1. Grete Moth The Danish GP-contact registration project The Research Unit for General Practice and the Department for General Medicine Aarhus University Grete Moth, Senior researcher, MHSc, Ph.D.

2. Grete Moth What’s going on in general practice? 1.What do patients present with in the GP practices? - and with 1, 2, 3 …. problems? 2.For how many patient encounters can an exact diagnosis be made? 3.How often do the GP consider cancer during the contacts? 4. Which types of encounters are experienced by the GP as weighing heavily and exhausting? Background

3. Grete Moth Background Previous registrations: 1975, 1983 and 1993 1.Patient age and gender 2.Type of contact, due to symptom or prevention 3.Reason for encounter and diagnosis 4.Referral or prescription

4. Grete Moth Background Limitations: Limited information of the contact Clinical staff not involved Patient experiences not involved No knowledge on patient care pathways

5. Grete Moth Aim Obtain knowledge of: 1.The activity of the GPs and their auxiliary staff 2.Patient experiences of their contact with the GP clinic and of their self-rated health 3.Patients’ use of medication 4.Patient care pathways in the care health service

6. Grete Moth Methods Sources of data: - GP - Clinical staff - Patients - Registries

7. Grete Moth Methods Study period: 2009 Eligible participants: 850 GPs in Central Denmark Region

8. Grete Moth GPs registrate all contacts on one day Methods

9. Grete Moth About the patient -the unique personal registration number - chronic diseases (ICPC codes) GPs registrate all contacts on one day Methods

10. Grete Moth Type of contact -office visit, telephone encounter, email, or home visit. - contact due to prevention - contact concerning a formular due to e.g. sick leave or insurance GPs registrate all contacts on one day Methods

11. Grete Moth Content of the contact - reason for encounter - diagnosis of the contact (ICPC-coding) - number of problems raised - referrals - involvement of staff - ending of the contact GPs registrate all contacts on one day Methods

12. Grete Moth About the contact - degree of biomedical, psycological and social elements - medically unexplained symptoms - suspicion of cancer - GP experienced heaviness of the contact GPs registrate all contacts on one day Methods

13. Grete Moth The primary reason for encounter: Cough - ICPC-code: R05 Diagnosis: Asthma - ICPC-code: R96 ICPC coding Methods

14. Grete Moth The primary reason for encounter Suspicion OR96 Follow up-appointment K Questions Q Sequela S Recurrent R GPs registrate all contacts on one day Methods

15. Grete Moth 1.Type of contact 2.Content of the contact 3.About the contact Methods The staff registrates all contacts involving clinical or consulting tasks

16. Grete Moth Patients’ experience of: 1. the contact to the GP clinic 2. reason for encounter 3. health Methods Patient questionnaire

17. Grete Moth Patients’ care pathway through the health care system The personal registration number Register of Medicinal Product Statistics - prescriptions of medicine Danish National Patient Registry - hospitalisations and visits to outpatient clinics National Health Insurance Service Registry - visits to GPs and primary care specialists Statistics Denmark - socio-demographic factors Methods Registry data

18. Grete Moth 400 GPs have accepted to participate – new invitation in August 2009 150 GPs and 110 staff members have registrated 5.000 patient questionnaires, respond rate 65% Status May 2009

19. Grete Moth 1.– what is going on during the contacts - reasons for encounter and diagnosis? 2. How often do the GPs experience medically unexplained symptoms and suspicion of cancer? 3. How often do encounters require follow up? 4. Do GP registrations agree with the experiences of the patients? 5. How are the care pathways of the patients? 6. How has the contact pattern to GPs developed through the last decades? Research questions to be addressed:

20. Grete Moth Updating the knowledge of the GP activity Quality improvement of the organisation through identification af performances and groups of patients with a potential of improvement in the cooperation between the health care sectors optimise the services of the health care system Perspectives Documentation and quality improvement of the clinical practice by GPs

21. Grete Moth Registration projects to come: a registration project of the out of hours activity by GPs a sentinel registration of contacts by a number of GPs Perspectives

22. Grete Moth Thank you! Steering group: Peter Vedsted Frede Olesen Marianne Rosendal Kaj Sparle Christensen Bo Christensen Ineta Sokolowski Grete Moth