Diapositive 1

Diapositive 1

Attempt to classify main descriptors of GP/FM job. Proposal for a new classification Core Content Classification of GP/FM 3C GP/FM Marc Jamoulle, md, mph. GP & Health data management specialist Researcher, Dep. of General Practice, UCL Wonca Europe 2007 Friday 17 Oct. 2007 Wonca 2007 m.j. 3C GP/FM 1 ICPC is great But only clinical Family doctor work area and work load need specific descriptors Wonca 2007 m.j.

3C GP/FM 2 GP/FM needs Global description of activity, skills and knowledge Classification complementary to ICPC Descriptors for indexation Main axes of training for undergraduate and vocational Wonca 2007 m.j. 3C GP/FM 3 GP/FM needs Examples Journal watch indexing Grey production retrieval Internet sites indexing Wonca abstract archives Teaching program evaluation Wonca 2007 m.j.

3C GP/FM 4 Specific tool design evolution 1987 : Q CODES (Lamberts) 2005-6 : Metaclinical WICC Heidelberg De 2007 : 3C GP/FM WICC Dunedin NZ Wonca 2007 m.j. 3C GP/FM 5 Q-CODES (level 1) Amsterdam (+/- 1987) Dep of gen practice. Prof Lamberts Used for manual indexing. Translated in French (mj) Q0 Care process (patient linked ) Q1 Care process (not patient linked ) Q3 Support task Q4 Personal functioning Q5 Patients categories Q6 Research Q7 Teaching Wonca 2007 m.j. 3C GP/FM

6 Metaclinical (MJ 2005) All those items aim to describe the content of GP/FM in its non clinical approach. They constitute meta-information on the way the clinics and the patient doctor relationships are driven. Wonca 2007 m.j. 3C GP/FM 7 2007 8 domains GP/FM 3C Core Content Classification of GP/FM

Patient issues Providers issues Structure of practice Patients categories Hazards Ethics Training, teaching R & D tools Wonca 2007 m.j. QP Patient QD Doctor QS Structure QC Categories QH Hazards QE Ethics QT Knowledge QR Research 3C GP/FM 8 Please do refer to the desk

copy Wonca 2007 m.j. 3C GP/FM 9 3C GP/FM Domain Knowledge Management QT Categories Training QT4 Sub categories Trainers & Supervisors QT43 Wonca 2007 m.j. 3C GP/FM 10 Patient's categories QC Wonca 2007 m.j.

Age groups QC1 Gender issues QC2 Social high risk QC3 Addiction QC4 Assault QC5 3C GP/FM 11 Assault QC5 battered victims Wonca 2007 m.j. women QC51

of abuses QC52 torture QC53 ritual QC54 mutilations 3C GP/FM 12 Knowledge management QT Wonca 2007 m.j. Teaching QT1 Training QT4

Quality assurance QT5 Editing QT6 Reporting QT7 3C GP/FM 13 Training QT4 Undergraduate QT41 Vocational training QT42 Continuous medical educ. QT43 Supervision & Balint QT44 Trainers and supervisors QT45 Academics QT46 Wonca 2007 m.j. 3C GP/FM 14

Exercise with Medline Aim: pre test, to compare content of Medline abstract related to GP/FM with the concepts of metaclinical classification Methods: Choice of medline abstracts: one descriptor with several limits to get a little number of abstracts to analyse "family practice"[MeSH Terms] Limits: only items with links to full text, only items with abstracts, English, published in the last 3 years, Humans, Core clinical journals Review: 39 items Each content of abstract is compared to the metaclinical classification and correspondences are searched. Wonca 2007 m.j. 3C GP/FM 15 Exercise with Medline Analysis The number of health issue management (QD33) is wondering 29/39 This give an insight on the way the indexing process is done in Medline under the Descriptors review and family practice This Pretest has been edited by MJ April 15, 2007 Available at http://docpatient.net/class/meta.html Wonca 2007 m.j.

