International Classification of Primary Care-2 coding of primary care data at the general out-patients' clinic of General Hospital, Lagos, Nigeria

Abstract

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.

Most common reasons for primary care visits in low- and middle-income countries: A systematic review

“…The classification systems used were ICPC-2 for six studies [14,22,25,[27][28][29], ICD-10 for four studies (17)(18)(19)24), in-house or unclear for six studies [13,15,16,20,21,23] and Medical…”

“…Unpooled results from studies which included specific provider diagnoses (one using ICD-10 [19] and three using in-house classification systems [16,23,24]), and from one study which included patient RFEs using an in-house classification system [29] are shown in S3 Appendix. Four studies (Chueiri 2020 [14], Mash 2012 [22], Olagundoye 2016 [25] and Swain 2017 [28]) using ICPC-2 contained data on both RFEs and provider diagnoses in adults and were pooled. The top nine RFEs were ranked.…”

“…It is notable that the top 10 diagnoses varied between the studies substantially more than the top 10 RFEs. The diagnoses of HIV/AIDS and tuberculosis appeared only in Mash 2012 [22] from South Africa whereas malaria appeared only in Olagundoye 2016 [25] from Nigeria, in which it was the most common diagnosis. Pregnancy appeared only in Chueiri 2020 [14], though the prevalence of pregnancy in primary care depends on the demographics of the region or country and the organisation of maternal health services.…”

“…It is unclear why Mash 2012 combined codes in a few select instances but presented most codes separately. Of the four pooled studies, one reported data from a three-month period so may not account for seasonal variation in disease presentation [25]. Additionally, we restricted our search to articles in English and French and did not include grey literature.…”

Morbidity Pattern, Physiologic Parameters and Outcome among Elderly Patients Attending Selected Primary Healthcare Facilities in an Urban Region of Lagos

“…The outcome of the study conducted by Uzoechina et al (11) revealed that 10.1% died, while 87.7% were discharged and none of the respondents was referred. Olawunmi et al (12) demonstrated that the International Classification of Primary Care-2 (ICPC-2) can be applied in evaluating the reasons for presenting in primary care facilities. Most of findings on morbidity pattern and physiologic parameters among the elderly were generated from secondary and tertiary health facilities.…”