12. møde i ICPC-baggrundsgruppen. Tirsdag den 5. marts 2013 kl. 15.00 til 17.30

12. møde i ICPC-baggrundsgruppen Tirsdag den 5. marts 2013 kl. 15.00 til 17.30

14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 2

ICPC BAGGRUNDSGRUPPEMØDE 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 5

sundhed.dk 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 7

The mission of the Wonca International Classification Committee is to develop and maintain classifications that accommodate the complete domain of family/general practice, and to ensure that these classifications are interoperable to the highest degree possible with standard international health care terminologies and classifications, in order to contribute to equitable quality health care worldwide. 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 10

Dilemmaer i ICPC kodningen? Oversigt Specificitet Arbejdsområde Multimorbiditet Funktionsstatus Samarbejdspartnere Kommunerne Sekundær sektor Andre faggrupper Mapping andre kodesystemer 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 11

Fordele ved diagnosekodning. Af Erik Falkø. Månedskr Prakt Lægegern 2009; 87:838-46 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 12

Dataelementer almen praksis Person: demographics, social structure, goals, preferences Problem(s): RFE as starting point. current/active severity Clinical Modifiers: prevention, risk factors Significant events Actions ( Process ): Decisions Interventions Plans Time: Episode structure Data Import/Export Exchange Protocols ICNP? International Classification for Nursing Practice ICPCC ICF ICD International Classification of ICPC-ICD-SNOMED Functioning, Disability maps and Health (Systematized (ICF) FællesSprog Nomenclature II Of Medicine ICPCC ) ACG ICD Adjusted ICPC - proceskoder Clinical Groups - Multimorbiditet ICHI International Classification of Health Interventions ICNP ATC ICPC-ICD-SNOMED maps 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 19

ICPC-2 > ICPC-3 The proposed set of Family Practice classification tools will include in the central role ICPC-3, linked to a revised and simplified functional status classification, a Non-Episode Related Information classification, a classification of patient preferences and goals, and a revised process/intervention classification. 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 20

ICPC-2 > ICPC-3 1. ICPC-3 - the backbone of the tool set. Correcting errors in individual rubrics and in mappings to ICD-10 Merging of Chapters X and Y Significant revision to Chapters P and Z Adding rubrics to Component 7 new and important diagnoses Reducing, restructuring, or eliminating Components 2-6 ( process components) Improving the prevention and risk factor content 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 21

ICPC-2 > ICPC-3 The basic ICPC-3 will retain its biaxial chapter-and-component structure but feature 4-digit codes. The first alpha term will confirm the chapter, the second will contain added information in the form of subcategories of interest to health authorities. The initial list of second alpha terms will include: S = Symptoms/complaints G = infections (Germs) N = Neoplasms with discussion about whether to further divide into Malignant/Benign/Uncertain T = Trauma/injury A = congenital Anomalies D = other Diseases 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 22

ICPC-2 > ICPC-3 ICPC-2 ICPC-3 A01 Almen/udbredt smerte AS01 A75 Mononukleose AG75 A99 Sygdom/tilstand af uspecifik natur/lokalisation AD99 D76 Kræft i bugspytkirtel DN76 S = Symptoms/complaints G = infections (Germs) N = Neoplasms D = other Diseases 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 23

På dette niveau er det for de fleste af dagens læger alt for nørdet. Men det har det jo altid været helt fra ICPC's start og verden kan jo udvikle sig, når nye generationer kommer til. Det er da sket før VH Clemme 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 24

ICPC-2 - Use around the world Argentina Australia Belgium Cameroon Cyprus Denmark Finland Germany Greece Japan Malta Netherlands Norway Portugal Romania Russia Serbia Slovenia Spain Sri Lanka United States of America 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 25

ICPC-2 - Use around the world Argentina Australia Belgium Cameroon Cyprus Denmark Finland Germany Greece Japan Malta 16.045.465 koder fra 18-12-10 18-12-12 (ca 50% samtlige kontakter) Netherlands Norway Portugal Romania Russia Serbia Slovenia Spain Sri Lanka United States of America Kilde 2010 http://sydney.edu.au/medicine/fmrc/icpc-2/world-usage/index.php 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 26

Dear Preben, In the newest version ICPC-2-v4.2 you can classify it using the classes D85 or D86 when it is an ulcer and D87 for gastritis. Of course we could discuss, and we did it in our mapping group if finding a helicobacter should also be mapped to A91, abnormal finding. But we do the same in our countries if we find a helicobacter we treat it and there is a need to relate to a disease (although about 100% of all adults in many countries in the word have an infection with helicobacter). So treating helicobacter and using the class D02 is somehow a little bit strange. Advise in this case D87 Best regards, Kees 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 34

Dear Preben, ICPC baggrundsgruppemøde the problem you meet is that ICPC-2 is a localization based, not an etiology based classification. What you know of this patient is that he has epigastric pain. And you have a positive breath test. What you suppose is that there is a relationship between the two. Otherwise you would not want to treat with triple-therapy. In the German modification of ICD-10 we have the possibility to code the certainty of our diagnoses. In this case we could code suspicion of gastritis/ ulcer. ICPC-2 does not offer this option. As you don t know what it is you could either stick to the symptom or by postcoordination add A91 for the breath-test. Classification is inevitably reduction of information. Herzliche Gruesse Thomas Priv. Doz., Dr. med. Thomas Kühlein Universitätsklinikum Heidelberg Abteilung Allgemeinmedizin und Versorgungsforschung Dept. of General Practice and Health Services Research Voßstr. 2, Gebäude 37, 69115 Heidelberg Tel +49(0)6221-56-4818, Fax +49(0)6221-56-1972 thomas...@med.uni-heidelberg.de www.content-info.org www.allgemeinmedizin.uni-hd.de www.versorgungsforschung-aktuell.de 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 35

Dear Preben, As ICPC privileges location before etiology, I usually classify H pylori infection as gastritis, since I'm treating H pylori as a cause of gastric complaints. H pylori infection rates can be very high in certain parts of the world, so I wouldn't classify it's presence as a disease if there are no symptoms. Hence, my suggestion would be D87, which includes gastritis. If you look at ICD-10's notes on the B98 code, it says up top: Chapter I Certain infectious and parasitic diseases (A00-B99) Bacterial, viral and other infectious agents (B95-B98) Note:These categories should never be used in primary coding. They are provided for use as supplementary or additional codes when it is desired to identify the infectious agent(s) in diseases classified elsewhere. Best regards, Daniel Pinto WWW: www.danielpinto.net Informaï ½ï ½o de contacto: www.danielpinto.net/contacto/ 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 36

Kl. 17.20 17.30 Eventuelt Næste møde Sandwich og vand Afslutning TAK FOR IDAG 14-05-2013 DAK-E//PREBEN LARSEN ICPC KONSULENT 42