age-related healthcare demands, continuing education and training of both nurses and GPs to adequately and efficiently address the needs of this prisoner group is critical. Allowing prisoners to carry out some care activities for minor self-manageable complaints will reduce the demand for healthcare. Originality/value This study presents unique data on healthcare concerns for which prisoners visit prison nurses and GPs. It highlights the varied needs of older prisoners as well as how these needs are addressed based on the availability of the primary healthcare provider within the prison.
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Affiliation(s)
- Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel , Basel, Switzerland
| | - Sirin Hauri
- Faculty of Medicine, University of Basel , Basel, Switzerland
| | - Andrea H Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel , Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel , Basel, Switzerland
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Corrigan D, Munnelly G, Kazienko P, Kajdanowicz T, Soler J, Mahmoud S, Porat T, Kostopoulou O, Curcin V, Delaney B. Requirements and validation of a prototype learning health system for clinical diagnosis. Learn Health Syst 2017; 1:e10026. [PMID: 31245568 PMCID: PMC6508515 DOI: 10.1002/lrh2.10026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Diagnostic error is a major threat to patient safety in the context of family practice. The patient safety implications are severe for both patient and clinician. Traditional approaches to diagnostic decision support have lacked broad acceptance for a number of well-documented reasons: poor integration with electronic health records and clinician workflow, static evidence that lacks transparency and trust, and use of proprietary technical standards hindering wider interoperability. The learning health system (LHS) provides a suitable infrastructure for development of a new breed of learning decision support tools. These tools exploit the potential for appropriate use of the growing volumes of aggregated sources of electronic health records. METHODS We describe the experiences of the TRANSFoRm project developing a diagnostic decision support infrastructure consistent with the wider goals of the LHS. We describe an architecture that is model driven, service oriented, constructed using open standards, and supports evidence derived from electronic sources of patient data. We describe the architecture and implementation of 2 critical aspects for a successful LHS: the model representation and translation of clinical evidence into effective practice and the generation of curated clinical evidence that can be used to populate those models, thus closing the LHS loop. RESULTS/CONCLUSIONS Six core design requirements for implementing a diagnostic LHS are identified and successfully implemented as part of this research work. A number of significant technical and policy challenges are identified for the LHS community to consider, and these are discussed in the context of evaluating this work: medico-legal responsibility for generated diagnostic evidence, developing trust in the LHS (particularly important from the perspective of decision support), and constraints imposed by clinical terminologies on evidence generation.
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Fukushi M, Ishibashi Y, Nago N. Final diagnoses and probability of new reason-for-encounter at an urban clinic in Japan: A 4-year observational study. Medicine (Baltimore) 2017; 96:e6999. [PMID: 28562551 PMCID: PMC5459716 DOI: 10.1097/md.0000000000006999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Past clinical data are not currently used to calculate pretest probabilities, as they have not been put into a database in clinical settings. This observational study was designed to determine the initial reasons for utilizing home visits or visits to an outpatient urban clinic in Japan.All family medical clinic outpatients and patients visited by the clinic (total = 11,688) over 1460 days were enrolled.We used a Bayes theorem-based clinical decision support system to analyze codes for initial reason-for-encounter (examination and final diagnosis: pretest probability) and final diagnosis of patients with fever (conditional pretest probability).Total number of reasons-for-encounter: 96,653 (an average of 1.2 reasons per visit). Final diagnosis: 62,273 cases (an average of 0.75 cases per visit). The most common reasons for initial examination were immunizations, physical examinations, and upper respiratory conditions. Regarding the final diagnosis, the combination of physical examinations and acute upper respiratory infections comprised 73.4% of cases. In cases where fever developed, the bulk of the final diagnoses were infectious diseases such as influenza, strep throat, and gastroenteritis of presumed infectious origin. For the elderly, fever often occurred with other health issues such as pneumonia, dementia, constipation, and sleep disturbances, though the cause of the fever remained undetermined in 40% of the cases.The pretest probability changed significantly based on the reason or the combination of reasons for which patients requested a medical examination. Using accumulated data from past diagnoses to modify subsequent subjective diagnoses, individual diagnoses can be improved.
