ICPC-2-Code: Malaysian Clinical Research Centre’s experience! · • ICPC-2-code emphasises the need to include why patinets come to seek a doctor (reasons for encounter). • Data

Acknowledgement The authors wish to express their gratitude to the following: 1. Director General of Health Malaysia for the permission to publish this poster, 2. WONCA organisation for granting the free research license for ICPC-2-code 3.

MINISTRY OF HEALTH

MALAYSIA

ICPC-2-Code: Malaysian Clinical Research Centre’s experience!

Hwong WY, Sivasampu S

National Clinical Research Centre, Ministry of Health Malaysia

Lessons Learned

Introduction

Objectives

Our Main Obstacle

Results

Future Directions

Based on ICPC-2-code, NMCS 20122 was able to show:

STRENGTHS AND LIMITATIONS OF ICPC-2-CODE

COMPONENT RESULTS

Reasons for

Encounter (RFE)

- 59.4% of the RFEs were based on symptoms and complaints.

-

Investigations - Glucose/glucose tolerance tests were the most frequently ordered investigations at 14.6%.

- Top most frequently ordered diagnostic imaging was antenatal ultrasound scan (9.1%).

Procedures

- Dressing was the leading procedure provided (45.0%) followed by excision/biopsy at 12.7%.

- 4.4% of the procedures were administrative tasks such as issuance of medical certificates and notifications of infectious diseases.

References 1. ICPC-2-PLUS – DEMONSTRATOR. Family Medicine Research Centre, University of Sydney Australia, 2011

[viewed 16th April 2014]. Available from: http://sydney.edu.au/medicine/fmrc/icpc-2-plus/demonstrator/index.php

2.

COMPONENT DESCRIPTION ICD-10 ICPC-2-CODE

Reasons for

Encounter (RFE)

Follow-up for known conditions

X √ Review test results Requesting for medications Renewal of medications

Diagnosis Smoking addiction To rule out certain diseases

Investigation All investigations such as:

- Fasting blood sugar - Full blood count

Procedures

Most procedures such as: - Incision and drainage - Toilet and suturing - Biopsy Referral for certain investigations

Referrals

Referral to secondary/tertiary care/allied health

General Home visits

LIMITATIONS DESCRIPTION Disease based versus system based

Infectious disease

Infections in multiple sites

Terms exclusive to Malaysian healthcare Pre-marital screening

• National Medical Care Survey (NMCS) is the first cross-sectional provider based survey in Malaysia. This survey captures data on the morbidity pattern of the attendees and the processes of care in a Malaysian primary care setting.

• The shortcomings of the International Classification of Diseases (ICD)-10 was realised during data coding in this survey. Classifications are difficult in primary care, especially for vague and symptom-based conditions, administrative tasks, referrals and procedures.

• The journey with ICPC-2-code started from there.

• The International Classification of Primary Care (ICPC-2-code) enables the whole process of care to be coded in A SINGLE classification.• ICPC-2-code emphasises the need to include why patients come to seek a doctor (reasons for encounter).• Data coding has to be tailored to the local setting to ensure terms which are exclusive to Malaysian healthcare can be coded.

• This presentation aims to highlight the team’s experience in using the ICPC-2-code; the strengths and limitations focusing on its usage in the Malaysian primary healthcare.

• Formal and proper training is expensive. We self-trained by using available materials which include the Demonstrator from the University of Sydney1, reliable websites and reading materials and whenever necessary, emailing our questions to the experts in the University of Sydney.

• The advantages of ICPC-2-code in primary care should be advocated to more healthcare professionals; both primary care practitioners and researchers.

• The focus of primary healthcare should be steered away from merely looking into morbidity and pharmacological treatment but more emphasis has to be placed on evaluating why patients come to seek care and the whole process of care.

Sivasampu S, Yvonne Lim, Norazida AR, Hwong WY, Goh PP, Hisham AN. National Clinical Research Centre. National Medical Care Statistics (NMCS) 2012. Kuala Lumpur 2014.

- No chapters specifically focusing on infectious disease- Coded against the body system that is affected, for example typhoid

is coded under Digestive system (D)- Data extraction and analysis is difficult

- No specific code for infections in multiple sites- For example: acute pharyngotonsilitis is coded under upper

respiratory tract infection (URTI)

- Not a norm in all countries to have this screening- Coded under health screening

Prof Helena Britt and other Bettering the Evaluation and Care of Health (BEACH) team members from the Family Medicine Research Centre, University of Sydney for introducing ICPC-2-code to us and for the continuous support, and the rest of our NMCS Primary Care team members for joining us in the journey of learning the ICPC-2-code!

9.9% of the RFEs were for diagnostic and therapeutic procedures, request for medications, review of test results, request for medical certificates and referrals.