3C GP/FM 16 Indexing Wonca Europe 2007 abstracts Direct acces to reviewer screens Copy of 998 abstracts in a database Indexing by max 3 codes of 3CGP/FM max 3 codes of ICPC-2 Special thanks to Bernard Gay, Hector Falcoff, Michele Lieurade Anne Marie Magnier and Madedeleine Favre for helping me And to Tarik Jamoulle for copying the abstracts Wonca 2007 m.j. 3C GP/FM 17

Ecran wonca 2007 avec 1 page dabstracts inserer ici Wonca 2007 m.j. 3C GP/FM 18 Ecran wonca 2007 avec 1 abstract inserer ici Wonca 2007 m.j. 3C GP/FM 19 Coding process Some abstract titles seems meaningfull adn enough to make the codes easily # 1344 QR2 Epidemiology The prevalence of asthma in rural areas in Crete is similar to that of urban areas QS11

Setting (incl rural) R96 Asthma Reading abstract add information QC12 Children Wonca 2007 m.j. 3C GP/FM 20 Coding process after reading abstracts # 1373 Yearly influenza vaccination of elderly: when do the French GP vaccinate? QR42 Research network Wonca 2007 m.j. R44 Vaccination Influenza 3C GP/FM

QC14 Ageing 21 Back from codes to abstract QD14 : QD : Provider QD1 Communicator QD14 : systemic + QC13 : QC : Patients categories QC1 : age groups QC13 : adolescents + QC34 : QC : Patients categories QC3 : Social high risk QC 34 : in jail + P ; chapter P : psychological = Lack of family support in the responsibility of the mental disorder in jail adolescents Poster # 639 Wonca 2007 m.j. 3C GP/FM 22

Examples of concepts added during the abstract indexing Patient views Patient appraisal Patient satisfaction Patient knowledge Patient autonomy/dependency Patient cultural background Patient expenses Patient health habits Nutrition Sexuality Self care & hygiene Wonca 2007 m.j. 3C GP/FM QP4 QP41 QP42 QP43 QP44 QP45 QP46 QP5 QP51 QP52 QP53 23

Examples of some other concepts added during the Abstract indexing ritual mutilations QC54 Confidentiality QE41 Informed consent QE42 Pharmacoepidemiology QR21 Community health QR22 Wonca 2007 m.j. 3C GP/FM 24

Results Analyse and presentation of the content of the base Elaboration of the project of a knowledge base 998 Abstracts ; types distribution Poster 39; 4% Oral 289; 29% Workshop 671; 67% ICPC coding on 872 abstracts 1036 coding but some clusters 768 in chapters 168 in Process codes One ragbag:

T99 metabolic syndrome First results with simple excell db Wonca 2007 m.j. A84/A85/A86/ All medicine late effects A87 K74/K75 chronic ischaemic K74/K75/76 chronic and acute D19/D20 mouth K86/K87 HTA P02/P74 anxiety

R95/R96 airways obstruction S18/S19 skin cut and inj T82/T83 overweight T89/T90 diabetes U88/U99 chronic kydney disease (CKD) 3C GP/FM 27 Process codes ; Mainly drugs. Surprising 48 872 abstracts 70

20 12 31 9 33 5 7 8 34 37 39 8 3 40 41 1

44 48 50 2 2 1 1 51 52 53 59 Process codes Wonca 2007 m.j. 3C GP/FM 28 998 abstracts, ICPC chapters distribution

183 179 P T 130 120 103 B Z 42 33 28 18 A B 17 D 6

3 F H K L N 18 10 P R S 24 24 7 T U

W X Y Z About age categories : on 990 abstracts 70 39 16 4 infants children ados ageing QC11 QC12 QC13 QC14

Metabolic S. 24 Hyperlipid 16 Diabetes 62 28 Obesity Nutrition 4 0 20 Opening of T chapters 40 60

80 BURNOUT 4 DEPRESSION 33 NICOTINE 28 ALCOHOL ANXIETY TR. 18 12 UNSP.PSY Opening of P chapter 19 Wonca Paris 2007 643 405

197 QC QD 16 3 QE QH 151 162 QP QS 8 main domains 3CGP on 998 abstracts QT Care manager (QD3 to QD35) Care management

3 Health risk management 75 Health issue management 88 Health issue assesm. 184 51 Outcome Genetic issue 1 R & D 27 PHC planification & organisation

