MI 224: International Classification for Primary Care

International Classification for Primary Care (ICPC)ROY O. DAHILDAHIL, RMTBS Public HealthMS Health Informatics

@rdahildahil_ | #ISKOMULI #ICPC #MSHI2017 #MI224

• The International Classification of Primary Care (ICPC) is the most widely used international classification for systematically capturing and ordering clinical information in primary care.

International Classification for Primary Care (ICPC)


ICPC• The International Classification of Primary Care (ICPC) is compact,

containing only 1400 classes. However it is comprehensive, covering multiple aspects of primary care. It is based on the epidemiology of primary care – classes are developed based on: Frequency of occurrence in primary care; Public Health importance (described as 1 / 1 000 patients per year); prognosis/outcome; Value of interventions.


Rationale• Policy-makers, funders and providers of healthcare need to have

information about the epidemiology of their communities, and they need to understand what is happening within primary care to improve health services. For providers to effectively record information about this as part of routine clinical practice, easy to use classification tools are necessary.

(Globalfamilydoctor.com)


• ICPC is formally recognized by the World Health Organization’s (WHO) Family of International Classifications (WHO-FIC) as a classification system for primary care.

• It is mapped to the International Classification of Diseases (ICD). • This allows communication between the two classification systems

and complementary usage. Ongoing cooperation between WONCA and the WHO-FIC network exists for the revision of ICD-10 to ICD-11 and harmonization with ICPC.

ICPC


1972• the Classification Committee of the World Organization of National

Colleges, Academies and Academic Association of General Practitioners/Family Doctors (WONCA), now World Organization of Family Doctors first met in Melbourne, many of its members had already been corresponding for years about morbidity classifications for general practice. They agreed that it was time to design a classification specifically for primary care

History


1975• Recognizing the problems of the ICD, and the need for an

internationally recognized classification for general practice, the WONCA classification committee (now Wonca International Classification Committee) designed the international Classification of Health Problems in Primary Care (ICHPPC) published in 1975

History


1978• the WHO Conference on primary Health Care in Alma Ata, adequate primary health care was recognized as the

key to the goal of “health for all by the year 2000”. WHO recognized that building appropriate primary care systems to allow assessment and implementation of health care priorities was only possible if the right information was available to health care planners. Classification of primary care data was seen as vital to this process.

• within WHO, this led to the development of the concept of a “Family of Classifications”, requiring new classification systems, particularly for primary care. The US National Center for Health Statistics (NCHS), developed a classification of patients reasons for visiting physicians. The NCHS supported the development of a new classification of Reasons for Encounter in primary care. A small working party was formed under the auspice of WHO, to develop the Reason for Visit Classification. Over the years of work, the party developed the Reason for Encounter Classification.

• RFE are the agreed statement of the reason why a patient enters the health care system.• The RFEC focuses on data elements from the patients perspective, making it patient oriented rather than disease

or provider oriented.

History


• 1979 – the second edition of ICHPPC was published related to the 9th revision of ICD

• 1980 – The first field trial to test the completeness and reliability of RFEC was a pilot study carried out in Netherlands.

• 1983 – The results obtained from the pilot study prompted further feasibility testing carried out in 9 countries including the Philippines. Australia, brazil, Barbados, hungary, Malaysia, Netherlands, Norway, and USA.

• - the 3rd edition of ICHPPC was published. (ICHPPC-2-Defined)

History


1985• Studies by a number of European countries was conducted to test the usefulness of the new

classification system in producing morbidity data from general practice to for national health information systems. This involved translations of the classification and comparative studies across the countries.

1987• In the course of the feasibility testing, it was noted that RFEC could easily be used to classify

simultaneously the RFE, process of care and health problems diagnosed. Thus, RFEC evolved into ICPC. However, problems in the development of ICD 10 prevented who from publishing ICPC, but after negotiation, WONCA published the ICPC.

• The first version of ICPC was published and is referred to as ICPC-1.

1993• Revised and published in 1993 publication The International Classification of Primary Care in the

European Community: With a Multi-Language Layer (ICPC-E)

History


1998• WONCA published a revised version of ICPC (ICPC-2) with inclusion and

exclusion criteria and mapping to the ICD 10

2000• A revised electronic version was released• This was referred to as ICPC-2-E where “E” referred to a revised electronic

version

2003• WHO recognized ICPC-2 as a WHO related classification for the recording of

data in primary care.

History


2015• WONCA published a revised version of ICPC (ICPC-2) with inclusion and

exclusion criteria and mapping to the ICD 10

2000• A revised electronic version was released• This was referred to as ICPC-2-E where “E” referred to a revised electronic

version

2003• WHO recognized ICPC-2 as a WHO related classification for the recording of

data in primary care.

History


• The International Classification of Primary Care (ICPC) broke new ground in the world of classification when for the first time, primary health care providers could classify, using a single classification, three important elements of the health care encounter:

Reasons for encounter (RFE) Diagnoses or problems

Process of care.

History


(GC Miller, 2009)

• Understanding the reasons for encounters across a primary care population is essential for the development of people-centred health services.

• ICD was designed to allow healthcare providers to code a patient’s health problem in the form of a diagnosis.

• However, many symptoms and non-disease conditions that present in primary care are difficult to code with the ICD, which in principle has been designed for mortality and morbidity statistics with a disease-based structure and so a diagnosis represents the healthcare provider’s view on a patient’s illness – which it may not necessarily be correct or appropriate.

