wonca 2007 m.j.3c gp/fm1 attempt to classify main descriptors of gp/fm job. proposal for a new...
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Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 11
Attempt to classify main descriptors of GP/FM Attempt to classify main descriptors of GP/FM job. Proposal for a new classificationjob. Proposal for a new classification
Core Content Classification of GP/FMCore Content Classification of GP/FM
3C GP/FM3C GP/FM
Marc Jamoulle, md, mph. Marc Jamoulle, md, mph. GP & Health data management specialistGP & Health data management specialistResearcher, Dep. of General Practice, UCLResearcher, Dep. of General Practice, UCL
Wonca Europe 2007
Friday 17 Oct. 2007
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 22
ICPC is great ICPC is great
But only clinicalBut only clinical
Family doctor work area and work Family doctor work area and work load need specific descriptors load need specific descriptors
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 33
GP/FM needsGP/FM needs
Global description of activity, skills Global description of activity, skills and knowledge and knowledge
Classification complementary to Classification complementary to ICPC ICPC
Descriptors for indexationDescriptors for indexation Main axes of training for Main axes of training for
undergraduate and vocationalundergraduate and vocational
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GP/FM needsGP/FM needs
ExamplesExamples Journal watch indexingJournal watch indexing Grey production retrievalGrey production retrieval Internet sites indexingInternet sites indexing Wonca abstract archives Wonca abstract archives Teaching program evaluationTeaching program evaluation
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Specific tool design Specific tool design evolutionevolution
1987 : Q CODES (Lamberts)
2005-6 : Metaclinical WICC Heidelberg De
2007 : 3C GP/FM WICC Dunedin NZ
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Q-CODES (level 1) Amsterdam (+/- 1987) Dep of gen practice. Prof LambertsUsed 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’s categories
Q6 Research
Q7 Teaching
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Metaclinical (MJ 2005)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 They constitute meta-information on the way the clinics and the patient doctor relationships are clinics and the patient doctor relationships are drivendriven.
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 88
2007 8 domains 3C 2007 8 domains 3C GP/FM GP/FM
Core Content Classification of GP/FMCore Content Classification of GP/FM
Patient issuesPatient issues Provider’s issues Provider’s issues Structure of Structure of
practicepractice Patient’s categories Patient’s categories Hazards Hazards EthicsEthics Training, teachingTraining, teaching R & D toolsR & D tools
QP Patient
QD Doctor
QS Structure
QC Categories
QH Hazards
QE Ethics
QT Knowledge
QR Research
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 99
Please do refer to the desk Please do refer to the desk copycopy
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1010
3C GP/FM 3C GP/FM
DomainKnowledge Management QT
CategoriesTraining QT4
Sub categoriesTrainers & Supervisors
QT43
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1111
Patient's categories Patient's categories QC QC
Age groups QC1Age groups QC1
Gender issues QC2Gender issues QC2
Social high risk QC3Social high risk QC3
Addiction QC4Addiction QC4
Assault QC5Assault QC5
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Assault QC5 Assault QC5
battered women battered women QC51QC51
victims of abuses QC52victims of abuses QC52
torture torture QC53QC53
ritual mutilations ritual mutilations QC54QC54
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1313
Knowledge management QTKnowledge management QT
Teaching QT1Teaching QT1
Training QT4Training QT4
Quality assurance QT5Quality assurance QT5
Editing QT6Editing QT6
Reporting QT7Reporting QT7
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1414
Training QT4Training QT4
Undergraduate Undergraduate QT41QT41 Vocational training Vocational training QT42QT42 Continuous medical educ. Continuous medical educ. QT43QT43 Supervision Supervision & Balint& Balint QT44QT44 Trainers and supervisorsTrainers and supervisors QT45QT45 Academics Academics QT46QT46
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1515
Exercise with MedlineExercise with Medline
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
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1616
Exercise with MedlineExercise with Medline
AnalysisThe 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.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1717
Indexing Wonca Europe 2007 Indexing Wonca Europe 2007 abstractsabstracts
Direct acces to reviewer screensDirect acces to reviewer screens Copy of 998 abstracts in a Copy of 998 abstracts in a
databasedatabase Indexing by Indexing by
– max 3 codes of 3CGP/FMmax 3 codes of 3CGP/FM– max 3 codes of ICPC-2max 3 codes of ICPC-2
Special thanks to Bernard Gay, Hector Falcoff, Michele LieuradeAnne Marie Magnier and Madedeleine Favrefor helping meAnd to Tarik Jamoulle for copying the abstracts
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1818
Ecran wonca 2007 avec 1 page d’abstracts à inserer ici
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 1919
Ecran wonca 2007 avec 1 abstract à inserer ici
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2020
Coding processCoding process Some abstract titles seems Some abstract titles seems
meaningfull adn enough to make meaningfull adn enough to make the codes easilythe codes easily# 1344 The prevalence of asthma in rural areas in Crete is similar to that of urban areas
QR2
Epidemiology
QS11Setting (incl rural)
