The use of ICPC in teaching and research in primary health care Prof. Dr. J. De Maeseneer, MD, PhD Family Physician, Community Health Centre Botermarkt, Ghent-Ledeberg Head of the Department of Family Medicine and Primary Health Care, Ghent University, Belgium WONCA, Kos,

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 DiagnosisProcess RFE, demand for care DiagnosisProcess RFE, demand for care DiagnosisProcess

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 unspecified B Blood/bloodforming organs, lymphatics (spleen, bone marrow) D Digestive F Eye (Focal) H Ear (Hearing) K Circulatory L Musculoskeletal (Locomotion) N Neurological P Psychological R Respiratory S Skin T Endocrine, metabolic and nutritional (Thyroid) U Urological W 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 Diagnostic and preventive Treatment, procedures and medication Test results Administrative 62 6.Referral and other reasons for encounter63-69 (64!!) 7.Diagnoses/diseases: 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:

Epidemiology of Primary Care Top 10: “Diagnoses” ICPC- code DiagnosisNumber% 1K86Hypertension546,2 2A97No disease354,0 3T90Diabetes, non-insuline dependent303,4 4L87Bursitis/tendinitis/synovites nos212,4 5L99Musculoskeletal disease, other202,3 6R74Upper respiratory tract infection, acute202,3 7S03Warts151,7 8T93Lipid disorder141,6 9R95Chronic obstructive pulmonary disease111,3 10A98Preventie91,0 Total top-1026,2%

3. The use of ICPC in post-graduate teaching 3.1.Analysis from Flanders

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-codeDiagnosisFlandersS-Africa R74 Upper respiratory infection, acute 6,8 %8,7 % K86Hypertension, uncomplicated6,3 %7,9 % A97No disease4,1 %- R78Acute bronchitis/bronchiolitis2,6 %2,2 % T90Diabetes Mellitus2,0 % R76Tonsillitis, acute1,9 %2,0 % R80Influenza1,9 %2,1 % R95Chronic obstructive pulmonary disease1,9 %0,5 % W11Contraception, oral1,6 %0,3 % P02Acute stress reaction1,6 %0,5 % S18Laceration/cut1,5 %0,6 % D73Gastroenteritis, presumed infection1,4 %2,3 % L89Osteoarthrosis of hip1,3 %0 % L99Musculoskeletal disease/other1,3 %0,1 % A85Adverse effect medical agent1,2 %- 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. AAlimentary tract and metabolism BBlood and blood forming organs CCardiovascular system DDermatologicals GGenito urinary system and sex hormones HSystematic hormonal preparations, excl. sex hormones and insulins JAntiinfectives for systematic use LAntineoplastic and immonomodulating agents MMusculo-skeletal system NNervous system PAntiparasitic products, insecticides and repellents RRespiratory system SSensory organs VVarious

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