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Affiliation(s)
| | | | - Naoki Nago
- Musashi Kokubunji Park Clinic (Jikkoukai Medical Corporation)
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15
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Fink W, Kasper O, Kamenski G. [Health disorders and their prevalence in two primary care practices from the perspective of different coding]. Wien Med Wochenschr 2017; 167:320-332. [PMID: 28493140 DOI: 10.1007/s10354-017-0567-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/18/2017] [Indexed: 11/30/2022]
Abstract
Family practices provide medical care for the majority of health problems. This already highlights the importance of primary health care with respect to quantity. A detailed five-year survey of cases in two rural practices gives insight into everyday practice. During the whole period of this year's prevalence survey, 24,541 or 32,605 episodes of care were recorded in a mean practice population of 1500 or 1700 persons, respectively. The frequency rates of more than 500 different health problems show a typical Pareto distribution. This distribution of the cases characterizes the subject of general practice/family medicine and essentially determines handling illness in practice. Lack of a common technical language, with regard to the classification of health disorders, becomes evident when comparing the practices. An issue whose impact on medical care, education and research should be further investigated.
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Affiliation(s)
- Waltraud Fink
- Karl Landsteiner Institut für Systematik in der Allgemeinmedizin, Straning 153, 3722, Straning, Österreich.
| | | | - Gustav Kamenski
- Karl Landsteiner Institut für Systematik in der Allgemeinmedizin, Ollersbachgasse 144, 2261, Angern, Österreich
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Smits FT, Brouwer HJ, Schene AH, van Weert HCPM, ter Riet G. Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care. BMJ Open 2016; 6:e012563. [PMID: 27965250 PMCID: PMC5168647 DOI: 10.1136/bmjopen-2016-012563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs. DESIGN Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients' problem lists were defined as chronic ECs (CECs), other episodes as TECs. SETTING 1 Dutch urban primary healthcare centre served by 5 GPs. PARTICIPANTS All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009. OUTCOME MEASURES Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs. RESULTS The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52-54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs). CONCLUSIONS FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs.
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Affiliation(s)
- Frans T Smits
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk J Brouwer
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Olagundoye OA, van Boven K, van Weel C. International Classification of Primary Care-2 coding of primary care data at the general out-patients' clinic of General Hospital, Lagos, Nigeria. J Family Med Prim Care 2016; 5:291-297. [PMID: 27843830 PMCID: PMC5084550 DOI: 10.4103/2249-4863.192341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Primary care serves as an integral part of the health systems of nations especially the African continent. It is the portal of entry for nearly all patients into the health care system. Paucity of accurate data for health statistics remains a challenge in the most parts of Africa because of inadequate technical manpower and infrastructure. Inadequate quality of data systems contributes to inaccurate data. A simple-to-use classification system such as the International Classification of Primary Care (ICPC) may be a solution to this problem at the primary care level. Objectives: To apply ICPC-2 for secondary coding of reasons for encounter (RfE), problems managed and processes of care in a Nigerian primary care setting. Furthermore, to analyze the value of selected presented symptoms as predictors of the most common diagnoses encountered in the study setting. Materials and Methods: Content analysis of randomly selected patients’ paper records for data collection at the end of clinic sessions conducted by family physicians at the general out-patients’ clinics. Contents of clinical consultations were secondarily coded with the ICPC-2 and recorded into excel spreadsheets with fields for sociodemographic data such as age, sex, occupation, religion, and ICPC elements of an encounter: RfE/complaints, diagnoses/problems, and interventions/processes of care. Results: Four hundred and one encounters considered in this study yielded 915 RfEs, 546 diagnoses, and 1221 processes. This implies an average of 2.3 RfE, 1.4 diagnoses, and 3.0 processes per encounter. The top 10 RfE, diagnoses/common illnesses, and processes were determined. Through the determination of the probability of the occurrence of certain diseases beginning with a RfE/complaint, the top five diagnoses that resulted from each of the top five RfE were also obtained. The top five RfE were: headache, fever, pain general/multiple sites, visual disturbance other and abdominal pain/cramps general. The top five diagnoses were: Malaria, hypertension uncomplicated, visual disturbance other, peptic ulcer, and upper respiratory infection. From the determination of the posterior probability given the top five RfE, malaria, hypertension, upper respiratory infection, refractive error, and conjuctivitis were the five most frequent diagnoses that resulted from a complaint of a headache. Conclusion: The study demonstrated that ICPC-2 can be applied to primary care data in the Nigerian context to generate information about morbidity and services provided. It also provided an empirical basis to support diagnosis and prognostication in a primary care setting. In developing countries where the transition to electronic health records is still evolving and fraught with limitations, more reliable data collection can be achieved from paper records through the application of the ICPC-2.
