Health Problems in a Rural Island of Okinawa: Changes Over 25 Years / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>Currently, there are no studies on changes in health problems due to population aging in Japan. This study was conducted to estimate the changes by comparing the present health problems using the International Classification of Primary care second edition (ICPC-2) with a previous study.</p><p><b>Methods: </b>We conducted a retrospective open cohort study on a rural island in Okinawa. We classified health problems of all patients using ICPC-2, and compared the data with a previous study using the International Classification of Health problems in Primary care-2 defined (ICHPPC-2 defined) from 1990.</p><p><b>Result: </b>The total number of visits to the clinic was 4660 per year (age 0-14 years, n=828; age 15-64, n=2146; age 65 or older, n=1688). In 2015, the frequency of musculoskeletal, skin and general, and unspecified problems was higher. The number of health problems contained within the top 50% of all health problems, which is an indicator of the comprehensiveness of practice, was higher in the previous study.</p><p><b>Conclusion: </b>The present study suggested that orthopedic and dermatological disorders increased, and greater comprehensiveness of practice is needed.</p>

Reasons for Encounter and Health Problems Using ICPC-2 in a Rural Area with Limited Access to Advanced Care : A Retrospective Open Cohort Study / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : This study was conducted to estimate actual reasons for encounters and health problems, which is difficult to assess in a free-access system, in an area with limited access to advanced care by using the International Classification of Primary care second edition (ICPC-2).<br><b>Methods</b> : We conducted a retrospective open cohort study on an isolated island in Okinawa Prefecture, Japan. We encoded reasons for encounter (RFE) and health problems of all patients using ICPC-2.<br><b>Results</b> : The total number of visits to the clinic was 5682 a year (age 0-14 years, n=862 ; age 15-64 years, n=2205 ; age 65 or older, n=2615). The top 3 RFE classified by organic systems were R (respiratory), S (skin) and L (musculoskeletal). Dementia (ICPC-2 code : P-70) was eighth in the rank of chronic health problem among elderly people. Visits due to health maintenance/prevention (ICPC-2 code : A-98) was third in the rank of new health problem among children.<br><b>Conclusion</b> : In the present study, rankings of major RFE and health problems are similar to those in previous studies. Among elderly people, however, the rank order of dementia among chronic health problems was higher than that in previous studies. In addition, among children, the rank order of health maintenance/prevention among new health problems was higher than that in previous studies.

A informação na consulta presencial em Medicina Geral e Familiar: classificações segundo a ICPC-2 e anotações livres para a memória futura no SOAP / Information available in general practice/family medicine consultations: coding and annotations for future use / La información en la consulta médica presencial en Medicina General y Familiar: clasificaciones según ICPC-2 y apuntes libres para la memoria futura en el SOAP

Objetivos: assumindo a obrigatoriedade de classificação ICPC-2 em cada consulta, conhecer a informação, em consultas passadas pelo método de Weed-SOAP segundo o gênero e idade de quem consulta o médico (consulente ou paciente), caracterizando o nível de registro pelo método SOAP em Subjetivo (S) - classificação e anotações - em Objetivo (O) anotações sobre o estado do paciente, em Avaliação (A) da classificação e em Plano (P) da classificação e anotações. Métodos: estudo observacional, transversal em outubro de 2012, em amostra aleatorizada das consultas presenciais de dois médicos orientadores de internato de especialidade, em três meses sorteados do 1º semestre de 2012, e em quatro dias sorteados em cada mês, em amostra representativa com intervalo de confiança de 95% e margem de erro de 6%. Utilizou-se estatística descritiva e inferencial. Resultados: amostra de 318 consultas, n=149 (46,9%) no gênero masculino, n=61 (19,2%) no grupo etário <18 anos e n=194 (61,0%) no ≥18 e <65 anos, ns por grupos etários e gênero. Em S, há classificação em 98,7% e anotação em 47,2% das consultas; Em O, verificamos "As anotações demonstram o estado do paciente" em 66,0% e "As anotações são explícitas e entendíveis" em 79,9%; em A, 97,8% das consultas têm classificação; Em P, há classificação em 96,5% e anotações explicando o plano em 23,0% das consultas. Distribuição sem significado por grupo etário para as variáveis estudadas. É mais frequente haver no gênero feminino em S "As anotações são explícitas e entendíveis" e em P "Há classificação de procedimentos". Conclusão: há campo para mais completa coleta da informação na consulta, permitindo, assim, melhor conhecimento de cada consulta e caso para o futuro.

