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WONCA EuropeWONCA EuropeParis 2007Paris 2007
Marc JamoulleMarc Jamoullefamily doctorfamily doctor
Researcher, Departement of General PracticeResearcher, Departement of General PracticeUniversity of Louvain, BelgiumUniversity of Louvain, Belgium
Conflict of interest : unfortunately none
ICPC step by stepICPC step by step
International International Classification of Primary Classification of Primary Care is a tool for GP/FMCare is a tool for GP/FM
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What is ICPC meant for ?What is ICPC meant for ?
IndividualyIndividualy ; it provides a ; it provides a representation ofrepresentation of
patient doctor interactionpatient doctor interaction doctor's decision processdoctor's decision process Along the time lineAlong the time line
• CollectivelyCollectively; Allows ; Allows Satistical & Satistical & epidemiological studiesepidemiological studies
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Why a code ?Why a code ?
Lowering of Lowering of redundancyredundancy
From pencil to machineFrom pencil to machine
Redundancy / Redndancy / Redndncy / Redndnc / Rdndnc / RdncRedundancy / Redndancy / Redndncy / Redndnc / Rdndnc / Rdnc
Source : Claude Elwood Shannon (1916-2001)
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Why a specific GP/FM Why a specific GP/FM classification?classification?
• ICPC (WONCA)ICPC (WONCA)
• Conceptual constructConceptual construct
• About health problems About health problems
• Patient centeredPatient centered
• Structural basementStructural basement
• ICD (WHO)ICD (WHO)
• Historical constructHistorical construct• About diseasesAbout diseases• Provider centeredProvider centered• Linear basementLinear basement
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ICPC : factsICPC : facts
WICCWICC
Since the 70'Since the 70'
41 members 41 members
25 countries25 countries
5 continents5 continents
Preparing ICPC-3Preparing ICPC-3
ICPC-2ICPC-2
18 languages18 languages
Various licencesVarious licences
UniversalUniversal
Endorsed by WHOEndorsed by WHO
TerminologiesTerminologies
17 chapters17 chapters
1515somaticsomatic
11PsychologicPsychologic
1 1 SocialSocial
3 components coming from 3 gathered 3 components coming from 3 gathered classificationsclassifications
Symptoms Symptoms and complaintsand complaints ProcessProcess DiagnosesDiagnoses
R F E CR F E CReason for Reason for Encounter Encounter ClassificationClassification
IC-Proces-PCIC-Proces-PCInternational International ClassificationClassificationof Process of Process in Primary Carein Primary Care
ICHPPCICHPPC
ICHPPC-2-dICHPPC-2-dInternational International ClassificationClassification
of Health Problem of Health Problem inin
Primary CarePrimary Care1& 2 edition, 1& 2 edition,
defineddefined & &
ICPCICPC
ICPC 2ICPC 2
Revision and inclusion of criteria and definitionsRevision and inclusion of criteria and definitions
ICPC 2 RICPC 2 RRevised transcoding to ICD-10Revised transcoding to ICD-10
Towards ICPC 3Towards ICPC 3
1974
1981
1983
1985
1987
1998
2005
1974
1979
ICPC story
ICPCICPC
orders the domain orders the domain
of primary careof primary care
(family medicine)… (family medicine)…
.. and allows the coding of .. and allows the coding of encountersencounters in an in an episode of episode of
carecare structure structure
17 alpha-coded chapters based on 17 alpha-coded chapters based on body systemsbody systems
7 identical components, with rubrics 7 identical components, with rubrics bearing a two-digit numeric codebearing a two-digit numeric code
ICPC-2 Bi-Axial structureICPC-2 Bi-Axial structure
ICPC CHAPTERSICPC CHAPTERS
AA General and unspecified General and unspecifiedBB Blood/bloodforming organs, lymphatics (spleen, bone marrow) Blood/bloodforming organs, lymphatics (spleen, bone marrow)DD Digestive DigestiveFF Eye (Focal) Eye (Focal)HH Ear (Hearing) Ear (Hearing)KK Circulatory CirculatoryLL Musculoskeletal (Locomotion) Musculoskeletal (Locomotion)NN Neurological NeurologicalPP Psychological PsychologicalRR Respiratory RespiratorySS Skin SkinTT Endocrine, metabolic and nutritional (Thyroid) Endocrine, metabolic and nutritional (Thyroid)UU Urological UrologicalWW Pregnancy, child bearing, family planning (Women) Pregnancy, child bearing, family planning (Women)XX Female genital (X-chromosome) Female genital (X-chromosome)YY Male genital (Y-chromosome) Male genital (Y-chromosome)ZZ Social problems Social problems
ICPC COMPONENTSICPC COMPONENTS(standard, if possible, for all chapters)(standard, if possible, for all chapters)
1.1. Symptoms and complaints Symptoms and complaints 1-291-292.2. Diagnostic and preventive procedures Diagnostic and preventive procedures 30-4930-493.3. Treatment procedures, medication Treatment procedures, medication 50-5950-594.4. Test resultsTest results 60-6160-615.5. Administrative Administrative 62626.6. Referral and other reasons for encounter Referral and other reasons for encounter 63-6963-697.7. Diseases:Diseases: 70-9970-99
- infectious diseases- infectious diseases- neoplasms- neoplasms- injuries- injuries
- congenital anomalies- congenital anomalies- other specific diseases- other specific diseases
Chapters and components Chapters and components together form a ‘chessboard’..together form a ‘chessboard’..