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Affiliation(s)
| | - Kees van Boven
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia
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Ramond-Roquin A, Bouton C, Bègue C, Petit A, Roquelaure Y, Huez JF. Psychosocial Risk Factors, Interventions, and Comorbidity in Patients with Non-Specific Low Back Pain in Primary Care: Need for Comprehensive and Patient-Centered Care. Front Med (Lausanne) 2015; 2:73. [PMID: 26501062 PMCID: PMC4597113 DOI: 10.3389/fmed.2015.00073] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/22/2015] [Indexed: 12/19/2022] Open
Abstract
Non-specific low back pain (LBP) affects many people and has major socio-economic consequences. Traditional therapeutic strategies, mainly focused on biomechanical factors, have had moderate and short-term impact. Certain psychosocial factors have been linked to poor prognosis of LBP and they are increasingly considered as promising targets for management of LBP. Primary health care providers (HCPs) are involved in most of the management of people with LBP and they are skilled in providing comprehensive care, including consideration of psychosocial dimensions. This review aims to discuss three pieces of recent research focusing on psychosocial issues in LBP patients in primary care. In the first systematic review, the patients' or HCPs' overall judgment about the likely evolution of LBP was the factor most strongly linked to poor outcome, with predictive validity similar to that of multidimensional scales. This result may be explained by the implicit aggregation of many prognostic factors underlying this judgment and suggests the relevance of considering the patients from biopsychosocial and longitudinal points of view. The second review showed that most of the interventions targeting psychosocial factors in LBP in primary care have to date focused on the cognitive-behavioral factors, resulting in little impact. It is unlikely that any intervention focusing on a single factor would ever fit the needs of most patients; interventions targeting determinants from several fields (mainly psychosocial, biomechanical, and occupational) may be more relevant. Should multiple stakeholders be involved in such interventions, enhanced interprofessional collaboration would be critical to ensure the delivery of coordinated care. Finally, in the third study, the prevalence of psychosocial comorbidity in chronic LBP patients was not found to be significantly higher than in other patients consulting in primary care. Rather than specifically screening for psychosocial conditions, this suggests taking into account any potential comorbidity in patients with chronic LBP, as in other patients. All these results support the adoption of a more comprehensive and patient-centered approach when dealing with patients with LBP in primary care. As this condition is illustrative of many situations encountered in primary care, the strategies proposed here may benefit most patients consulting in this setting.
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Affiliation(s)
- Aline Ramond-Roquin
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Céline Bouton
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of General Practice, University of Nantes, L’Université Nantes Angers Le Mans, Nantes, France
| | - Cyril Bègue
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
| | - Audrey Petit
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Yves Roquelaure
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Department of Occupational Health, University Hospital of Angers, Angers, France
| | - Jean-François Huez
- Department of General Practice, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
- Laboratory of Ergonomics and Epidemiology in Occupational Health, University of Angers, L’Université Nantes Angers Le Mans, Angers, France
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Kostopoulou O, Lionis C, Angelaki A, Ayis S, Durbaba S, Delaney BC. Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece. Fam Pract 2015; 32:323-8. [PMID: 25800247 DOI: 10.1093/fampra/cmv012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a recent randomized controlled trial, providing UK family physicians with 'early support' (possible diagnoses to consider before any information gathering) was associated with diagnosing hypothetical patients on computer more accurately than control. Another group of physicians, who gathered information, gave a diagnosis, and subsequently received a list of possible diagnoses to consider ('late support'), were no more accurate than control, despite being able to change their initial diagnoses. OBJECTIVE To replicate the UK study findings in another country with a different primary health care system. METHODS All study materials were translated into Greek. Greek family physicians were randomly allocated to one of three groups: control, early support and late support. Participants saw nine scenarios in random order. After reading some information about the patient and the reason for encounter, they requested more information to diagnose. The main outcome measure was diagnostic accuracy. RESULTS One hundred fifty Greek family physicians participated. The early support group was more accurate than control [odds ratio (OR): 1.67 (1.21-2.31)]. Like their UK counterparts, physicians in the late support group rarely changed their initial diagnoses after receiving support. The pooled OR for the early support versus control comparison from the meta-analysis of the UK and Greek data was 1.40 (1.13-1.67). CONCLUSION Using the same methodology with a different sample of family physicians in a different country, we found that suggesting diagnoses to consider before physicians start gathering information was associated with more accurate diagnoses. This constitutes further supportive evidence of a generalizable effect of early support.
