Core Content Classification of GP/FM

3C GP/FM

Attempt to classify main descriptors of GP/FM job. Proposal for a new classification

1

Marc Jamoulle, md, mph.

GP & Health data management specialist

Researcher, Dep. of General Practice, UCL

Wonca Europe 2007

Friday 17 Oct. 2007

But only clinical

Family doctor work area and work load need specific descriptors

ICPC is great

2

Global description of activity, skills and knowledge

Classification complementary to ICPC

Descriptors for indexation

Main axes of training for undergraduate and vocational

GP/FM needs

3

Examples

Journal watch indexing

Grey production retrieval

Internet sites indexing

Wonca abstract archives

Teaching program evaluation

GP/FM needs

4

Specific tool design evolution

5

1987 : Q CODES (Lamberts)

2005-6 : Metaclinical WICC Heidelberg De

2007 : 3C GP/FM WICC Dunedin NZ

6

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 Patient’s‏categories‏

Q6 Research

Q7 Teaching

Metaclinical (MJ 2005)‏

7

• 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.

Patient issues

Provider’s issues

Structure of practice

Patient’s categories

Hazards

Ethics

Training, teaching

R & D tools

2007 8 domains 3C GP/FM Core Content Classification of GP/FM

8

QP Patient

QD Doctor

QS Structure

QC Categories

QH Hazards

QE Ethics

QT Knowledge

QR Research

Patient’s issue

Provider’s issue

Structure of practice

Patient’s categorie

Hazard

Medical ethic

Training, teaching

R & D tool

Other

9

QP Patient

QD Doctor

QS Structure

QC Categories

QH Hazards

QE Ethics

QT Knowledge

QR Research

QO Other

3C GP/FM

10

Domain Knowledge Management QT

Categories Training QT4

Sub categories Trainers & Supervisors

QT43

Age groups QC1 Gender issues QC2 Social high risk QC3 Addiction QC4 Assault QC5

Patient's categories QC

11

battered women QC51

victims of abuses QC52

torture QC53

ritual mutilations QC54

Assault QC5

12

Teaching QT1 Training QT4 Quality assurance QT5 Editing QT6 Reporting QT7

Knowledge management QT

13

Undergraduate QT41

Vocational training QT42

Continuous medical educ. QT43

Supervision & Balint QT44

Trainers and supervisors QT45

Academics QT46

Training QT4

14

Exercise with Medline

15

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.

Aim: pre test, to compare content of Medline abstract related

to GP/FM with the concepts of metaclinical classification

Exercise with Medline

16

Analysis

The‏number‏of‏‏“health‏issue‏management”‏

(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

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

Indexing Wonca Europe 2007 abstracts

17

Special thanks to

Bernard Gay, Hector Falcoff, Michele Lieurade

Anne Marie Magnier and Madeleine Favre

for helping me

And to Tarik Jamoulle for copying the abstracts

18

Ecran‏wonca‏2007‏avec‏1‏page‏d’abstracts‏‏à‏inserer‏ici

19

Ecran wonca 2007 avec 1 abstract à inserer ici

Some abstract titles seems meaningfull adn enough to make the codes easily

Coding process

20

# 1344 The prevalence of asthma in rural areas in Crete

is similar to that of urban areas QR2

Epidemiology

QS11

Setting (incl rural)‏

• Reading abstract add information

QC12

Children

R96

Asthma

Coding process after reading abstracts

21

# 1373 Yearly influenza vaccination of elderly:

when do the French GP vaccinate?

QR42

Research network

QC14

Ageing R44

Vaccination

Influenza

Referent with definition, incl, excl. VOCATIONAL TRAINING APPRENTICESHIP TRAINEE

Concept VOCATIONAL TRAINING Knowledge interpretation

Representation

QT42

Stands for

{

Back from codes to abstract

23

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

Examples of concepts added during the abstract indexing

24

•Patient views QP4

•Patient appraisal QP41

•Patient satisfaction QP42

•Patient knowledge QP43

•Patient autonomy/dependency QP44

•Patient cultural background QP45

•Patient expenses QP46

•Patient health habits QP5

•Nutrition QP51

•Sexuality QP52

•Self care & hygiene QP53

Examples of some other concepts added during the Abstract indexing

25

• ritual mutilations QC54

• Confidentiality QE41

• Informed consent QE42

• Pharmacoepidemiology QR21

• Community health QR22

Analyse and presentation of the content of the base

Elaboration of the project of a knowledge base

Results

998 Abstracts ; types distribution

671; 67%

289; 29%

39; 4% Poster

Oral

Workshop

{

ICPC coding on 872 abstracts

1036 coding but some clusters

768 in chapters

168 in Process codes

28

One ragbag:

chronic kydney disease

(CKD)‏ U88/U99

diabetes T89/T90

overweight T82/T83

skin cut and inj S18/S19

airways obstruction R95/R96

anxiety P02/P74

HTA K86/K87

mouth D19/D20

chronic and acute K74/K75/76

chronic ischaemic K74/K75

All medicine late effects

A84/A85/A86/

A87

metabolic

syndrome T99

First results with simple excell db

Process codes ; Mainly drugs. Surprising 48

29

129

5 7 83

8

20

1

70

2 2 1 1

31 33 34 37 39 40 41 44 48 50 51 52 53 59

Process codes

872 abstracts

103

18

28

6 3

130

33

17

183

120

10

179

1824 24

7

42

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

998 abstracts, ICPC chapters distribution

P

Z

T

B

4

16

39

70

infants children ados ageing

QC11 QC12 QC13 QC14

About age categories : on 990 abstracts

4

28

62

16

24

0 20 40 60 80

Nutrition

Obesity

Diabetes

Hyperlipid

Metabolic S.