19 Health economy 56 Scales & Questionnaires 17 Classification 101 Research methods 20 Functional status 91 Epidemiology Science philosophy 1 of which of w hich

Community health Research netw orks Pharmacoepid. Qualitative studies 0 20 40 60 80 100 0 10 20 30

40 50 60 49 13 8 NETWORK SENTINEL EVENT REPORT QR42 QT71 QT73 About Prevention 51 28 19

5 6 NP I II III IV QD4 QD41 QD42 QD43 QD44 Tree communications with erroneous concepts of secondary prevention 127 337

1020 Secondary prevention therapies in patients with coronary heart disease Secondary cardiovascular prevention: Is there a correlation between patients awareness of high cardiovascular risk and treatment outcomes? Secondary prevention of ischemic cardiopathy in primary care Prevention term following time frame concept only Secondary used for consecutive to Such vocabulary issued from Specialist care and Pharmaceutical Cies Quality QT5 to QT57 (160 16%) 9 DEVICE ASSESM. 32 PRACT. ASSESMENT ACREDITATION PEER REVIEW CRIT. READING & REVIEW 4 8

11 38 GUIDELINES EBM QA METHODS 14 44 Opening of QT62 (On line) 3 TELEMEDECINE ONLINE HIS e-PATIENTS 1 5 11 ONLINE EBM DIST LEARNING 8 Wonca abstracts Paris 2007 on 871 indexed abstracts QT4 domain (Training) distribution

30 26 25 20 15 17 13 8 10 3 5 3 0 1 Wonca 2007 m.j. QT41 student QT42 QT44 trainers

QT45 superv 3C GP/FM VT QT43 CME QT46 academ 41 DEMAND A P P R A IS A L S A T IS F A C T IO N K N OW LE D GE A U T ON OM Y C U LT U R A L EXPENSES DISTRIBUTION OF PATIENTS VIEWS QP4 22 22

12 5 5 2 1 QP40 QP41 QP42 QP43 QP44 QP45 QP46 SOCIAL HIGH RISK (on 998 abstracts) 12 11 10 8 6 4 2 1 1

0 0 Ethnic subgroups Migrants & refugees Homeless In jail First results with simple excell db A23 Risk others A70 Tuberculosis example of QC32 : migrants On 23 occurences A78

Infect dis others A80 influenza B90 HIV ICPC associated codes P Psycho P15 Alcohool P74 Acute stress A

5 T Nutrition B 1 T89/T90 Diabetes P 3 T90 Diabetes NID T 3 *41 Imaging

W78 Pregnancy W 2 A44 immunization W78 Z 4 B34 Blood analysis Z01 Poverty Z07 Litteracy

Z10 Health care access Z25 Violence chapters Wonca 2007 m.j. process 3C GP/FM 44 example of QC32 : migrants On about 800 abstracts : 23 occurrences 48 other Q codes associated First results with simple excell

db Wonca 2007 m.j. QC22 Womens health 1 QC51 battered women 1 QD27 A&E 2 QD31 Health risk assessment 1 QD32 Health issue managem.

2 QD33 Health issue assessment 5 QD35 Prevention 3 QE2 Ethics 1 QP31 Availability of health care 1 QP32 Accessib. of health care

3 QP33 Acceptab. of health care 4 QP43 Patient knowledge 1 QP51 Nutrition 2 QR2 Epidemiology 1 QR3 Functional status

1 QR6 Scales & Questionnaires 1 3C GP/FM 45 Utility of 3CGP/FM looks evident But No Reproductibility Not all domains Not all categories No error control (ex QT2 and QT3 missing in the code list) One man show Little scientific value Wonca 2007 m.j. 3C GP/FM 46

Proposal to the WICC ; plan & develop 3CGP/FM Methods Funds and grants? Bibliography on the subject Structure of the classification Domain, cat, sub cat, definitions, excl, incl. Database appropriation Online testing using GP productions Evolutive product Open minded (open document free & controlled acces) Wonca 2007 m.j. 3C GP/FM 47

Now, let we see how to use 3CGP/FM and ICPC as indexing tool for Wonca earchive knowledge base

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