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Affiliation(s)
- Olga Kostopoulou
- Department of Primary Care & Public Health Sciences, King's College London, London, UK and
| | - Christos Lionis
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | - Agapi Angelaki
- Clinic of Social and Family Medicine, University of Crete, Heraklion, Greece
| | - Salma Ayis
- Department of Primary Care & Public Health Sciences, King's College London, London, UK and
| | - Stevo Durbaba
- Department of Primary Care & Public Health Sciences, King's College London, London, UK and
| | - Brendan C Delaney
- Department of Primary Care & Public Health Sciences, King's College London, London, UK and
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Ramond-Roquin A, Pecquenard F, Schers H, Van Weel C, Oskam S, Van Boven K. Psychosocial, musculoskeletal and somatoform comorbidity in patients with chronic low back pain: original results from the Dutch Transition Project. Fam Pract 2015; 32:297-304. [PMID: 25911506 DOI: 10.1093/fampra/cmv027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Better insight into frequent comorbidities in patients with chronic (≥ 3 months) low back pain (LBP) may help general practitioners when planning comprehensive care for these patients. OBJECTIVE To prospectively study the prevalence of psychological, social, musculoskeletal and somatoform disorders in patients presenting with chronic non-specific LBP to general practitioners, in comparison to a contrast group of patients consulting in the same setting. METHODS This case-control study is embedded in a historical cohort, based on a primary care practice-based research network. All the health problems presented by the patients were prospectively coded according to the international classification of primary care between 1996 and 2013. The prevalence of psychological, social, musculoskeletal and somatoform disorders presented by the adult patients from 1 year before the onset of chronic LBP to 2 years after onset was compared to that of matched patients consulting without LBP, using conditional logistic regressions. RESULTS The 1511 patients with chronic LBP more often presented musculoskeletal disorders than the contrast group during the year before the onset of LBP and during the second year after it, with odds ratios (95%confidence intervals) of 1.39 (1.20-1.61) and 1.56 (1.35-1.81), respectively. They did not more often present psychological, social or non-musculoskeletal somatoform disorders. CONCLUSIONS General practitioners should consider all the musculoskeletal symptoms when caring for patients with chronic LBP. Rather than systematically screening for specific psychological, social or somatoform disorders, they should consider with the patient how LBP and any type of potential comorbidity interfere with his/her daily functioning.
