Download - Wonca Europe 20071 WONCA Europe Paris 2007 Marc Jamoulle family doctor Researcher, Departement of General Practice University of Louvain, Belgium Conflict.

Wonca Europe 2007Wonca Europe 2007 11

WONCA EuropeWONCA EuropeParis 2007Paris 2007

Marc JamoulleMarc Jamoullefamily doctorfamily doctor

Researcher, Departement of General PracticeResearcher, Departement of General PracticeUniversity of Louvain, BelgiumUniversity of Louvain, Belgium

Conflict of interest : unfortunately none

ICPC step by stepICPC step by step

International International Classification of Primary Classification of Primary Care is a tool for GP/FMCare is a tool for GP/FM


What is ICPC meant for ?What is ICPC meant for ?

IndividualyIndividualy ; it provides a ; it provides a representation ofrepresentation of

patient doctor interactionpatient doctor interaction doctor's decision processdoctor's decision process Along the time lineAlong the time line

• CollectivelyCollectively; Allows ; Allows Satistical & Satistical & epidemiological studiesepidemiological studies


Why a code ?Why a code ?

Lowering of Lowering of redundancyredundancy

From pencil to machineFrom pencil to machine

Redundancy / Redndancy / Redndncy / Redndnc / Rdndnc / RdncRedundancy / Redndancy / Redndncy / Redndnc / Rdndnc / Rdnc

Source : Claude Elwood Shannon (1916-2001)


Why a specific GP/FM Why a specific GP/FM classification?classification?

• ICPC (WONCA)ICPC (WONCA)

• Conceptual constructConceptual construct

• About health problems About health problems

• Patient centeredPatient centered

• Structural basementStructural basement

• ICD (WHO)ICD (WHO)

• Historical constructHistorical construct• About diseasesAbout diseases• Provider centeredProvider centered• Linear basementLinear basement


ICPC : factsICPC : facts

WICCWICC

Since the 70'Since the 70'

41 members 41 members

25 countries25 countries

5 continents5 continents

Preparing ICPC-3Preparing ICPC-3

ICPC-2ICPC-2

18 languages18 languages

Various licencesVarious licences

UniversalUniversal

Endorsed by WHOEndorsed by WHO

TerminologiesTerminologies

Heidelberg 2006

17 chapters17 chapters

1515somaticsomatic

11PsychologicPsychologic

1 1 SocialSocial

3 components coming from 3 gathered 3 components coming from 3 gathered classificationsclassifications

Symptoms Symptoms and complaintsand complaints ProcessProcess DiagnosesDiagnoses

R F E CR F E CReason for Reason for Encounter Encounter ClassificationClassification

IC-Proces-PCIC-Proces-PCInternational International ClassificationClassificationof Process of Process in Primary Carein Primary Care

ICHPPCICHPPC

ICHPPC-2-dICHPPC-2-dInternational International ClassificationClassification

of Health Problem of Health Problem inin

Primary CarePrimary Care1& 2 edition, 1& 2 edition,

defineddefined & &

ICPCICPC

ICPC 2ICPC 2

Revision and inclusion of criteria and definitionsRevision and inclusion of criteria and definitions

ICPC 2 RICPC 2 RRevised transcoding to ICD-10Revised transcoding to ICD-10

Towards ICPC 3Towards ICPC 3

1974

1981

1983

1985

1987

1998

2005

1974

1979

ICPC story

ICPCICPC

orders the domain orders the domain

of primary careof primary care

(family medicine)… (family medicine)…

.. and allows the coding of .. and allows the coding of encountersencounters in an in an episode of episode of

carecare structure structure

17 alpha-coded chapters based on 17 alpha-coded chapters based on body systemsbody systems

7 identical components, with rubrics 7 identical components, with rubrics bearing a two-digit numeric codebearing a two-digit numeric code

ICPC-2 Bi-Axial structureICPC-2 Bi-Axial structure

ICPC CHAPTERSICPC CHAPTERS

AA General and unspecified General and unspecifiedBB Blood/bloodforming organs, lymphatics (spleen, bone marrow) Blood/bloodforming organs, lymphatics (spleen, bone marrow)DD Digestive DigestiveFF Eye (Focal) Eye (Focal)HH Ear (Hearing) Ear (Hearing)KK Circulatory CirculatoryLL Musculoskeletal (Locomotion) Musculoskeletal (Locomotion)NN Neurological NeurologicalPP Psychological PsychologicalRR Respiratory RespiratorySS Skin SkinTT Endocrine, metabolic and nutritional (Thyroid) Endocrine, metabolic and nutritional (Thyroid)UU Urological UrologicalWW Pregnancy, child bearing, family planning (Women) Pregnancy, child bearing, family planning (Women)XX Female genital (X-chromosome) Female genital (X-chromosome)YY Male genital (Y-chromosome) Male genital (Y-chromosome)ZZ Social problems Social problems

ICPC COMPONENTSICPC COMPONENTS(standard, if possible, for all chapters)(standard, if possible, for all chapters)

1.1. Symptoms and complaints Symptoms and complaints 1-291-292.2. Diagnostic and preventive procedures Diagnostic and preventive procedures 30-4930-493.3. Treatment procedures, medication Treatment procedures, medication 50-5950-594.4. Test resultsTest results 60-6160-615.5. Administrative Administrative 62626.6. Referral and other reasons for encounter Referral and other reasons for encounter 63-6963-697.7. Diseases:Diseases: 70-9970-99

- infectious diseases- infectious diseases- neoplasms- neoplasms- injuries- injuries

- congenital anomalies- congenital anomalies- other specific diseases- other specific diseases

Chapters and components Chapters and components together form a ‘chessboard’..together form a ‘chessboard’..