A - general A - general B - blood , immune B - blood , immune
systemsystem D - digestiveD - digestive F - eyeF - eye H - ear (hearing)H - ear (hearing) K - circulatoryK - circulatory L - musculoskeletalL - musculoskeletal N - neurologicalN - neurological P - psychologicalP - psychological
R - respiratoryR - respiratory S - skinS - skin T - metabolic, T - metabolic,
endocrineendocrine U - urologicalU - urological W - women’s health, W - women’s health,
pregnancy, family planpregnancy, family plan X - female genitalX - female genital Y - male genitalY - male genital Z - social problemsZ - social problems
ICPC-2 Structure : ChaptersICPC-2 Structure : Chapters
Z25 ASSAULT & HARMFUL EVENTZ25 ASSAULT & HARMFUL EVENT bewitchmentbewitchment bewitchment with pig's liverbewitchment with pig's liver damage from maledictiondamage from malediction desecration of grave by witchesdesecration of grave by witches dupa spellsdupa spells evil influence nsevil influence ns harm from fightingharm from fighting harm from troublesome spiritsharm from troublesome spirits harm from warharm from war harm from witchcraftharm from witchcraft harm from witches' familiarsharm from witches' familiars makgoba bewitchmentmakgoba bewitchment negative condition nsnegative condition ns possession by spiritspossession by spirits possession by bad spiritspossession by bad spirits possession by evil spiritspossession by evil spirits
Cridland JS,.Koonin S. Use of traditional medicinestowards a classification. S.Afr.Med J 2001;91:489-91
Example of opening of an ICPC rubric
• Implies opening of the rubrics of ICPC
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ICPC adaptabilityICPC adaptability
Paper & PencilPaper & Pencil ElectronicElectronic
Mnemotechnic
Central coding
Terminologies
Automatic coding
1987 2007
StudiesStudies
Clinical : transversal or Clinical : transversal or longitudinallongitudinal
Electronic patient recordElectronic patient record Huge database or personal oneHuge database or personal one Quality assuranceQuality assurance Documents indexingDocuments indexing
..THE PATIENT’S PROBLEM LIST..THE PATIENT’S PROBLEM LIST(8 episodes of care that are considered important; see Glossary: problem list)(8 episodes of care that are considered important; see Glossary: problem list)
From Transhis, Amsterdam
Distribution of the Distribution of the 624 P diagnosis, same health centre624 P diagnosis, same health centre
0
20
40
60
80
100
120Medicinal drug dependency
The workload in mental health in GP/FM
Medicinal drug Drug addiction
P03 P76
Liege, Belgium, on 10440 episodes, 1999Liege, Belgium, on 10440 episodes, 1999
Comparison of chapter P diagnosis of two family doctors each in solo practice
Courtesy of Dr Joseph Huberty, Ciney, Belgium
A new insight in GP practice allowing quality assessment and
alternative teaching process
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998 abstracts, ICPC chapters distribution
103
1828
6 3
33
17
183
120
10
179
1824 24
7
42
130
A B D F H K L N P R S T U W X Y Z
P
Z
T
B
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EPISODES on the time lineEPISODES on the time lineLife and death of one patientLife and death of one patient
Conception-RéalisationConception-Réalisation
Dr Jacques Dr Jacques HumbertHumbertDr Jacques HDr Jacques HidieridierDr Marc JamoulleDr Marc JamoulleDr Michel RolandDr Michel Roland
CISP-Club
June 2000Adapted from Lamberts
FECONDATION
K 73
R71
R82
S87
P76
P15 P17
Z11
P77
D97
Z11
T90
P70
R82
This day
Episode initiated or closed by the doctor
Life conditions
Death
Episode initiated or closed by doctor – patient consensus
Episode initiated or closed by the patient
Life story