the danish gp-contact registration project

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.

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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

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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

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Background

Limitations:

Limited information of the contact

Clinical staff not involved

Patient experiences not involved

No knowledge on patient care pathways

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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

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Methods

Sources of data:

- GP

- Clinical staff

- Patients

- Registries

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Methods

Study period:

2009

Eligible participants:

850 GPs in Central Denmark Region

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GPs registrate all contacts on one day

Methods

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About the patient-the unique personal registration number - chronic diseases (ICPC codes)

GPs registrate all contacts on one day

Methods

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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

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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

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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

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The primary reason for encounter:Cough - ICPC-code: R05

Diagnosis:Asthma - ICPC-code: R96

ICPC coding

Methods

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The primary reason for encounterSuspicion OR96

Follow up-appointment K

Questions Q

Sequela S

Recurrent R

GPs registrate all contacts on one day

Methods

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1. Type of contact

2. Content of the contact

3. About the contact

Methods

The staff registrates all contacts involving clinical or consulting tasks

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Patients’ experience of:

1. the contact to the GP clinic

2. reason for encounter

3. health

Methods

Patient questionnaire

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Patients’ care pathway through the health care systemThe 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

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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

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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:

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• 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 cooperationbetween the health care sectors optimise the services of the health care system

Perspectives

• Documentation and quality improvement of the clinical practice by GPs

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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

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Thank you!

Steering group:Peter VedstedFrede OlesenMarianne RosendalKaj Sparle ChristensenBo Christensen Ineta SokolowskiGrete Moth