Objectives: assuming the mandatoriness of ICPC2 classification in every consultation, the objective of this study was to ascertain the frequency of this type of classification in past consultations. This analysis was performed using the Weed-SOAP method, where Subjective (S) is measured by classifications and annotations, Objective (O) by annotations, Avaliation (A) by classification, and Plan (P) by classification and annotations. Methods: a cross-sectional observational study was performed in October 2012, with a 95% confidence interval and 6% error margin, on a representative random sample of consultations conducted on 4 random days of 3 random months of the first semester of 2012, and data were analyzed using descriptive and inferential statistics. Results: among the sample of 318 consultations, 149 (46.9%) were with male patients and 61 (19.2%) were aged under 18 years, while 194 (61.0%) were aged 18 or above but under 65 years, after sorting by age groups and gender. In terms of S, 98.7% of consultations had an ICPC-2 classification and 47.2% had an annotation; in terms of O, 66.0% had an annotation demonstrating the state of the patient and 79.9% were explicit; in terms of A, 97.8% had a classification; and in terms of P, 96.5% had a classification and 23.0% had an annotation explaining the plan. There was no statistically significant difference by age group for the studied variables. However, for gender, women had more "Clear and explicit" annotations in S, and "Classification of plan" instances in P. Conclusion: more complete recall of information in consultations is required in order to gain better knowledge about individual consultations and patients for future use.

Objetivos: asumiendo la obligatoriedad de clasificar con la ICPC-2 en cada consulta, conocer la información, en consultas tras-efectuadas pelo método Weed-SOAP según el género y edad de quien consulta al médico (los pacientes), caracterizando el nivel de registro por el método SOAP en Subjetivo (S) - clasificación y anotaciones - en Objetivo (O) apuntes sobre el estado del paciente, en Evaluación (A) de la clasificación y en Pleno (P) de la clasificación y apuntes. Métodos: estudio observacional, transversal en octubre del 2012, en muestra aleatoria de las consultas presenciales de dos médicos tutores de residencia de la especialidad, por tres meses sorteados del 1º semestre del 2012 y en cuatro días sorteados en cada mes, en muestra representativa con intervalo de seguridad del 95% y margen de error del 6%. Se utilizó estadística descriptiva e inferencial. Resultados: muestra de 318 consultas, n=149 (46,9%) en el género masculino, n=61 (19,2%) en el grupo de edad <18 años y n=194 (61,0%) en el ≥18 y <65 años, ns por grupos de edad y género. En S, hay clasificación en el 98,7% y apuntes en el 47,2% de las consultas; En O, verificamos "Los apuntes demuestran el estado del paciente" en 66,0% y "Los apuntes son explícitos y comprensibles" en el 79,9%; en A, el 97,8% de las consultas tienen clasificación; En P, hay clasificación en el 96,5% y apuntes explicando el plan en el 23,0% de las consultas. Distribución sin significado por grupo de edad para las variables estudiadas. Es más frecuente haber en el género femenino en S "Los apuntes son explícitos y comprensibles" y en P "Hay clasificación de procedimientos". Conclusión: hay campo para un recogido de informaciones más completo, permitiendo de esta manera, mejor conocimiento de cada consulta en el futuro.

A study of the triage function of referrals in an urban clinic / 日本プライマリ・ケア連合学会誌

<b>Introduction</b> : To promote disease management in the community, general physicians should refer their patients to specialists in a timely and appropriate manner. In this study, we propose an indicator for evaluation of such referrals.<br><b>Methods</b> : We analyzed all referrals in an urban clinic from September 1, 2011 to August 31, 2012. Symptoms and diagnoses documented by general physicians were collected from medical records, and the final diagnoses by specialists were collected from their reports. The symptoms and diagnoses were classified using the International Classification of Primary Care second edition (ICPC-2). Referral rates, hospitalization rates, and place of referral were analyzed.<br><b>Results</b> : The average number of encounters in the candidate clinic was 1402 per month, and the mean number of referrals was 23 (1.6% of encounters). Of patients who received a referral, 6.75 (29.1%) were admitted to hospitals. The symptoms and diagnoses of the referred patients were distributed across all chapters (A to Z) of ICPC-2. Diagnoses of admitted patients included pneumonia (R81) (24%), urinary tract infection (U70 and U71) (9%), and acute gastroenteritis with dehydration (D73 with T11) (9%).<br><b>Conclusion</b> : We identified the referral rates, hospitalization rates, and distribution of referral patients as indicators of the triage function of primary care physicians. These should be evaluated further as potential indicators of “the quality of medical care.”

