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Sixteen years of ICPC use in Norwegian primary care: looking through the facts

机译：在挪威的初级保健中使用ICPC已有16年：通过事实调查

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Background The International Classification for Primary Care (ICPC) standard aims to facilitate simultaneous and longitudinal comparisons of clinical primary care practice within and across country borders; it is also used for administrative purposes. This study evaluates the use of the original ICPC-1 and the more complete ICPC-2 Norwegian versions in electronic patient records. Methods We performed a retrospective study of approximately 1.5 million ICPC codes and diagnoses that were collected over a 16-year period at 12 primary care sites in Norway. In the first phase of this period (transition phase, 1992-1999) physicians were allowed to not use an ICPC code in their practice while in the second phase (regular phase, 2000-2008) the use of an ICPC code was mandatory. The ICPC codes and diagnoses defined a problem event for each patient in the PROblem-oriented electronic MEDical record (PROMED). The main outcome measure of our analysis was the percentage of problem events in PROMEDs with inappropriate (or missing) ICPC codes and of diagnoses that did not map the latest ICPC-2 classification. Specific problem areas (pneumonia, anaemia, tonsillitis and diabetes) were examined in the same context. Results Codes were missing in 6.2% of the problem events; incorrect codes were observed in 4.0% of the problem events and text mismatch between the diagnoses and the expected ICPC-2 diagnoses text in 53.8% of the problem events. Missing codes were observed only during the transition phase while incorrect and inappropriate codes were used all over the 16-year period. The physicians created diagnoses that did not exist in ICPC. These 'new' diagnoses were used with varying frequency; many of them were used only once. Inappropriate ICPC-2 codes were also observed in the selected problem areas and for both phases. Conclusions Our results strongly suggest that physicians did not adhere to the ICPC standard due to its incompleteness, i.e. lack of many clinically important diagnoses. This indicates that ICPC is inappropriate for the classification of problem events and the clinical practice in primary care.
机译：背景技术国际初级保健分类（ICPC）标准旨在促进在国家边界内和跨国界对临床初级保健实践进行同时和纵向比较。它也用于管理目的。这项研究评估了原始ICPC-1和更完整的ICPC-2 Norwegian版本在电子病历中的使用。方法我们进行了一项回顾性研究，对16年来在挪威12个初级保健场所收集的约150万份ICPC代码和诊断进行了研究。在此阶段的第一阶段（过渡阶段，1992-1999年），允许医生在实践中不使用ICPC代码，而在第二阶段（常规阶段，2000-2008年）则必须使用ICPC代码。 ICPC代码和诊断在面向问题的电子病历（PROMED）中为每个患者定义了一个问题事件。我们分析的主要结果度量是具有不适当（或丢失）的ICPC代码的PROMED中问题事件的百分比，以及未映射最新ICPC-2分类的诊断的百分比。在同一背景下检查了特定的问题区域（肺炎，贫血，扁桃体炎和糖尿病）。结果在6.2％的问题事件中缺少代码。在4.0％的问题事件中观察到错误的代码，并且在53.8％的问题事件中，诊断与预期的ICPC-2诊断文本之间的文本不匹配。仅在过渡阶段才观察到缺少代码，而在整个16年期间都使用了不正确和不合适的代码。医生创建了ICPC中不存在的诊断。这些“新”诊断的使用频率有所不同。其中许多仅使用了一次。在选定的问题区域以及两个阶段也都发现了不合适的ICPC-2代码。结论我们的结果有力地表明，由于ICPC标准不完整，即缺乏许多临床上重要的诊断方法，因此医生未遵守该标准。这表明ICPC不适合在初级保健中对问题事件进行分类和临床实践。

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