No abstract

BackgroundReliable information which can only be derived from accurate data is crucial to the success of the health system. Since encoded data on diagnoses and procedures are put to a broad range of uses, the accuracy of coding is imperative. Accuracy of coding with the International Classification of Diseases, 10th revision (ICD-10) is impeded by a manual coding process that is dependent on the medical records officers’ level of experience/knowledge of medical terminologies.Aim statementTo improve the accuracy of ICD-10 coding of morbidity/mortality data at the general hospitals in Lagos State from 78.7% to ≥95% between March 2018 and September 2018.MethodsA quality improvement (QI) design using the Plan–Do–Study–Act cycle framework. The interventions comprised the introduction of an electronic diagnostic terminology software and training of 52 clinical coders from the 26 general hospitals. An end-of-training coding exercise compared the coding accuracy between the old method and the intervention. The outcome was continuously monitored and evaluated in a phased approach.ResultsResearch conducted in the study setting yielded a baseline coding accuracy of 78.7%. The use of the difficult items (wrongly coded items) from the research for the end-of-training coding exercise accounted for a lower coding accuracy when compared with baseline. The difference in coding accuracy between manual coders (47.8%) and browser-assisted coders (54.9%) from the coding exercise was statistically significant. Overall average percentage coding accuracy at the hospitals over the 12-month monitoring and evaluation period was 91.3%.ConclusionThis QI initiative introduced a stop-gap for improving data coding accuracy in the absence of automated coding and electronic health record. It provides evidence that the electronic diagnostic terminology tool does improve coding accuracy and with continuous use/practice should improve reliability and coding efficiency in resource-constrained settings.

Background:Primary care serves as an integral part of the health systems of nations especially the African continent. It is the portal of entry for nearly all patients into the health care system. Paucity of accurate data for health statistics remains a challenge in the most parts of Africa because of inadequate technical manpower and infrastructure. Inadequate quality of data systems contributes to inaccurate data. A simple-to-use classification system such as the International Classification of Primary Care (ICPC) may be a solution to this problem at the primary care level.Objectives:To apply ICPC-2 for secondary coding of reasons for encounter (RfE), problems managed and processes of care in a Nigerian primary care setting. Furthermore, to analyze the value of selected presented symptoms as predictors of the most common diagnoses encountered in the study setting.Materials and Methods:Content analysis of randomly selected patients’ paper records for data collection at the end of clinic sessions conducted by family physicians at the general out-patients’ clinics. Contents of clinical consultations were secondarily coded with the ICPC-2 and recorded into excel spreadsheets with fields for sociodemographic data such as age, sex, occupation, religion, and ICPC elements of an encounter: RfE/complaints, diagnoses/problems, and interventions/processes of care.Results:Four hundred and one encounters considered in this study yielded 915 RfEs, 546 diagnoses, and 1221 processes. This implies an average of 2.3 RfE, 1.4 diagnoses, and 3.0 processes per encounter. The top 10 RfE, diagnoses/common illnesses, and processes were determined. Through the determination of the probability of the occurrence of certain diseases beginning with a RfE/complaint, the top five diagnoses that resulted from each of the top five RfE were also obtained. The top five RfE were: headache, fever, pain general/multiple sites, visual disturbance other and abdominal pain/cramps general. The top five diagnoses were: Malaria, hypertension uncomplicated, visual disturbance other, peptic ulcer, and upper respiratory infection. From the determination of the posterior probability given the top five RfE, malaria, hypertension, upper respiratory infection, refractive error, and conjuctivitis were the five most frequent diagnoses that resulted from a complaint of a headache.Conclusion:The study demonstrated that ICPC-2 can be applied to primary care data in the Nigerian context to generate information about morbidity and services provided. It also provided an empirical basis to support diagnosis and prognostication in a primary care setting. In developing countries where the transition to electronic health records is still evolving and fraught with limitations, more reliable data collection can be achieved from paper records through the application of the ICPC-2.

IntroductionUrinary incontinence (UI) is common among older men. Epidemiological studies have established many risk factors for UI but these studies are not always specific to men aged 65 and above. The literature is yet to be systematically and comprehensively reviewed to identify UI risk factors specific to these men. Such evidence is required for the development of evidence-based interventions. This scoping review will synthesise evidence regarding UI risk factors in older men.Methods and analysisThe Joanna Briggs Institute (JBI) method for scoping reviews will guide the conduct of this scoping review and its reporting alongside the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews checklist. JBI’s Population, Concept and Context framework is used to frame inclusion criteria, and JBI’s scoping review protocol template was used to format this protocol. Our comprehensive search will include Ovid MEDLINE, Ovid Embase, CINAHL, Scopus, Web of Science Core Collection, Cochrane Library (via Wiley) and ProQuest Dissertations & Theses Global. There will be no language restriction since approximately 10% of preliminary search results were in languages other than English. Study type or publication date will not be restricted. Besides databases, we will review Google Scholar results and bibliographies. Two independent reviewers will screen, select and extract eligible studies. A preliminary search was performed on 24 May 2022. The search strategy and data extraction template are in online supplemental appendix. A qualitative and quantitative analysis of data will be performed as a means of describing the risk factors for UI identified among older men by using frequencies and descriptive methods.Ethics and disseminationThe review does not require ethics approval. Findings will be disseminated at conferences, in a peer-reviewed journal and used to inform the development of an evidence-based tool for self-management of UI in older men.

The older persons in our society are a special group of people in need of additional measures of care and protection. They have medical, financial, emotional and social needs. The novel Coronavirus disease 2019 (COVID-19) only exacerbates those needs. COVID-19 is a new disease, and there is limited information regarding the disease. Based on currently available information, older persons and people of any age who have serious underlying medical conditions may be at higher risk of severe illness from COVID-19. Family physicians provide care for individuals across their lifespan. Because geriatricians are internists or family physicians with post-residency training in geriatric medicine, they are major stakeholders in geriatric care. The authors are concerned about the absence of a COVID-19 response guideline/special advisory targeting the vulnerable population of older adults. The management and response to COVID-19 will be implemented in part based on the local context of available resources. Nigeria has been described as a resource-constrained nation. Infection prevention in older persons in Nigeria will far outweigh the possibilities of treatment given limited resources. The aim was to recommend actionable strategies to prevent COVID-19-related morbidity or mortality among older persons in Nigeria and to promote their overall well-being during and after the pandemic. These recommendations cut across the geriatric medicine domains of physical health, mental health, functioning ability and socio-environmental situation.