[Diagnosis coding of the musculoskeletal system in general practice]. / Diagnosekodning i almen praksis af lidelser i bevaegeapparatet.

INTRODUCTION: Danish general practitioners are encouraged to code diagnoses according to the Danish version of ICPC. In order to evaluate feasibility, we aimed to estimate sensitivity of ICPC coding of patients with symptoms from the musculoskeletal system (ICPC L01-20 and 83-99) in general practice compared to health information from other sources. MATERIALS AND METHODS: We identified patients connected to one general practice in July 2005. We retrieved information on referred care by specialists in neurology, rheumatology, and orthopaedic surgery as well as treatments by physiotherapists from the Danish Health Insurance. We received ICD10 codes within chapter 8 (diseases of the musculoskeletal system and connective tissue) from the Danish Hospital Register. Sensitivity was calculated according to criteria based on whether the patients had received an ICD10 code or other public health services. RESULTS: Of 2649 patients registered in the general practice, 496 had recorded an ICPC code in chapter L (the musculoskeletal system). Sensitivity was calculated to 0.83. Of all patients with musculoskeletal diseases 82.5% were identified by ICPC codes, but only 45% by other health sources. CONCLUSION: The coding of ICPC in a general practice had an acceptable sensitivity and constitutes a useful opportunity to identify a group of patients with musculoskeletal diseases. An optimal identification of specific patient subgroups, by using ICPC coding, requires the construction of a national registry of the ICPC coding made in all Danish general practices.

Health care in the circumpolar world: Greenland.

Greenland is part of the Kingdom of Denmark and it is the world's largest island. An ice cap covers 85% of its territory. The population is about 57,000 inhabitants, with 14,000 living in the capital Nuuk, and 10,000 in villages and other small settlements. There are pronounced regional variations in lifestyle and living conditions. The Greenland Home Rule Government assumed responsibility, for health care on 1 January 1992. Greenland's territory is divided into 16 health care districts. Queen Ingrid's Hospital in Nuuk is the national hospital and has 156 beds and numerous specialist physicians associated with it. Each health district has a health care centre with one or more physicians, nurses and other health care personnel appropriate for the number of people living in the district. Each district health centre is responsible for primary health care in towns, villages and other small settlements, and the health centres treat all common illnesses. The health centres handle uncomplicated births, minor surgery, common treatment in internal medicine and community mental health services. The centres have a number of inpatient beds proportional to the number of people in the health district. People with more complicated illnesses are referred to Queen Ingrid's Hospital in Nuuk or to specialised treatment in Denmark.

Respiratory tract infections in Greenland: results of an audit project.

OBJECTIVES: To elucidate and improve quality of diagnosis and treatment of respiratory tract infections in Greenland. STUDY DESIGN: All district medical officers and nursing staff in the Greenlandic coastal health services were invited to participate in the study. Twenty-five district medical officers and the nursing staff from nine districts completed the project and registered in a 3-week period 1,163 contacts involving respiratory tract infections. METHODS: Self-registration according to the Audit Project Odense (APO) method on a simple APO registration chart. All contacts involving respiratory tract infections were registered with regard to sex, type of contact, contact form, infection focus, diagnosis and treatment, origin of infection, antibiotic treatment, choice of antibiotics and possible sick-leave. RESULTS: Of the 1,163 registered contacts lung infections represented 26%, throat infections 22% and otitis media 16%. Paraclinical tests were performed in 32% of the cases, 47% of the cases were treated with antibiotics, in 2/3 of the cases with penicillin V. The use of paraclinical tests was somewhat lower and the use of antibiotics was higher than in Denmark. CONCLUSION: The study showed that it is possible to carry out an APO audit in Greenland, and that there was a moderate difference in the diagnosis and treatment between Greenland and Denmark. An increased use of paraclinical tests may result in quality improvement.

Changes in causes of death and mortality rates among children in Greenland from 1987 - 91 to 1992 - 99.

AIMS: This study analysed the spontaneous trends in mortality among children in Greenland from 1987 - 91 to 1992 - 99 and describes the changes in the causes of death, mortality rates, and variation between regions. METHODS: The data are based on the Greenland Registry of Causes of Death and the birth registry of the Medical Office of Health in Greenland. The causes of death and relevant mortality rates, the trends over time and the differences between regions were analysed epidemiologically for 1992 - 99 and compared with those for 1987 - 91. RESULTS: From 1992 to 1999, 8709 children were born in Greenland. The data include information on 313 child deaths during this period: 64 stillbirths, 158 deaths before one year of age (infants) and 91 deaths between one and 14 years of age. There were fewer stillbirths due to placenta previa, abruptio placentae, and prematurity, fewer infants died from birth asphyxia and infectious diseases and fewer children aged 1 - 14 years died from accidents in 1992 - 99 compared with 1987 - 91. Infant mortality in Greenland declined from 25.2 per 1000 live births to 18.3 and mortality among children 1 - 14 years old from 122.7 per 100000 person-years to 80.4 between 1987 - 91 and 1992 - 99. Mortality dropped proportionally more in East Greenland. CONCLUSION: The decline in child mortality in all age groups probably resulted from general societal trends and general improvement in the healthcare system. Child mortality is still unacceptably high, and it is recommended that sectors other than healthcare become aware of their responsibility for preventing the high rate of child mortality.