Tendência de classificação no Capítulo Z da CIAP-2 entre 2006 e 2011 em um centro de saúde de Medicina Familiar em Coimbra, Portugal / Classification trends with the ICPC-2 Z Chapter from 2006 to 2011 in a Family Medicine Health Centre in Coimbra, Portugal / Tendencia de la clasificación en el Capitulo Z de la CIAP-2 entre 2006 y 2011 en un Centro de Salud de Medicina Familiar en Coimbra, Portugal

Objetivo: Estudar a tendência evolutiva da classificação com a CIAP-2 no Capítulo Z, no período de 2006 a 2011 quanto a: variação de frequência do número total de componentes de sinais e sintomas; volume de "classificação ajustada à população" e, através da coleta de informação SOAP, quais dos seus componentes foram mais frequentemente registrados nos campos Subjetivo (S) e Avaliação (A). Métodos: Estudo transversal, observacional e descritivo dos registros eletrônicos efetuados por todos os médicos na plataforma Serviço de Apoio ao Médico (SAM) utilizando a ferramenta de coleta de dados (SAM-Estatísticas) em agosto de 2012 em um centro de saúde em Coimbra, região central de Portugal. O volume de codificação foi estudado em código/1.000 hab./dia, tendo como base de cálculo a metade de cada ano estudado. Foram selecionados os seis códigos mais frequentes de cada ano. Resultados: Verificou-se uma dinâmica de crescimento positivo nos componentes registrados nos campos Subjetivo e Avaliação entre 2006 e 2011, tanto no número total de códigos (S:+4,83 e A:+6,44) e volume de codificação ­ código/1.000 hab./dia (S:+4,40 e A:+6,44) como na percentagem de diferentes componentes de sinais e sintomas do Capítulo Z (S:+0,30; A:+0,56). Conclusão: Entre 2006 e 2011 verificou-se uma dinâmica de crescimento positivo na classificação no Capítulo Z da CIAP-2 que foi mais importante no campo Avaliação e nos tipos de componente. O desenvolvimento profissional e a educação médica continuada são necessários para melhorar o desempenho na tarefa de classificar e registrar adequadamente, bem como no criterioso registro das anotações clínicas feitas na consulta, evitando perda de informação clínica.

Objective: To study the classification trend in ICPC-2, Z Chapter, in the period 2006-2011, in terms of frequency in variation of the total number of sign and symptom components; volume of "population-adjusted classification"; and - based on SOAP for collecting information - which of its components were more frequently recorded in the Subjective (S) and Assessment (A) fields. Methods: Cross-sectional, observational, descriptive study of electronic registries in the SAM (Serviço de Apoio ao Médico - medical visit assistant software) using data collection tool (SAM-Statistics) in August 2012 in Coimbra, central Portugal. Classification volume was studied using codes/1000 inhab/day. The population for each year was calculated based on the middle of each study period. The six most frequent codes in each year were selected. Results: A positive increasing trend was found between 2006 and 2011 in the Subjective and Assessment recording fields, in terms of the total of codes (S:+4,83; A:+6,44) and classification volume - codes/1000 inhab/day (S:+4,40; A:+6,44), as well as in the percentage of different components of the Z sign and symptom codes (S: +0,30; A: +0,56). Conclusions: From 2006 to 2011, a positive trend was found in the ICPC-2 Z Chapter classification, which was more important in Assessment (A), and the type of components recorded through the SOAP method. Hence, continuing medical education is still necessary to improve performance in the crucial task of classification, registering and clinical noting to avoid lack of clinical information.