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Affiliation(s)
- Aline Ramond-Roquin
- Department of General Practice, PRES LUNAM, Angers, France, Laboratory of Ergonomics and Epidemiology in Occupational Health, PRES LUNAM, Angers, France,
| | | | - Henk Schers
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Chris Van Weel
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands, Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia and
| | - Sibo Oskam
- Formerly of the Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kees Van Boven
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Soler JK, Corrigan D, Kazienko P, Kajdanowicz T, Danger R, Kulisiewicz M, Delaney B. Evidence-based rules from family practice to inform family practice; the learning healthcare system case study on urinary tract infections. BMC FAMILY PRACTICE 2015; 16:63. [PMID: 25980623 PMCID: PMC4438341 DOI: 10.1186/s12875-015-0271-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Analysis of encounter data relevant to the diagnostic process sourced from routine electronic medical record (EMR) databases represents a classic example of the concept of a learning healthcare system (LHS). By collecting International Classification of Primary Care (ICPC) coded EMR data as part of the Transition Project from Dutch and Maltese databases (using the EMR TransHIS), data mining algorithms can empirically quantify the relationships of all presenting reasons for encounter (RfEs) and recorded diagnostic outcomes. We have specifically looked at new episodes of care (EoC) for two urinary system infections: simple urinary tract infection (UTI, ICPC code: U71) and pyelonephritis (ICPC code: U70). METHODS Participating family doctors (FDs) recorded details of all their patient contacts in an EoC structure using the ICPC, including RfEs presented by the patient, and the FDs' diagnostic labels. The relationships between RfEs and episode titles were studied using probabilistic and data mining methods as part of the TRANSFoRm project. RESULTS The Dutch data indicated that the presence of RfE's "Cystitis/Urinary Tract Infection", "Dysuria", "Fear of UTI", "Urinary frequency/urgency", "Haematuria", "Urine symptom/complaint, other" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection" . The Maltese data indicated that the presence of RfE's "Dysuria", "Urinary frequency/urgency", "Haematuria" are all strong, reliable, predictors for the diagnosis "Cystitis/Urinary Tract Infection". The Dutch data indicated that the presence of RfE's "Flank/axilla symptom/complaint", "Dysuria", "Fever", "Cystitis/Urinary Tract Infection", "Abdominal pain/cramps general" are all strong, reliable, predictors for the diagnosis "Pyelonephritis" . The Maltese data set did not present any clinically and statistically significant predictors for pyelonephritis. CONCLUSIONS We describe clinically and statistically significant diagnostic associations observed between UTIs and pyelonephritis presenting as a new problem in family practice, and all associated RfEs, and demonstrate that the significant diagnostic cues obtained are consistent with the literature. We conclude that it is possible to generate clinically meaningful diagnostic evidence from electronic sources of patient data.
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Affiliation(s)
- Jean K Soler
- Mediterranean Institute of Primary Care 19, Triq ir-Rand, Attard, Malta.
| | - Derek Corrigan
- Department of General Practice, HRB Centre for Primary Care Research, Beaux Lane House, Lower Mercer Street, Dublin, Ireland.
| | - Przemyslaw Kazienko
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | - Tomasz Kajdanowicz
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | | | - Marcin Kulisiewicz
- Wroclaw University of Technology, Wybrzeze Wyspianskiego 27, 50-370, Wroclaw, Poland.
| | - Brendan Delaney
- Wolfson Chair of General Practice, King's College London, Capital House, Guy's Hospital, London, England.
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Buja A, Toffanin R, Rigon S, Sandonà P, Carraro D, Damiani G, Baldo V. Out-of-hours primary care services: demands and patient referral patterns in a Veneto region (Italy) Local Health Authority. Health Policy 2015; 119:437-46. [PMID: 25620776 DOI: 10.1016/j.healthpol.2015.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 12/05/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to describe the characteristics of patients admitted to an out-of-hours (OOH) service and to analyze the related outputs. SETTING A retrospective population-based cohort study was conducted by analyzing an electronic database recording 23,980 OOH service contacts in 2011 at a Local Health Authority in the Veneto Region (North-East Italy). METHOD A multinomial logistic regression was used to compare the characteristics of contacts handled by the OOH physicians with cases referred to other services. RESULTS OOH service contact rates were higher for the oldest and youngest age groups and for females rather than males. More than half of the contacts concerned patients who were seen by a OOH physician. More than one in three contacts related problems managed over the phone; only ≈10% of the patients were referred to other services. Many factors, including demographic variables, process-logistic variables and clinical characteristics of the contact, were associated with the decision to visit the patient's home (rather than provide telephone advice alone), or to refer patients to an ED or to a specialist. Our study demonstrated, even after adjusting, certain OOH physicians were more likely than their colleagues to refer a patient to an ED. CONCLUSION Our study shows that OOH services meet composite and variously expressed demands. The determining factors associated with cases referred to other health care services should be considered when designing clinical pathways in order to ensure a continuity of care. The unwarranted variability in OOH physicians' performance needs to be addressed.