Opening of T chapters

19

12

18

28

33

4

UNSP.PSY

ANXIETY TR.

ALCOHOL

NICOTINE

DEPRESSION

BURNOUT

Opening of P chapter

197

643

16 3

151 162

405

QC QD QE QH QP QS QT

8 main domains 3CGP on 998 abstracts

Wonca Paris 2007

1

51

184

88

75

3

Genetic issue

Outcome

Health issue

assesm.

Health issue

management

Health risk

management

Care

management

Care manager (QD3 to QD35)

R & D

1

91

20

101

17

56

19

27

Science philosophy

Epidemiology

Functional status

Research methods

Classification

Scales & Questionnaires

Health economy

PHC planification & organisation

0 20 40 60 80 100

Pharmacoepid.

Communityhealth

of which of which

0 10 20 30 40 50 60

Qualitative

studies

Research

netw orks

NETWORK SENTINEL EVENT REPORT

QR42 QT71 QT73

49

13

8

NP I II III IV

QD4 QD41 QD42 QD43 QD44

51

2819

5 6

kkk

About Prevention

Tree communications with erroneous concepts of

secondary prevention

Secondary prevention of ischemic

cardiopathy in primary care 1020

Secondary cardiovascular prevention: Is

there a correlation between patients’

awareness of high cardiovascular risk and

treatment outcomes?

337

Secondary prevention therapies in patients

with coronary heart disease 127

Prevention term following time frame concept only

Secondary used for consecutive to

Such vocabulary issued from Specialist care and

Pharmaceutical Cies

44

14

38

11

8

4

32

9

QA METHODS

EBM

GUIDELINES

CRIT. READING & REVIEW

PEER REVIEW

ACREDITATION

PRACT. ASSESMENT

DEVICE ASSESM.

Quality QT5 to QT57 (160 16%)

8

11

5

1

3

DIST LEARNING

ONLINE EBM

e-PATIENTS

ONLINE HIS

TELEMEDECINE

Opening of QT62 (On line)

42

Wonca abstracts Paris 2007

on 871 indexed abstracts

13

26

17

3

8

3

0

5

10

15

20

25

30

1

QT41 student QT42 VT QT43 CME

QT44 trainers QT45 superv QT46 academ

QT4 domain (Training) distribution

5

12

22 22

5

2 1

DE

MA

ND

AP

PR

AIS

AL

SA

TIS

FA

CT

ION

KN

OW

LE

DG

E

AU

TO

NO

MY

CU

LT

UR

AL

EX

PE

NS

ES

QP40 QP41 QP42 QP43 QP44 QP45 QP46

DISTRIBUTION OF PATIENT’S VIEWS QP4

{

1

11

0

1

0

2

4

6

8

10

12

Ethnicsubgroups

Migrants &refugees

Homeless In jail

SOCIAL HIGH RISK (on 998 abstracts)

First results with simple excell db

example of QC32 : migrants

On 23 occurences

ICPC associated codes

45

Violence Z25

Health care access Z10

Litteracy Z07

Poverty Z01

W78

Pregnancy W78

Diabetes NID T90

Diabetes T89/T90

Nutrition T

Acute stress P74

Alcohool P15

Psycho P

HIV B90

influenza A80

Infect dis others A78

Tuberculosis A70

Risk others A23

4 Z

2 W

3 T

3 P

1 B

5 A

Blood analysis B34

immunization A44

Imaging *41

chapters process

First results with simple excell db

example of QC32 : migrants

On about 800 abstracts :

23 occurrences

48 other Q codes associated

46 1 Scales & Questionnaires QR6

1 Functional status QR3

1 Epidemiology QR2

2 Nutrition QP51

1 Patient knowledge QP43

4 Acceptab. of health care QP33

3 Accessib. of health care QP32

1 Availability of health care QP31

1 Ethics QE2

3 Prevention QD35

5 Health issue assessment QD33

2 Health issue managem. QD32

1 Health risk assessment QD31

2 A & E QD27

1 battered women QC51

1 Women’s‏health QC22

But

No Reproductibility

Not all domains

Not all categories

No error control (ex QT2 and QT3 missing in the code list)‏

One man show

Utility of 3CGP/FM looks evident

47

Little scientific value

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)‏

48

Proposal to the WICC ;

plan & develop 3CGP/FM

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