The use of ICPC in teaching and research in primary health care

Prof. Dr. J. De Maeseneer, MD, PhDFamily Physician, Community Health Centre Botermarkt,

Ghent-LedebergHead of the Department of Family Medicine andPrimary Health Care, Ghent University, Belgium

WONCA, Kos, 06.09.05

The use of ICPC in teaching and research in primary health care

1. Introduction

2. The use of ICPC in undergraduate teaching

3. The use of ICPC in post-graduate training

4. The use of ICPC in research

5. Conclusions

EPISODE OF CARE

Perceived health problem

Perceived need for care

RFE, demand for care

Diagnosis Process

RFE, demand for care

Diagnosis Process

RFE, demand for care

Diagnosis Process

ICPC ICPC

• bi-axial structure

• 17 alpha-coded chapters based on body systems/problem areas

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

ICPC Chapters (Systems)

A General and unspecifiedB Blood/bloodforming organs, lymphatics (spleen, bone marrow)D DigestiveF Eye (Focal)H Ear (Hearing)K CirculatoryL Musculoskeletal (Locomotion)N NeurologicalP PsychologicalR RespiratoryS SkinT Endocrine, metabolic and nutritional (Thyroid)U UrologicalW Pregnancy, child bearing, family planning (Women)X Female genital (X-chromosome)Y Male genital (Y-chromosome)Z Social problems

ICPC Components

Components (standard for each chapter) CODES

1. Complaints and symptoms 1-292. Diagnostic and preventive 30-493. Treatment, procedures and medication 50-594. Test results 60-615. Administrative 626. Referral and other reasons for encounter 63-69 (64!!)

7. Diagnoses/diseases: 70-99- infectious diseases- neoplasms- injuries

- congenital anomalies- other

TOOLS

• ICPC-2 – 1404 terms including all process codes

– Acts as ordering principle

– Common entities have distinct codes

– Surprisingly complete given small size

– Context of episode adds specificity

• ICD-10– 14,000 terms

– Adds clinical specificity to ICPC

2. The use of ICPC in undergraduate teaching at Ghent University

- 4th year students

- Clerkship Family Medicine and Primary Health Care

- Epidemiology of primary care

Process: - introduction

- registration during consultations

and home visits

- coding

Epidemiology of Primary Care - june 2003

Socio-economic status:

35,7%

27,0%

10,8%

22,9%

3,6%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

30,0%

35,0%

40,0%

I II III IV V

Social CLass

%

Epidemiology of Primary Care

Top 10: “Diagnoses”

ICPC-code

Diagnosis Number %

1 K86 Hypertension 54 6,2

2 A97 No disease 35 4,0

3 T90 Diabetes, non-insuline dependent 30 3,4

4 L87 Bursitis/tendinitis/synovites nos 21 2,4

5 L99 Musculoskeletal disease, other 20 2,3

6 R74 Upper respiratory tract infection, acute 20 2,3

7 S03 Warts 15 1,7

8 T93 Lipid disorder 14 1,6

9 R95 Chronic obstructive pulmonary disease 11 1,3

10 A98 Preventie 9 1,0

Total top-10 26,2%

3. The use of ICPC in post-graduate teaching

3.1. Analysis from Flanders

7,4%

0,9%

8,0%

0,8%

2,8%

14,0%12,4%

2,2%

7,1%

19,3%

10,1%

4,4%

1,8%

3,7%2,9%

0,8% 1,4%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

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

ICPC

%

3.2. Analysis from South-Africa

3. The use of ICPC in post-graduate teaching

3.3. The core of family medicine: comparative analysis: Flanders - South-Africa

ICPC-code Diagnosis Flanders S-Africa

R74 Upper respiratory infection, acute 6,8 % 8,7 %

K86 Hypertension, uncomplicated 6,3 % 7,9 %

A97 No disease 4,1 % -

R78 Acute bronchitis/bronchiolitis 2,6 % 2,2 %

T90 Diabetes Mellitus 2,0 % 2,0 %

R76 Tonsillitis, acute 1,9 % 2,0 %

R80 Influenza 1,9 % 2,1 %

R95 Chronic obstructive pulmonary disease 1,9 % 0,5 %

W11 Contraception, oral 1,6 % 0,3 %

P02 Acute stress reaction 1,6 % 0,5 %

S18 Laceration/cut 1,5 % 0,6 %

D73 Gastroenteritis, presumed infection 1,4 % 2,3 %

L89 Osteoarthrosis of hip 1,3 % 0 %

L99 Musculoskeletal disease/other 1,3 % 0,1 %

A85 Adverse effect medical agent 1,2 % -

3. The use of ICPC in post-graduate teaching

4. The use of ICPC in research

- ATC-classification ~ ICPC-Drug-classification

- Episode-oriented analysis

- Quality of drug-prescription

Analysis of drug prescription

ATC-classification: levels

1st level: 14 main groups

2nd +3rd level: therapeutic/pharmacological subgroup

4th level: therapeutic/pharmacological/chemical

subgroup

5th level: chemical substance

ATC system main groups

The main groups of the ATC classification system are listed low. A survey of

each main group is given in the beginning of each of the following chapters.

A Alimentary tract and metabolism

B Blood and blood forming organs

C Cardiovascular system

D Dermatologicals

G Genito urinary system and sex hormones

H Systematic hormonal preparations, excl. sex hormones and insulins

J Antiinfectives for systematic use

L Antineoplastic and immonomodulating agents

M Musculo-skeletal system

N Nervous system

P Antiparasitic products, insecticides and repellents

R Respiratory system

S Sensory organs

V Various

Conclusions

- ICPC used in an episode oriented registration

provides a powerfull tool for 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