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Affiliation(s)
- Alessandra Buja
- Dipartimento di Medicina Molecolare, Sezione di Sanità Pubblica, Laboratorio di Sanità Pubblica e Studi di Popolazione, Università di Padova, Italy.
| | | | - Stefano Rigon
- Direzione Sanitaria, Azienda ULSS 4, Regione Veneto, Italy
| | - Paolo Sandonà
- Scuola di Specializzazione in Igiene e Medicina Preventiva, Università di Padova, Italy
| | | | - Gianfranco Damiani
- Facoltà di Medicina, Departmemt of Public Health, Università Cattolica del Sacro Cuore, Italy
| | - Vincenzo Baldo
- Dipartimento di Medicina Molecolare, Sezione di Sanità Pubblica, Laboratorio di Sanità Pubblica e Studi di Popolazione, Università di Padova, Italy
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Heinonen J, Koskela T, Soini E, Ryynänen O. Primary-care-based episodes of care and their costs in a three-month follow-up in Finland. Scand J Prim Health Care 2015; 33:283-90. [PMID: 26683288 PMCID: PMC4750738 DOI: 10.3109/02813432.2015.1114352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To explore patient characteristics, resource use, and costs related to different episodes of care (EOC) in Finnish health care. DESIGN Data were collected during a three-month prospective, non-randomized follow-up study (Effective Health Centre) using questionnaires and an electronic health record. SETTING Three primary health care practices in Pirkanmaa, Finland. SUBJECTS Altogether 622 patients were recruited during a one-week period. Inclusion criteria: the patient had a doctor's or nurse's appointment on the recruiting day and agreed to participate. Exclusion criteria: patients visiting a specialized health guidance clinic for pregnant women, children, and mothers. MAIN OUTCOME MEASURES Patient characteristics, resource use, and costs based on the ICPC-2 EOC classification. RESULTS On average, the patients had 1.22 EOCs during the three months. Patient characteristics and resource use differed between the EOC chapters. Chapter L, "Musculoskeletal", had the most episodes (17%). The most common (8%) single EOC was "upper respiratory infection". The mean cost of an episode (COE) was €389.56 (standard error 61.11) and the median COE was €165.00 (interquartile range €118.46-288.56) during the three-month follow-up. The most expensive chapter was K, "Circulatory", with a mean COE of €909.85. The most expensive single COE was in chapter K, €32 545.56. The most expensive 1% of the COEs summed up covered 36% of the total COEs. CONCLUSION Patient characteristics, resource use, and costs differed between the ICPC-2 chapters, which could be taken into account in service planning and pricing. Future studies should incorporate more specific diagnoses, larger data sets, and longer follow-up times. Key points The most common episodes were under the ICPC-2 "Musculoskeletal" chapter, but the highest mean and single-episode costs were related to the "Circulatory" chapter. The mean (median) cost of episodes that started in primary care was €390 (€165) during the three-month follow-up. Patient characteristics, resource use, and costs differed significantly between the ICPC-2 chapters. The most expensive 1% of the episodes covered 36% of the total costs of all the episodes.
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Affiliation(s)
- J. Heinonen
- School of Medicine, University of Tampere, Tampere, Finland
- CONTACT Johanna Heinonen School of Medicine, University of Tampere, Tampere, Finland
| | - T.H. Koskela
- Department of General Practice, University of Tampere, Finland
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Takeshima T, Kumada M, Mise J, Ishikawa Y, Yoshizawa H, Nakamura T, Okayama M, Kajii E. Reasons for encounter and diagnoses of new outpatients at a small community hospital in Japan: an observational study. Int J Gen Med 2014; 7:259-69. [PMID: 24940078 PMCID: PMC4051729 DOI: 10.2147/ijgm.s62384] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE) and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods. Methods This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, “Symptoms/Complaints”, and component 7, “Diagnosis/Diseases”, of the International Classification of Primary Care, 2nd edition (ICPC-2). We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship. Results We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2,252 RFEs, 1,408 (62.5%) included at least one of the 36 symptoms listed in the Model Core Curriculum and 1,443 (64.1%) included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, “A91 Abnormal result investigation”, “R21 Throat symptom/complaint”, and “R07 Sneezing/nasal congestion”, which were among the top 10 RFEs, were not included in these two guidelines. Conclusion We identified the common RFEs and diagnoses at a small hospital in Japan and revealed the inconsistencies between the RFEs observed and common symptoms listed in the guidelines. Our findings can be useful in improving the general practice medical education curricula.
