An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing incidence and prevalence rates of reasons for encounter and diagnostic titles of episodes of care across populations

Abstract

Data that are collected with an episode-based model define incidence and prevalence rates much more precisely. Incidence and prevalence rates reflect the content of the doctor-patient encounter in FM but only from a superficial perspective. However, we found evidence of an international FM core content and a local FM content reflected by important similarities in such distributions. FM is a complex discipline, and the reduction of the content of a consultation into one or more medical diagnoses, ignoring the patient's RfE, is a coarse reduction, which lacks power to fully characterize a population's health care needs. In fact, RfE distributions seem to be more consistent between populations than distributions of EoCs are, in many respects.

Revisiting the concept of 'chronic disease' from the perspective of the episode of care model. Does the ratio of incidence to prevalence rate help us to define a problem as chronic?

“…5 The duration of selected EoCs was calculated using the standard approach in the Episodes of Care in Family Practice (EFP) program, 9 but using a more recent database. The EoCs analysed in Table 1 were selected as examples of acute and chronic conditions, and the trends observed are typical of other acute and chronic conditions in the database (data available in EFP).…”

“…Table 2 gives the incidence to prevalence rate ratio for the 20 most common distributions of EoCs in the three populations. 5 Mean incidence to prevalence rate ratios ranged from 9.0% (for complicated hypertension, K87) to 85.7% (for excessive ear wax, H81, and gastroenteritis, D87), but some ratios lay outside even this wide range, in one or more populations. Health problems classically described as chronic had lower incidence to prevalence rate ratios, both in individual populations and on average: 11.8% for uncomplicated hypertension (K86, unweighted mean of three populations), 15.0% for type II diabetes mellitus (T90, 15 the ratio of incident to prevalent episodes of care for that ICPC code in each population, and the mean incidence to prevalence ratio in the three populations (un-weighted mean of previous three columns).…”

“…3,4 The use of the episode of care (EoC) data model 3,4 allows for increased precision in calculating incidence and prevalence rates. 2,5 In the Transition Project, such data have been collected with ICPC in the Netherlands, Japan, Poland, Malta, Serbia and other countries [6][7][8][9][10] from the daily practice of a cohort of family doctors (FDs) using similar methodology over a period of 1 to 11 years. These data allow the calculation of incidence and prevalence rates per 1000 patient years of observation in a population, this being a controlled denominator independent of consultation rates.…”

“…The datasets from the Netherlands, Malta and Serbia have been used for this study because they are available and validated, recent and overlap in time. 5 At a recent European General Practice Research Network (EGPRN; www.egprn.org) conference on chronic disease in FM, at Nice in France, it was clear that there is no international consensus definition as to what is, and what is not, a chronic disease. As a lay example of this issue, the Concise Oxford English Dictionary definition is also rather vague, defining chronic (illness) as: 'persisting for a long time or constantly recurring' (p. 255).…”

“…We consider that the increased precision of incidence and prevalence rates afforded by the use of ICPC in an EoC data model would provide new perspectives on chronic disease and health problems. 5 The research question of this study is: 'What are the similarities and differences in the duration of episodes of care in different countries? ' During the course of the study, we observed and hereby describe an interesting phenomenon related to the ratio of incidence to prevalence rates for acute and chronic illnesses.…”