Primary health care ICD--a tool for general practice research.

The International Classification of Diseases (ICD) has become the only diagnostic classification system of international standard that allows reliable comparisons of epidemiological data between countries, parts of a country, levels of health care systems, or different periods of time. However, for primary health care purposes it is too specific to describe problems relevant to the work of general practitioners (GPs). Tools are thus needed to 'compress' data in primary health care for educational, administrative and research purposes. The objective of this paper was to introduce a diagnosis coding system that can be used in primary health care settings for these purposes. Principal diagnoses, as assessed by medical doctors, were collected from 20,648 patient visits. After primary coding, according to the ICD on a five-digit scale, the diagnoses were grouped into larger entities, which reduced the number of diagnoses to one eighth of the original number. The ten most common original five-digit diagnoses accounted for one quarter of all consultations, whereas the ten most common diagnoses counted for one half of all consultations after compressing the data into new categories. Analysing epidemiological data in the records of primary health care by the ICD offers benefits because of the latter's wide use. These are discussed below.

Drug treatment for hypertension in Finnish primary health care.

OBJECTIVE: To analyse the prescribing patterns of antihypertensive drugs in Finnish primary health care and to describe the profiles of monotherapy and combination therapy in relation to the duration of high blood pressure. METHODS: Thirty out of 250 primary health care centres were randomly selected for the study. All doctors (n=337) from the participating health centres recorded all hypertensive patients (n=4405) during a 2-week period in May 1995. Adequate information was obtained concerning 4294 hypertensives, of whom 65% were women with a mean age for the total study population of 64 years. 85% of the patients (n=3638) had antihypertensive medication which was classified into five main categories: diuretics, beta blocking agents, calcium channel blockers, ACE inhibitors and hypotensives. RESULTS: Of the patients using antihypertensive medication, 48% were undergoing monotherapy and 52% combination therapy. Beta blocking agents were the most frequently prescribed drugs for hypertension, being used by half of the patients. ACE inhibitors and diuretics were prescribed in a different manner for male and female hypertensives, with men receiving more ACE inhibitors and women more diuretics. The number of antihypertensive drugs increased with the duration of hypertension, though 38% of the patients having hypertension for over 10 years were still undergoing monotherapy. Among patients undergoing combination therapy, 75% received two different agents, most often a diuretic with a beta blocking agent. CONCLUSIONS: With increasing duration of hypertension, the number of antihypertensive drugs also increased. Beta blocking agents were the drug of choice for all patients. For women, combination therapy more frequently included diuretics, whereas ACE inhibitors were favoured for men.

Treatment situation of hypertensive patients in Finnish primary health care.

OBJECTIVE: To highlight the present situation in hypertension control in Finnish primary healthcare. SUBJECTS AND METHODS: All health centre doctors from 30 primary health centres were asked to record every consulting patient, pick up hypertensives and evaluate their blood pressure (BP) level, drug treatment, side effects and symptoms related to drug treatment, and compliance during 2 weeks in May 1995. RESULTS: In all, 337 doctors from the 30 health centres participated in the study. They recorded altogether 4405 hypertensive patients, of which 1209 men (83%) and 2311 women (87%) had drug treatment for hypertension. Of all the drug-treated hypertensive men and women, 33% and 37%, respectively were obese (BMI > or = 30.0 kg/m2). Altogether, 13% of the drug-treated hypertensive men and 10% of women were in good control when BP < 140/90 mmHg was used as the criterion. These proportions doubled when BP < 160/90 mmHg and tripled when BP < 160/95 mmHg were applied as criteria. CONCLUSION: The proportion of drug-treated hypertensives under poor control is still high in Finland. Only a quarter of treated hypertensive patients are in good control when the criterion BP < 160/90 mmHg is applied.