How are reasons for encounter associated with influenza-like illness and acute respiratory infection diagnoses and interventions? A cohort study in eight Italian general practice populations

Background Influenza-like illness (ILI) and Acute Respiratory Infections (ARI) are a considerable health problem in Europe. Most diagnoses are made by family physicians (FPs) and based on symptoms and clinical signs rather than on diagnostic testing. The International Classification of Primary Care (ICPC) advocates that FPs record patients’ ‘Reasons for Encounters’ (RfEs) as they are presented to them. This study analyses the association of patients’ RfEs with FPs’ diagnoses of ILI and ARI diagnoses and FPs’ management of those patients. Methods Cohort study of practice populations. Over a 4-month period during the winter season 2013–14, eight FPs recorded ILI and ARI patients’ RfEs and how they were managed. FPs recorded details of their patients using the ICPC format, collecting data in an Episode of Care (EoC) structure. Results There were 688 patients diagnosed as having ILI; between them they presented with a total of 2,153 RfEs, most commonly fever (79.7%), cough (59.7%) and pain (33.0%). The 848 patients with ARI presented with a total of 1,647 RfEs, most commonly cough (50.4%), throat symptoms (25.9%) and fever (19.9%). For patients with ILI, 37.0% of actions were related to medication for respiratory symptoms; this figure was 38.4% for patients with ARI. FPs referred six patients to specialists or hospitals (0.39% of all patients diagnosed with ILI and ARI). Conclusions In this study of patients with ILI and ARI, less than half received a prescription from their FPs, and the illnesses were mainly managed in primary care, with few patients’ needing referral. The ICPC classification allowed a standardised data collection system, providing documentary evidence of the management of those diseases.

P and Z ICPC2 classifications as reason for encounter for sex and age in central Portugal in 2016 and 2019

Background ICPC2 reasons for encounter classified in P (Psychological) and Z (Social) chapters are scarce in the medical literature. We aimed to verify the frequency of such reasons for encounter classified in P and Z ICPC-2 chapters, to perceive their association by sex and age in the post-economic 2011 to 2015 economic and financial Portuguese crisis, calculating its trends from 2016 to 2019. Methods Observational, cross-sectional study in 2020 comparing data from 2016 and 2019 using the application R of the software RStudio® version 1.3.1093, considering 100 random samples of 10.000 dimension random samples with replacement from the original one. Absolute and relative frequencies and classification trends of all items corresponding to the component signs and symptoms and Illnesses and diagnostics of chapters P and Z in total and by gender were calculated. Results Classified reasons for encounter in 2016 and 2019 presented statistically significant association by sex (P < 0.001) and age (P < 0.001) being more common in women (67.4% in 2016 and 66.8% in 2019) and in adulthood (51.6 years in 2016 and 51.5 years in 2019). P and Z of components 1 and 7 reasons for encounter decreased in both chapters (Δ = -7.3% in component 1 and Δ = -2.3% in component 7 of P; Δ = -0.9% in component 1 of Z) between 2016 and 2019. Conclusions The P and Z ICPC-2 chapters classified as reasons for encounter presented statistically significant association by sex and age and were more frequent near to the crisis years, in the female sex and in those older than 50 years.

Physical examination performed by general practitioners in 5 community health service institutions in Beijing: an observational study

BackgroundPhysical examination is a central part of consultation. Evidence showed that clinical use of physical examination in hospital has decreased, but little is known about physical examination performed by general practitioners in community health service institutions.ObjectiveThis study aimed to investigate general practitioners’ performance of physical examination in community health service institutions in Beijing.MethodsAn observational study was conducted in 5 community health service institutions in Beijing, China between November 2019 and January 2020. And 11 participated general practitioners were observed for one workday. Information was recorded including patient characteristics, patient reasons for encounter, physical examinations provided by general practitioners, the length of consultation and time spent on specific activities in consultations.ResultsA total of 682 consultations were recorded from 11 general practitioners. Physical examination occurred in 15.8% of the consultations. Among the recorded 126 examinations, most were distributed in “Head, face, and neck examination” (n = 54, 42.9%) and “Cardiovascular examination” (n = 55, 43.7%), and no physical examination was performed on skin, male genitalia, female breasts and genitalia, and neurological systems. A total of 2823 minutes of activities were recorded. general practitioners only spent 3.1% of their time on physical examination, less than the time spent on taking history (18.2%), test (4.9%), diagnosis (22.7%), therapy (38.4%), and health education (8.6%). The mean length of time spent on physical examination portions was 0.8 ± 0.4 minutes.ConclusionPhysical examination was infrequently performed by general practitioners in community health service institutions in Beijing. More time and attention were needed for general practitioners performing a careful and appropriate physical examination in primary care.