Objetivo: Estudiar la tendencia evolutiva de la clasificación con CIAP-2 en el capítulo Z, en el período 2006-2011, en términos de: variación de la frecuencia del número total de los componentes de los signos y síntomas; el volumen de "clasificación ajustada a la población" y, a través de la recolección de información SOAP, cuáles de sus componentes se registraron con mayor frecuencia en los campos Subjetivo (S) y Evaluación (E). Métodos: Estudio transversal, observacional y descriptivo de los registros electrónicos realizados por todos los médicos en la plataforma Servicio de Apoyo Médico (SAM) en agosto de 2012 en un centro de salud de Coimbra, región central de Portugal, utilizando la herramienta de recolección de datos (SAM-estadística). El volumen de codificación fue estudiado en código/1000 hab./día, teniendo como base de cálculo la mitad de cada año estudiado. Fueron seleccionados los seis códigos más comunes de cada año. Resultados: Se observó una dinámica de crecimiento positivo, entre 2006-2011, de los componentes registrados en los campos Subjetivo y Evaluación, tanto en el número total de códigos (S: +4,83; E: +6,44) y volumen de codificación - código/1000/hab./día (S: +4,40; E: +6,44), como en el porcentaje de los diversos componentes de los signos y síntomas del Capítulo Z (S: +0,30; E: +0,56). Conclusión: Entre los años 2006 y 2011 hubo una dinámica de crecimiento positivo de la clasificación en el capítulo Z de la CIAP-2, más importante en el campo Evaluación y en los tipos de componente. El desarrollo profesional y la educación médica continua son necesarios para mejorar el rendimiento en la tarea de clasificar y registrar correctamente, así como para el registro cuidadoso de las notas clínicas realizadas durante las consultas, evitando, así, la pérdida de información clínica.

Medical Reimbursement Receipt Analysis to Determine the Relationship between Disease Type and Patients' Healthcare-seeking Behavior / General Medicine

<b>Background:</b> This study aimed to evaluate the relationship between disease type and healthcare-seeking behavior in patients in order to assess the role of primary care in rural areas of Japan.<br><b>Methods:</b> National Health Insurance receipt data were collected for outpatients from four towns in Hokkaido, Japan. Disease names were encoded using the International Classification of Primary Care-2 (ICPC-2) coding system. Patient data were divided into two categories: those visiting medical facilities in their own towns and those visiting medical facilities in other towns.<br><b>Results:</b> The percentage of patients who visited medical facilities outside their own town ranged from 42.9% to 72.7%; the mean value for all four towns was 54.6%. The three most frequent ICPC-2 codes according to the reimbursement receipts were K86 (hypertension, uncomplicated), T93 (lipid disorder), and T90 (diabetes, noninsulin dependent), and patients with T90 visited facilities in other towns more than those with K86 and T93. Patients with diseases of the eye, such as F91 (refractive error), F92 (cataract), and F71 (allergic conjunctivitis), and those with psychological disorders, such as P76 (depressive disorder), tended to visit facilities outside their towns rather than in their own towns.<br><b>Conclusions:</b> Data regarding patients who visit medical facilities in their own towns may provide information on the role of primary care in that particular town. The analysis of medical reimbursement receipts from a particular area provides useful information about disease distribution in addition to an overview of the healthcare needs of the entire community in that area.

Analysis of the Reasons for Visits to a Clinic on an Isolated Island / General Medicine

<b>Background:</b> To date there had been no investigations using the International Classification of Primary Care, Second Edition (ICPC-2) at a clinic on an isolated island. In order to analyze health problems on the island, we investigated the reasons for visits, chronic illnesses, and the number of cases referred to other medical facilities using the ICPC-2.<br><b>Methods:</b> The study was conducted over a 12-month period, from April 1, 2006 to March 31, 2007. Patient complaints/symptoms were classified according to ICPC-2, and diseases of patients who regularly visited the clinic as of November 2006 were investigated.<br><b>Results:</b> Half of the patients that regularly visited the clinic had lifestyle-related or musculoskeletal diseases. On the first visit, several patients presented with cold, musculoskeletal, or skin symptoms. The specialist care to which the patients were most frequently referred was orthopedic surgery.<br><b>Conclusion:</b> Physicians working at a clinic on an isolated island need to be able to control lifestyle-related diseases and provide initial treatment for musculoskeletal or skin diseases.

