An international comparative family medicine study of the Transition Project data from the Netherlands, Malta and Serbia. Is family medicine an international discipline? Comparing diagnostic odds ratios across populations

Abstract

ICPC, the RfE and the EoC data model are appropriate tools to study the process of diagnosis in FM. Distributions of diagnostic associations between RfEs and episode titles in the Transition Project international populations show remarkable similarities and congruencies in the process of diagnosis from both the RfE and the episode title perspectives. The congruence of diagnostic associations between populations supports the use of such data from one population to inform diagnostic decisions in another. Differences in the magnitude of such diagnostic associations are significant, and population-specific data are therefore desirable. We propose that both an international (common) and a local (health care system specific) content of FM exist and that the empirical distributions of diagnostic associations presented in this paper are a reflection of both these effects. We also observed that the frequency of exposure to such diagnostic challenges had a strong effect on the confidence intervals of diagnostic ORs reflecting these diagnostic associations. We propose that this constitutes evidence that expertise in FM is associated with frequency of exposure to diagnostic challenges.

The interpretation of the reasons for encounter 'cough' and 'sadness' in four international family medicine populations

“…The RfE should be recognised by the patient as an acceptable description of the demand for care. 4,14,15 FDs recording data for the Transition Project were trained to record RfEs according to the definitions above and the recommendations in the ICPC book, 4 Japan (1996Japan ( -1998. The practice populations in the Netherlands, Serbia and Japan represent registered patient populations (only those over 15 years of age in Serbia), whereas the population in Malta represents patients consulting over a fiveyear period.…”

“…We aggregated or pooled LR values across practices, as we have done in previous studies. 14,15 It would be possible to analyse such relationships between all possible combinations of episode titles and RfEs, using the Transition Project databases. 8,10 The analysis was limited to two selected RfE examples for practical reasons.…”

“…If the size of the observation was equivalent to or larger than the width of the 95% CI of that observation itself, the relationship was noted as one which was potentially statistically significant. 1,14,16 All such episode titles were selected for further analysis in all four population databases. The next step was a series of cross-tabulations of both the LR+ and the LR-, performed one-way for the two RfEs against all selected episode titles in each database.…”

“…1,[14][15][16][17] Cut-off levels of > 2 for the LR of a positive association and < 0.5 for the LR of a negative association, were thus taken as minimum thresholds for clinical significance. [18][19][20][21][22][23][24][25] LRs outside these limits were considered clinically insignificant.…”

“…Furthermore, the congruency (and often statistical consistency) of diagnostic associations between these populations, and especially the fact that most of them are in the same direction from unity, sustain our confidence in their validity. 14,15 Additionally, the fact that we also present incidence and prevalence rates in these populations allows one to calculate prior and posterior probabilities for these diagnostic entities.…”