• Reading abstract add informationQC12
Children
R96Asthma
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2121
Coding process after reading Coding process after reading abstractsabstracts
# 1373 Yearly influenza vaccination of elderly: when do the French GP vaccinate?
QR42
Research network
QC14AgeingR44
Vaccination Influenza
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2222
Back from codes to abstractBack 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.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2323
Examples of concepts added duringExamples of concepts added during the abstract indexing the abstract indexing
•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
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2424
Examples of some other concepts Examples of some other concepts addedadded
during the Abstract indexingduring the Abstract indexing
• ritual mutilations QC54
• Confidentiality QE41
• Informed consent QE42
• Pharmacoepidemiology QR21
• Community health QR22
ResultsResults
Analyse and presentation of the Analyse and presentation of the content of the basecontent of the base
Elaboration of the project of a Elaboration of the project of a knowledge baseknowledge base
998 Abstracts ; types distribution
671; 67%
289; 29%
39; 4% Poster
Oral
Workshop
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2727
ICPC coding on 872 abstractsICPC coding on 872 abstracts
1036 coding but some 1036 coding but some clustersclusters768 in chapters768 in chapters168 in Process codes168 in Process codes
One ragbag:
chronic kydney disease (CKD)
U88/U99
diabetesT89/T90
overweightT82/T83
skin cut and injS18/S19
airways obstructionR95/R96
anxiety P02/P74
HTAK86/K87
mouthD19/D20
chronic and acuteK74/K75/76
chronic ischaemic K74/K75
All medicine late effectsA84/A85/A86/A87
metabolic syndrome
T99
First results with simple excell db
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 2828
Process codes ; Mainly drugs. Process codes ; Mainly drugs. Surprising 48Surprising 48
872 abstracts
12 9 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
998 abstracts, ICPC chapters distribution
103
1828
6 3
33
17
183
120
10
179
1824 24
7
42
130
A B D F H K L N P R S T U W X Y Z
P
Z
T
B
About age categories : on 990 abstracts
4
16
39
70
infants children ados ageing
QC11 QC12 QC13 QC14
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
Wonca Paris 2007
197
643
16 3
151 162
405
QC QD QE QH QP QS QT
8 main domains 3CGP on 998 abstracts
Care manager (QD3 to QD35)
1
51
184
88
75
3
Genetic issue
Outcome
Health issueassesm.
Health issuemanagement
Health riskmanagement
Caremanagement
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
of w hich
0 20 40 60 80 100
Pharmacoepid.
Communityhealth
of which
0 10 20 30 40 50 60
Qualitativestudies
Researchnetw orks
49
138
NETWORK SENTINEL EVENT REPORT
QR42 QT71 QT73
51
2819
5 6
NP I II III IV
QD4 QD41 QD42 QD43 QD44
About Prevention
Tree communications with erroneous Tree communications with erroneous concepts of secondary preventionconcepts 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 onlySecondary used for consecutive toSuch vocabulary issued from Specialist care and Pharmaceutical Cies
Quality QT5 to QT57 (160 16%)
44
14
38
11
8
4
32
9
QA METHODS
EBM
GUIDELINES
CRIT. READING & REVIEW
PEER REVIEW
ACREDITATION
PRACT. ASSESMENT
DEVICE ASSESM.
Opening of QT62 (On line)
8
11
5
1
3
DIST LEARNING
ONLINE EBM
e-PATIENTS
ONLINE HIS
TELEMEDECINE
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 4141
Wonca abstracts Paris 2007on 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
DISTRIBUTION OF PATIENT’S VIEWS DISTRIBUTION OF PATIENT’S VIEWS QP4QP4
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
SOCIAL HIGH RISK (on 998 abstracts)
1
11
0
1
0
2
4
6
8
10
12
Ethnicsubgroups
Migrants &refugees
Homeless In jail
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 4444
First results with simple First results with simple excell dbexcell db
example of QC32 : example of QC32 : migrantsmigrants
On 23 occurencesOn 23 occurences
ICPC associated ICPC associated codescodes
ViolenceZ25
Health care accessZ10
LitteracyZ07
PovertyZ01
W78
PregnancyW78
Diabetes NIDT90
DiabetesT89/T90
NutritionT
Acute stressP74
AlcohoolP15
PsychoP
HIVB90
influenzaA80
Infect dis othersA78
TuberculosisA70
Risk othersA23
4Z
2W
3T
3P
1B
5A
Blood analysisB34
immunizationA44
Imaging*41
chapters process
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 4545
First results with simple excell First results with simple excell dbdb
example of example of QC32 : QC32 : migrantsmigrants
On about 800 On about 800 abstracts : abstracts :
23 23 occurrencesoccurrences
48 other Q 48 other Q codes codes associated associated
1Scales & QuestionnairesQR6
1Functional statusQR3
1EpidemiologyQR2
2NutritionQP51
1Patient knowledgeQP43
4Acceptab. of health careQP33
3Accessib. of health careQP32
1Availability of health careQP31
1EthicsQE2
3PreventionQD35
5Health issue assessmentQD33
2Health issue managem.QD32
1Health risk assessmentQD31
2A & EQD27
1battered womenQC51
1Women’s healthQC22
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 4646
UtilityUtility of 3CGP/FM looks of 3CGP/FM looks evidentevident
ButBut No ReproductibilityNo Reproductibility Not all domainsNot all domains Not all categoriesNot all categories No error control (ex QT2 No error control (ex QT2
and QT3 missing in the and QT3 missing in the code list)code list)
One man showOne man show
Little scientific value
Wonca 2007 m.j.Wonca 2007 m.j. 3C GP/FM3C GP/FM 4747
MethodsMethods Funds and grants?Funds and grants? Bibliography on the subjectBibliography on the subject Structure of the classificationStructure of the classification Domain, cat, sub cat, definitions, excl, incl.Domain, cat, sub cat, definitions, excl, incl. Database appropriationDatabase appropriation Online testing using GP productionsOnline testing using GP productions Evolutive productEvolutive product Open minded (open document – free & controlled Open minded (open document – free & controlled
acces)acces)
Proposal to the WICC ; plan & develop 3CGP/FM
Now, let we see how to use Now, let we see how to use 3CGP/FM and ICPC as 3CGP/FM and ICPC as
indexing tool for Wonca e-indexing tool for Wonca e-archive knowledge basearchive knowledge base