The relationship of common reasons for encounter and major diagnoses of patients admitted to a hospital

BACKGROUNDS: It is important to know the contents of health problems in patients in a primary care setting. The aim of this study was to explore the main chief complaints and major diagnoses of patients, who were admitted to a hospital using the ICD-10 and to observe difference according to each department and admission route and how diagnoses were made. METHODS: A total of 18,560 patients who were admitted to a hospital located in Chungnam Province from 1 Jan 1998 to 31 Dec 1998. Main chief complaints and major diagnoses made through the admissions departments were chosen as subjects (medical vs. surgical) and by admission route (emergency vs. OPD)were analyzed. How the diagnoses were derived from the most common chief complaints among medical and surgical departments were analyzed by admissions departments and by admission route. RESULTS: The most common 10 chief complaints revealed no significant difference by admission route in medical departments, but there was some difference in surgical departments. There was some difference in the most common 10 major diagnoses by admission routes in both medical and surgical departments. Abdominal and pelvic pain, which was the most common chief complaints, became a significantly different diagnosis by admission route in both departments. CONCLUSION: Main chief complaints were similar regardless of admission routes, but the diagnoses were different. ICD-10 classification may be useful to classify the diagnoses, but have limitations to classify chief complaints or reasons for encounter. It is necessary to introduce a new classification such as ICPC-2 for reasons for encounter in order to explore the dimension of health problems.

What do residents of family medicine discuss after outpatient care?

BACKGROUND: Physicians who provide primary care should be trained specifically to manage the problems encountered in a primary care practice. This study was carried out to know the resident's concerns and problems during outpstient care by analysing case discussions as an outpatient teaching. METHODS: We used 533 records discussed by 3 resident's teams for 1 year. Of discussion contents, symptoms or diseases were classified into codes and chapters using the ICPC(lnternational Classification of Primary Care) coding system and the main topics of discussion into 12 types. We compared data among 3 resident's teams and also between the discussed contents and the diseases of patients who visited a family practice for 1 year. We used relative discussion ratio to compare data. RESULTS: Of 533 discussed records, 106 kinds of symptoms or diseases were used and the 20 most common kinds accounted for 61.7%. Contents about menopausal sympto/complaint were 47 records(8.8%) and was the most frequent. Digestive part was the most frequent chapter(22.0%). Distribution of discussed main topics were diagnosis(35.5%), medication(26.8%), other treatment(11.6 %), follow-up(5.8%), etc. There was some difference among 3 resident's teams by chapters and topics. Visiting patients were 3,436 persons with 79 kinds of symptoms and diseases and prior 20 kinds accounted for 86.6%. Visited patients were some what different with the discussed contents by chapters. CONCLUSIONS: Contents of case discussion in ambulatory setting were some what different among each teams and more diverse than the visiting patients The residents could exchange many informations and find problems during ambulatory care. We think case discussion can be a good method for outpatient teaching.

Analysis of Clinical Contents in a Family Practice Clinic of Rural Area according to the ICPC Method

BACKGROUND: Research of clinical contents and proper development of education program is essential in family medicine. Therefore, this study is carried out to obtain data for residency training, and to provide references to family physicians who give primary health care in rural community by analyzing prospectively the clinical contents of new patients in a local family practice clinic. METHODS: The authors visited family practice clinic in a rural area practiced by a family physician board certified in family medicine. There were 3,126 new patients from Jan. 1996 to Dec. 1996 evenly distributed by month and area, 1,000 patients were sampled randomly and the collected data were classified according to the ICPC(International Classification of Primary Care) coding system. RESULTS: Among the selected 1,000 patients, males were 432(43.2%) and females were 568(56.8%). Age distribution was highest In the fifties(50-59 years old) (20.7%). The total number of Reason For Encounter(RFE) was 1,417, the average RFE was 1.41 per patient and the kind of RFEs was 93, among which cough was the most frequent RFE by 233 cases(16.4% ). The 87 kinds of diagnoses were used and URl(Upper Respiratory Infection) accounted for the major portion by 287 cases(21.9%). The diagnostic examination per patient was 0.42. The most frequently used test was x-ray of an extremity by 68 cases(16.1% ). Referrals to other departments were made in 3.3% of visitors of which Internal Medicine was highest(39.4%). CONCLUSIONS: The clinical contents were classified more comprehensively by using ICPC with given code RFE, care process, and diagnosis. More study on ICPC is necessary for classification to help analyze clinical contents in primary care.