The Danish GPcontact registration project

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The Danish GP-contact registration project
Grete Moth, Senior researcher, MHSc, Ph.D.
The Research Unit for General Practice and the
Department for General Medicine Aarhus University
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Whats going on in general practice?
Background

• What do patients present with in the GP
  practices?
• - and with 1, 2, 3 . problems?
• For how many patient encounters can an exact
  diagnosis be made?
• 3. How often do the GP consider cancer during the
  contacts?
• 4. Which types of encounters are experienced by
  the GP as weighing heavily and exhausting?

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Background

• Previous registrations 1975, 1983 and 1993
• Patient age and gender
• Type of contact, due to symptom or prevention
• Reason for encounter and diagnosis
• Referral or prescription

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Background

• Limitations
• Limited information of the contact
• Clinical staff not involved
• Patient experiences not involved
• No knowledge on patient care pathways

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Aim

• Obtain knowledge of
• The activity of the GPs and their auxiliary staff
• Patient experiences of their contact with the GP
  clinic and of their self-rated health
• Patients use of medication
• Patient care pathways in the care health service
  

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Methods

• Sources of data
• - GP
• - Clinical staff
• - Patients
• - Registries

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Methods
Study period 2009 Eligible participants 850
GPs in Central Denmark Region
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Methods
GPs registrate all contacts on one day
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Methods
GPs registrate all contacts on one day
About the patient-the unique personal
registration number - chronic diseases (ICPC
codes)
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Methods
GPs registrate all contacts on one day
Type of contact-office visit, telephone
encounter, email, or home visit. - contact due
to prevention - contact concerning a formular
due to e.g. sick leave or insurance
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Methods
GPs registrate all contacts on one day
Content of the contact - reason for encounter-
diagnosis of the contact (ICPC-coding)- number
of problems raised - referrals- involvement of
staff- ending of the contact
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Methods
GPs registrate all contacts on one day
About the contact- degree of biomedical,
psycological and social elements - medically
unexplained symptoms- suspicion of cancer - GP
experienced heaviness of the contact
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Methods
ICPC coding
The primary reason for encounterCough -
ICPC-code R05 DiagnosisAsthma - ICPC-code
R96
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Methods
GPs registrate all contacts on one day
The primary reason for encounter Suspicion
OR96 Follow up-appointment K Questions
Q Sequela S Recurrent R
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Methods
The staff registrates all contacts involving
clinical or consulting tasks

• Type of contact
• Content of the contact
• About the contact

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Methods
Patient questionnaire

• Patients experience of
• the contact to the GP clinic
• reason for encounter
• health

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Methods
Registry data
Patients care pathway through the health care
system The personal registration
number Register of Medicinal Product
Statistics - prescriptions of
medicine Danish National Patient
Registry - hospitalisations and visits to
outpatient clinics National Health Insurance
Service Registry - visits to GPs and primary
care specialists Statistics Denmark -
socio-demographic factors
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Status May 2009

• 400 GPs have accepted to participate new
  invitation in August 2009
• 150 GPs and 110 staff members have registrated
• 5.000 patient questionnaires, respond rate 65

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Research questions to be addressed

• what is going on during the contacts - reasons
  for encounter and diagnosis?
• How often do the GPs experience medically
  unexplained symptoms and suspicion of cancer?
• How often do encounters require follow up?
• Do GP registrations agree with the experiences
  of the patients?
• How are the care pathways of the patients?
• How has the contact pattern to GPs developed
  through the last decades?

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Perspectives

• Updating the knowledge of the GP activity

• Documentation and quality improvement of the
  clinical practice by GPs

• Quality improvement of the organisation through
  identification af performances and groups of
  patients with a potential of improvement in the
  cooperationbetween the health care sectors
  optimise the services of the health care system

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Perspectives

• Registration projects to come
• a registration project of the out of hours
  activity by GPs
• a sentinel registration of contacts by a number
  of GPs

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• Steering group
• Peter Vedsted
• Frede Olesen
• Marianne Rosendal
• Kaj Sparle Christensen
• Bo Christensen
• Ineta Sokolowski
• Grete Moth

Thank you!