Family Medicine

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World Book of Family Medicine – European Edition 2015 doctors and their relationships, it is clear that any quantitative measure of effectiveness based on the analysis of small numbers of consultations, will be unlikely to yield a reliable measure. Large numbers of unselected consultations are needed for the effect of influences to accumulate. PEI requires such conditions, which is both its strength and its possible limitation. Patient enablement (the PEI) provides us with a way to investigate effectiveness in general practice, which is sensitive to patient, doctors and consultations. It encapsulates general practice core values and a patient-centred approach. Take home messages Increasing patient involvement in the assessment of their own care is a 21st Century imperative. The medical consultation is pivotal to health care delivery, and the pursuit of excellence in consultations enables practitioners to activate their knowledge in the service of patients. There are many ways to approach the assessment of effectiveness, and patient centred outcomes are valued, but sometimes difficult to define and operationalise. The Patient Enablement Instrument (PEI): Patient offers an approach to investigate effectiveness in family practice, which is sensitive to patient, doctors and consultations. Original abstract http://www.woncaeurope.org/content/theme-c-measuring-effectiveness-general-practice-family-medicine References 1. Howie J, Heaney D, Maxwell M. Measuring quality in general practice. Occas Pap R Coll Gen Pract. 1997; 75:32. 2. Mercer S, Reilly D, Watt G. The importance of empathy in the enablement of patients attending the Glasgow Homoeopathic Hospital. Br J Gen Pract. 2002; 52(484): 901-5. 3. Pawlikowska T, Zhang W, Griffiths F, van Dalen J, van der Vleuten C. Verbal and non-verbal behavior of doctors and patients in primary care consultations - how this relates to patient enablement. Patient Educ Couns. 2012 Jan; 86(1): 70-6. 4. Howie J, Heaney D, Maxwell M, Walker J, Freeman G, Rai H. Quality at general practice consultations: cross-sectional survey. BMJ. 1999; 319: 738-43. 5. Pawlikowska T, Nowak P, Szumilo-Grzesik W, Walker J. Primary care reform: a pilot study to test the evaluative potential of the Patient Enablement Instrument in Poland. Fam Pract. 2002; 19(2): 197-201. 126
World Book of Family Medicine – European Edition 2015 Jean Karl Soler, MD, PhD info@thefamilypractice.com.mt Success Story 41 – The International Classification of Primary Care: a Jean Karl Soler, MD, PhD Wonca International Classification Committee (WICC) Wonca Informatics Working Party (WIWP) Co-authors Marc Jamoulle 1,2, Peter Schattner 2 1. Wonca International Classification Committee (WICC) 2. Wonca Informatics Working Party (WIWP) (°) The first WICC working group consisted of Charles Bridges- Webb (Australia), Robert Westbury (Canada), Philip Sive (Israel), Derek Callagher (New Zealand), Donald Crombie (United Kingdom) and Jack Froom (United States). ICPC was first developed by Henk Lamberts, Maurice Wood and Sue Meads. The Forty Year Story of ICPC The WONCA International Classification Committee (WICC) was set up by the WONCA Council in Melbourne in 1972 on the occasion of the Fifth World Conference (1). WONCA recognized the need for classifying and analysing data derived from clinical encounters with patients that was quite unique to family medicine. This would become increasingly important with the advent of electronic health records. From an initial small group led by Henk Lamberts and Maurice Wood (°), a tool which would become the ICPC was progressively developed and in 1987, the three existing classification systems, the International Classification of Health Problems in Primary Care (ICHPPC-2), ICPC-Process and Reason for Encounter - were merged into a single one; the ICPC. ICPC-2 was published in 1998 by the WONCA International Classification Committee, after several years of revision and cross-mapping with the International Classification of Diseases (ICD) – 10 (2). ICPC-2 is maintained by WICC and an updated version is edited on the site of the Norwegian Centre for Informatics in Health and Social Care. WICC members meet each year in a different country and communicate through a very active mailing list. ICPC and its Role in Primary Care ICPC is a coding and classification system that reflects the distribution and content of the domain of family medicine, and also acts as its ordering principle. It was designed as an epidemiological tool to classify and analyse data about three important elements of the health care encounter: the reasons for encounter (RFE), the diagnosis or problem, and the process of care in family medicine. Novel features are the inclusion of patients’ symptoms and complaints which allows the patient's reasons for encounter to enter a system of routine clinical data collection, the structuring of data into episodes of care, and the incorporation of the symptom as a diagnosis (3). The collation and analysis can occur at the level of an individual patient for clinical care, and at the practice level for recall, clinical audit and activity analysis for health services research. Maps are maintained from other classifications such as ICD-10 so that ICPC may also be used as an organizing principle for data collected in other systems such as the clinical terminology, SNOMED-CT. Linkage of elements permits categorization from the beginning of the encounter with a health problem to its conclusion, as well as a dynamic arrangement of encounters into episodes. ICPC-2 is available in more than 25 languages. It is compact, and the entire classification can fit onto two A4 pages. It is compatible with problem-oriented clinical records. In Norway, FDs are obliged to label all fee-for-service bills, sick-leave certificates and social security forms with an ICPC-diagnosis in order for them to be accepted by the health authorities. It is also used in referrals, e-Prescriptions and the 127
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