• For example weakness/tiredness in primary care – does not result in a clearly classifiable disease. ICPC allows such data elements from the patient’s perspective to be included. In doing so, it aims to be patient-oriented at the same time being able to capture the provider’s diagnosis and classify diseases which can be mapped to ICD when appropriate

Workflow


• A large proportion of the world’s medical care is provided by primary care• Primary care is expanding rapidly, particularly in developing countries and in

eastern Europe • Primary care physicians manage a very wide spectrum of patient problems:

physical, psychological, social and functional• Good primary care = good population health


(GC Miller, 2009)

Scope of Primary Care

• ICD is designed to serve the needs of hospital care where patients normally present for a single episode of care and mostly with one, often clearly differentiated, problem often clearly differentiated, problem.

• In primary care, however, healthcare providers deal typically with multiple episodes of care over time, and deal with many, often undifferentiated, problems simultaneously.

• The benefit of ICPC is that it captures episodes of care (EoC) over time. It does so by allowing the simple recording of the first contact between patient and healthcare provider concerning a certain health problem, and ends with the last contact relating to this same problem.

ICD vs ICPC (READ)


WorkflowRFE

I’m feeling Tired

DiagnosisFatigue

ProcessCBC

RFE“What’s the

Result?”

DiagnosisIron Deficiency

Anemia

ProcessColonoscopy

RFE“What’s the

Result?”

DiagnosisCancer of the

Colon

ProcessReferral


1st Encounter

2nd Encounter

3rd Encounter

ICD 10

• ICPC is based on a biaxial structure with 17 chapters on an axis and seven components on the other.

• The 17 chapters are based on the systems of the human body with two additional chapters, one for psychological problems and one for social problems. The seven components are:


(GC Miller, 2009)

Scope of Primary Care

ICPC 2 Structure


CHAPTER

COMPONENTS A B D F H K L N P R S T U W X Y Z

1. Symptoms, complaints

2. Diagnostic, Screening, prevention

3. Treatment, procedures, medicatiions

4. Test Results

5. Administrative

6. Others

7. Diagnoses, diseases

• Divided into 17 chapters by body systems representing the localisation of the problem and/or disease.

• Used by healthcare providers• There are chapters for different body systems, and chapters for

general and unspecified issues, and chapter for social problems• These two are important to understand what happens in primary care

ComponentS


17 Chapters


A – General and unspecifiedB – Blood/blood forming organs, lymphatic (spleen, bone marrow)D – DigestiveF – Eye (Focal)H – Ear (Hearing)K – CirculatoryL – Muskuloskeletal (Locomotion)N – NeurologicalP – Psychological

R – RespiratoryS – SkinT – Endocrine, metabolic and Nutritional (Thyroid)U – UrologicalW – Pregnancy, child bearing, family planning (Women)X – Female Genital (X-Chromosome)Y – Male Genital (Y-Chromosome)Z – Social Problems

7 Components


1 Symptoms, Complaints 1 - 292 Diagnostic Screening, Prevention 30 - 493 Treatment, Procedures, Medication 50 - 594 Test Results 60 – 615 Administrative 626 Other 63 – 697 Diagnoses, Diseases 70 – 79

Infectious DiseasesNeoplasmsInjuriesCongenital anomaliesOther Specific Diseases

Coding structure


• Alpha –Numeric (1A, 2N)• Alpha represents the chapter• Numeric represents the component

F02 – Red eye

• A great deal of attention is paid to the patient’s symptoms and complaints in the first component of each chapter as the reason for encounter (RFE), which is not captured by ICD. Linkage of codes from the beginning of an encounter, with the RFE, to its conclusion is possible with ICPC.

Components


Summary Sheet


Summary Sheet


• Color coded• Process codes (Grey)• Symptoms (Lime)• Infections (Yellow)• Neoplasm (Light

Blue)• Injuries (Red)• Congenital

Anomalies (Blue)• Other Diagnoses

(Violet)

Ragbag rubric


• In order to address those that are not yet classified, in every end of each chapters there is a Ragbag rubric to cater all other concepts

S29 – Other skin symptoms/complaintsK19 – Other Cardiovascular Diseases

• Benefits: Episodes of care allows for grouping of information over time. Healthcare providers can use this to improve continuity and coordination of care. The ability to collect data using the Episodes of care also creates more insight into the processes related to certain conditions reflect the content of primary care. The ICPC contains codes that are mainly based on the frequencies with which they are encountered in primary care and with a level of detail that is appropriate for primary care. It is possible to tailor ICPC to match local epidemiological needs.

USES


• It allows patients’ health problems to be tracked over time through the recording of episodes of care, and by allowing the coding of the reason for encounter through to a recognizable disease/problem and interventions.

• It reflects the frequency and distribution of health problems commonly encountered in primary care, and reflects the way in which primary care providers work to solve problems.

• It is simple and easy to use for primary care providers including doctors, nurses and other healthcare workers, therefore increasing the likelihood of consistent and accurate coding.

• It complements other classification systems such as ICD, and clinical terminology systems such as SNOMED CT and Read codes.

• It enables meaningful feedback to primary care, enables the exchange of information between primary and secondary care, as well as with policy-makers and funders to understand what is happening in primary care, and therefore improve the provision of care.

Benefits


(Globalfamilydoctor.com)

Thank You!