A - general A - general B - blood , immune B - blood , immune

systemsystem D - digestiveD - digestive F - eyeF - eye H - ear (hearing)H - ear (hearing) K - circulatoryK - circulatory L - musculoskeletalL - musculoskeletal N - neurologicalN - neurological P - psychologicalP - psychological

R - respiratoryR - respiratory S - skinS - skin T - metabolic, T - metabolic,

endocrineendocrine U - urologicalU - urological W - women’s health, W - women’s health,

pregnancy, family planpregnancy, family plan X - female genitalX - female genital Y - male genitalY - male genital Z - social problemsZ - social problems

ICPC-2 Structure : ChaptersICPC-2 Structure : Chapters

Z25 ASSAULT & HARMFUL EVENTZ25 ASSAULT & HARMFUL EVENT bewitchmentbewitchment bewitchment with pig's liverbewitchment with pig's liver damage from maledictiondamage from malediction desecration of grave by witchesdesecration of grave by witches dupa spellsdupa spells evil influence nsevil influence ns harm from fightingharm from fighting harm from troublesome spiritsharm from troublesome spirits harm from warharm from war harm from witchcraftharm from witchcraft harm from witches' familiarsharm from witches' familiars makgoba bewitchmentmakgoba bewitchment negative condition nsnegative condition ns possession by spiritspossession by spirits possession by bad spiritspossession by bad spirits possession by evil spiritspossession by evil spirits

Cridland JS,.Koonin S. Use of traditional medicinestowards a classification. S.Afr.Med J 2001;91:489-91

Example of opening of an ICPC rubric

• Implies opening of the rubrics of ICPC


ICPC adaptabilityICPC adaptability

Paper & PencilPaper & Pencil ElectronicElectronic

Mnemotechnic

Central coding

Terminologies

Automatic coding

1987 2007

StudiesStudies

Clinical : transversal or Clinical : transversal or longitudinallongitudinal

Electronic patient recordElectronic patient record Huge database or personal oneHuge database or personal one Quality assuranceQuality assurance Documents indexingDocuments indexing

..THE PATIENT’S PROBLEM LIST..THE PATIENT’S PROBLEM LIST(8 episodes of care that are considered important; see Glossary: problem list)(8 episodes of care that are considered important; see Glossary: problem list)

From Transhis, Amsterdam

JKS 593 CONSECUTIVE PATIENTS

0

20

40

60

80

100

120

140

160

A B D F H K L N P R S T U X Y

11 doctors in Belgium 1991, Distribution of 4.000 contacts

Distribution of the Distribution of the 624 P diagnosis, same health centre624 P diagnosis, same health centre

0

20

40

60

80

100

120Medicinal drug dependency

The workload in mental health in GP/FM

Medicinal drug Drug addiction

P03 P76

Liege, Belgium, on 10440 episodes, 1999Liege, Belgium, on 10440 episodes, 1999

Comparison of chapter P diagnosis of two family doctors each in solo practice

Courtesy of Dr Joseph Huberty, Ciney, Belgium

A new insight in GP practice allowing quality assessment and

alternative teaching process

200 Primary care practitionners in 5 years

Courtesy of Dr Alejandro Lopez, Buenos aires

!!


998 abstracts, ICPC chapters distribution

103

1828

6 3

33

17

183

120

10

179

1824 24

7

42

130

A B D F H K L N P R S T U W X Y Z

P

Z

T

B

Wonca 2007

EPISODES on the time lineEPISODES on the time lineLife and death of one patientLife and death of one patient

Conception-RéalisationConception-Réalisation

Dr Jacques Dr Jacques HumbertHumbertDr Jacques HDr Jacques HidieridierDr Marc JamoulleDr Marc JamoulleDr Michel RolandDr Michel Roland

CISP-Club

June 2000Adapted from Lamberts

FECONDATION

K 73

R71

R82

S87

P76

P15 P17

Z11

P77

D97

Z11

T90

P70

R82

This day

Episode initiated or closed by the doctor

Life conditions

Death

Episode initiated or closed by doctor – patient consensus

Episode initiated or closed by the patient

Life story

ConclusionsConclusions

- ICPC used in an episode oriented registration

provides a powerfull tool for clinical use as well as

teaching the epidemiology of primary care in

undergraduate and post-graduate training

- ICPC helps to define the content of family medicine

- ICPC contributes to research