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Affiliation(s)
- Taro Takeshima
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan ; Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Maki Kumada
- Division of The Project for Integration of Community Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan ; Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan
| | - Junichi Mise
- Division of Human Resources Development for Community Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | | | - Hiromichi Yoshizawa
- Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan
| | - Takashi Nakamura
- Division of The Project for Integration of Community Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan ; Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan
| | - Masanobu Okayama
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Eiji Kajii
- Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan
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Round T, Steed L, Shankleman J, Bourke L, Risi L. Primary care delays in diagnosing cancer: what is causing them and what can we do about them? J R Soc Med 2013; 106:437-40. [PMID: 24108536 DOI: 10.1177/0141076813504744] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Thomas Round
- Primary Care and Public Health Sciences, King's College London, Capital House, London SE1 3QD, UK
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Gérvas J, Pastor-Sánchez R, Pérez-Fernández M. Crying patients in General/Family Practice: incidence, reasons for encounter and health problems. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2012. [DOI: 10.5712/rbmfc7(24)629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Context: Despite evidence demonstrating the benefits of understanding patients, there is a paucity of information about how physicians address psychological and social concerns of patients. No one study has been published about the incidence of crying in General/Family Practice. Objective: To know the incidence of crying in primary care/general practice, and the patients’ characteristics, their reasons for encounter and their health problems. Design: A descriptive, prospective study, of one year, of three general practitioners/family physicians in Madrid, Spain. Setting: primary care (doctors’ office and patients’ home). Subjects: Face to face encounters with crying patients. Main outcome measure: At least one rolling tear. Results: Patients cried in 157 encounters out of a total of 18,627 giving an incidence rate of 8.4 per thousand. More frequent reasons for encounters were: feeling depressed (12.7%), social handicap (mainly social isolation/living alone) (6.4%), relationship problem with partner (5.1%) and feeling anxious (3.2%). More frequent health problems were: depressive disorder (23.6%), anxiety disorder (8.3%), cerebrovascular disease (5.1%) and loss/death of partner (3.8%). Conclusions: Crying in primary care is not uncommon. Reasons for crying cover the whole range of human problems, mainly social and psychological problems.
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Heins MJ, Schermer TRJ, de Saegher MEA, van Boven K, van Weel C, Grutters JC. Diagnostic pathways for interstitial lung diseases in primary care. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:253-4. [PMID: 22964744 DOI: 10.4104/pcrj.2012.00074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Soler JK, Okkes I. Reasons for encounter and symptom diagnoses: a superior description of patients' problems in contrast to medically unexplained symptoms (MUS). Fam Pract 2012; 29:272-82. [PMID: 22308181 DOI: 10.1093/fampra/cmr101] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.
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Affiliation(s)
- Jean Karl Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
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Dawes M. Symptoms, reasons for encounter and diagnoses. Family practice is an international discipline. Fam Pract 2012; 29:243-4. [PMID: 22421059 DOI: 10.1093/fampra/cms018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Soler JK, Okkes I, Oskam S, van Boven K, Zivotic P, Jevtic M, Dobbs F, Lamberts H. An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across populations. Fam Pract 2012; 29:299-314. [PMID: 22308178 DOI: 10.1093/fampra/cmr099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This is an international study of the epidemiology of family medicine (FM) in three practice populations from the Netherlands, Malta and Serbia. Diagnostic associations between common reasons for encounter (RfEs) and episodes titles are compared and similarities and differences are described and analysed. METHODOLOGY Participating family doctors (FDs) recorded details of all their patient contacts in an 'episode of care (EoC)' structure using the International Classification of Primary Care (ICPC). RfEs presented by the patient and episode titles (diagnostic labels of EoCs) were classified with ICPC. The relationships between RfEs and episode titles were studied with Bayesian methods. RESULTS Distributions of diagnostic odds ratios (ORs) from the three population databases are presented and compared. CONCLUSIONS ICPC, the RfE and the EoC data model are appropriate tools to study the process of diagnosis in FM. Distributions of diagnostic associations between RfEs and episode titles in the Transition Project international populations show remarkable similarities and congruencies in the process of diagnosis from both the RfE and the episode title perspectives. The congruence of diagnostic associations between populations supports the use of such data from one population to inform diagnostic decisions in another. Differences in the magnitude of such diagnostic associations are significant, and population-specific data are therefore desirable. We propose that both an international (common) and a local (health care system specific) content of FM exist and that the empirical distributions of diagnostic associations presented in this paper are a reflection of both these effects. We also observed that the frequency of exposure to such diagnostic challenges had a strong effect on the confidence intervals of diagnostic ORs reflecting these diagnostic associations. We propose that this constitutes evidence that expertise in FM is associated with frequency of exposure to diagnostic challenges.