Reasons for encounter in primary health care in Brazil

Background Primary health care (PHC) delivery in Brazil has improved in the last decades. However, it remains unknown whether the Family Health Strategy teams are meeting the health needs of the population. Objectives To describe the reasons for encounter (RFEs) in PHC in Brazil and to examine variations in RFEs according to sex, age and geographic region. Methods This descriptive study is part of a national cross-sectional study conducted in 2016. The sample was stratified by the number of PHC physicians per geographic region. Physicians who had been working for at least 1 year in the same PHC unit were included. For every participating physician, 12 patients aged ≥18 years who had attended at least two encounters were included. Patients were asked about their RFEs, which were classified according to the International Classification of Primary Care. Results In 6160 encounters, a total of 8046 RFEs were coded. Seven reasons accounted for 50% of all RFEs. There was a high frequency of codes related to test results, medication renewal and preventive medicine. RFEs did not vary significantly by sex or geographic region, but they did by age group (P < 0.001). The rates of prescriptions, requests for investigations and referrals to specialized care were 71.1%, 42.8%, and 21.3%, respectively. Conclusion This novel study opened the ‘black box’ of RFEs in PHC in Brazil. These findings can contribute to redefining the scope of PHC services and reorienting work practices in order to improve the quality of PHC in Brazil.

Health service use and costs among migrants in an irregular situation: cross-sectional register-based study from a voluntary-based clinic

AimThe increase in immigration to Europe has led to an increasing demand for information about healthcare needs and costs of vulnerable migrant populations, but few data based on actual demand for healthcare services and related costs exist.MethodsIn this single-centre retrospective register study, we examined the reasons for encounter and diagnoses, service use and costs of healthcare among patients at a voluntary clinic for migrants in an irregular situation in Helsinki, Finland in 2016. ICPC-2 classification and unit costs for primary healthcare in Finland were used as a basis for the cost estimation.Results546 patient visits accounted for 620 ICPC-2 coded reasons for encounter, diagnoses and process codes. The most common health problems were teeth/gum disease (10%), acute upper respiratory infection (5%) and oesophageal disease (3%). Visits seldom led to complementary investigations (2%), follow-up visit to the clinic (5%) or referral to public healthcare (11%). The total cost of treatment, excluding dental health costs, was 39 547 euros, or 71 euros per visit. ConclusionsMigrants in an irregular situation present with a variety of health concerns, the majority of which can be treated in a basic primary healthcare facility. The cost of healthcare was relatively low, as most of the complaints could be treated with simple means. More research is needed to understand the health and cost benefits of extending public healthcare services for migrants in an irregular situation beyond emergency care.

GP services in Australia: presentation profiles during usual practice hours and after-hours periods

After-hours general practitioner (GP) services can reduce emergency department demand, which is currently increasing in Australia. Understanding GP after-hours care may assist in service planning. From April 2014 to March 2015, 986 GPs recorded 38275 consultations with start and finish times in the Bettering the Evaluation and Care of Health (BEACH) study, a national, cross-sectional, representative study of GP activity. GP and patient characteristics and the content of encounters in usual-hours and after-hours were compared. Significantly more after-hours than usual-hours encounters were with: GPs aged 60+ years; in metropolitan practices; and practices with 10+ GPs. Patients seen after-hours were more often: male; aged 15–64 years; new to practice; and less likely to hold a Commonwealth Concession Card. They were more likely to be prescribed antibiotics and less likely to: have chronic problems managed; be referred; receive psycholeptic or psychoanaleptic prescription; and undergo a procedure. Throat symptoms, fever and injury were more common reasons for encounter, while infections and injury were more frequently managed problems after-hours. The patient mix, GP characteristics, problems managed and management actions in after-hours care differ from those in usual-hours care in Australia. This greater understanding of after-hours care is the first step to informed resource allocation to improve the delivery of after-hours primary care.

Multicentre descriptive cross-sectional study of Japanese home visit patients: reasons for encounter, health problems and multimorbidity

Background GP in Japan are encouraged to conduct home visits for older adults. However, most previous studies on home visits were based on secondary analyses of billing data that did not include reasons for the encounter. Objectives This study aimed to describe home visit care by GP in Japan, including reasons for encounter, health problems, episodes of care, comprehensiveness and multimorbidity. Methods This multicentre descriptive cross-sectional study used the International Classification of Primary Care, second edition, and was conducted in Japan from 1 October 2016 to 31 March 2017. Participants were patients who received home visits from 10 enrolled GPs working in urban and rural areas across Japan. The main outcome measures were reasons for encounter, health problems and multimorbidity. Results Of 253 potential patient participants, 250 were included in this analysis; 92.4% were aged 65 years and older. We registered 1,278 regular home visits and 110 emergency home visits. The top three reasons for encounters home visits were associated with cardiovascular and gastrointestinal disorders: prescriptions for cardiovascular diseases (n = 796), medical examination/health evaluation for cardiovascular diseases (n = 758) and prescriptions for gastrointestinal problems (n = 554). About 50% of patients had multimorbidity. Cardiovascular, endocrine and neuropsychological diseases were the most frequent problems in patients with multimorbidity. Conclusions The main reasons for encounter were prescriptions for chronic conditions. Emergency visits accounted for 8% of all visits. Around half of the patients had multimorbidity. This information may help GPs and policy makers to better assess home visit patients' needs.

Understanding patient profiles and characteristics of current chiropractic practice: a cross-sectional Ontario Chiropractic Observation and Analysis STudy (O-COAST)

ObjectivesThere is no current detailed profile of people seeking chiropractic care in Canada. We describe the profiles of chiropractors’ practice and the reasons, nature of the care provided to their patients and extent of interprofessional collaborations in Ontario, Canada.DesignCross-sectional observational study.SettingPrimary care setting in Ontario, Canada.ParticipantsWe randomly recruited chiropractors from a list of registered chiropractors (n=3978) in active practice in 2015. Of the 135 randomly selected chiropractors, 120 were eligible, 43 participated and 42 completed the study.Outcome measuresEach chiropractor recorded information for up to 100 consecutive patient encounters, documenting patient health profiles, reasons for encounter, diagnoses and care provided. Descriptive statistics summarised chiropractor, patient and encounter characteristics, with analyses accounting for clustering and design effects.ResultsChiropractors provided data on 3523 chiropractor-patient encounters. More than 65% of participating chiropractors were male, mean age 44 years and had practised on average 15 years. The typical patient was female (59% of encounters), between 45 and 64 years (43%) and retired (21%) or employed in business and administration (13%). Most (39.4%) referrals were from other patients, with 6.8% from physicians. Approximately 68% of patients paid out of pocket or claimed extended health insurance for care. Most common diagnoses were back (49%, 95% CI 44 to 56) and neck (15%, 95% CI 13 to 18) problems, with few encounters related to maintenance/preventive care (0.86%, 95% CI 0.2 to 3.9) and non-musculoskeletal problems (1.3%, 95% CI 0.7 to 2.3). The most common treatments included spinal manipulation (72%), soft tissue therapy (70%) and mobilisation (35%).ConclusionsThis is the most comprehensive profile to date of chiropractic practice in Canada. People who present to Ontario chiropractors are mostly adults with a musculoskeletal condition. Our results can be used by stakeholders to make informed decisions about workforce development, education and healthcare policy related to chiropractic care.

Reliability and validity of ICPC-2-R encoding by medical students

Objective: To estimate how reliably and validly can medical students encode reasons for encounter and diagnoses using the International Classification of Primary Care, revised 2nd edition (ICPC-2-R). Methods: For every encounter they supervised during an entire semester, three family and community physician teachers entered the reasons for encounter and diagnoses in free text into a form. Two of four medical students and one teacher encoded each reason for encounter or diagnosis using the ICPC-2-R. In the beginning of the study, two three-hour workshops were held, until the teachers were confident the students were ready for the encoding. After all the reasons for encounter and the diagnoses had been independently encoded, the seven encoders resolved the definitive codes by consensus. We defined reliability as agreement between students and validity as their agreement with the definitive codes, and used Gwet’s AC1 to estimate this agreement. Results: After exclusion of encounters encoded before the last workshop, the sample consisted of 149 consecutive encounters, comprising 262 reasons for encounter and 226 diagnoses. The encoding had moderate to substantial reliability (AC1, 0.805; 95% CI, 0.767–0.843) and substantial validity (AC1, 0.864; 95% CI, 0.833–0.891). Conclusion: Medical students can encode reasons for encounter and diagnoses with the ICPC-2-R if they are adequately trained.