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Affiliation(s)
- Jean K Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
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Soler JK, Okkes I, Oskam S, van Boven K, Zivotic P, Jevtic M, Dobbs F, Lamberts H. An international comparative family medicine study of the Transition Project data from the Netherlands, Malta, Japan and Serbia. An analysis of diagnostic odds ratios aggregated across age bands, years of observation and individual practices. Fam Pract 2012; 29:315-31. [PMID: 22308180 DOI: 10.1093/fampra/cmr100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION This is a study of the process of diagnosis in family medicine (FM) in four practice populations from the Netherlands, Malta, Serbia and Japan. Diagnostic odds ratios (ORs) for common reasons for encounter (RfEs) and episode titles are used to study the process of diagnosis in international FM and to test the assumption that data can be aggregated across different age bands, practices and years of observation. METHODOLOGY Participating family doctors (FDs) recorded details of all their patient contacts in an episode of care (EoC) structure using the International Classification of Primary Care (ICPC). RfEs presented by the patient and the diagnostic labels (EoC titles) recorded for each encounter were classified with ICPC. The relationships between RfEs and episode titles were expressed as ORs using Bayesian probability analysis to calculate the posterior (post-test) odds of an episode title given an RfE, at the start of a new EoC. RESULTS The distributions of diagnostic ORs from the four population databases are tabled across age groups, years of observation and practices. CONCLUSIONS There is a lot of congruence in diagnostic process and concepts between populations, across age groups, years of observation and FD practices, despite differences in the strength of such diagnostic associations. There is particularly little variability of diagnostic ORs across years of observation and between individual FD practices. Given our findings, it makes sense to aggregate diagnostic data from different FD practices and years of observation. Our findings support the existence of common core diagnostic concepts in international FM.
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Affiliation(s)
- Jean K Soler
- Faculty of Life and Health Sciences, University of Ulster, Coleraine, UK.
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Soler JK, Okkes I, Oskam S, van Boven K, Zivotic P, Jevtic M, Dobbs F, Lamberts H. An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing incidence and prevalence rates of reasons for encounter and diagnostic titles of episodes of care across populations. Fam Pract 2012; 29:283-98. [PMID: 22308182 DOI: 10.1093/fampra/cmr098] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION This is a study of the epidemiology of family medicine (FM) in three practice populations from the Netherlands, Malta and Serbia. Incidence and prevalence rates, especially of reasons for encounter (RfEs) and episode labels, are compared. METHODOLOGY Participating family doctors (FDs) recorded details of all their patient contacts in an episode of care (EoC) structure using electronic patient records based on the International Classification of Primary Care (ICPC), collecting data on all elements of the doctor-patient encounter. RfEs presented by the patient, all FD interventions and the diagnostic labels (EoCs labels) recorded for each encounter were classified with ICPC (ICPC-2-E in Malta and Serbia and ICPC-1 in the Netherlands). RESULTS The content of family practice in the three population databases, incidence and prevalence rates of the common top 20 RfEs and EoCs in the three databases are given. CONCLUSIONS Data that are collected with an episode-based model define incidence and prevalence rates much more precisely. Incidence and prevalence rates reflect the content of the doctor-patient encounter in FM but only from a superficial perspective. However, we found evidence of an international FM core content and a local FM content reflected by important similarities in such distributions. FM is a complex discipline, and the reduction of the content of a consultation into one or more medical diagnoses, ignoring the patient's RfE, is a coarse reduction, which lacks power to fully characterize a population's health care needs. In fact, RfE distributions seem to be more consistent between populations than distributions of EoCs are, in many respects.
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Affiliation(s)
- Jean K Soler
- Mediterranean Institute of Primary Care, 19, Triq ir-Rand, Attard ATD1300, Malta.
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