Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
Fam Pract. 2012 Jun;29(3):299-314. doi: 10.1093/fampra/cmr099. Epub 2012 Feb 3.
This is an international study of the epidemiology of family medicine (FM) in three practice populations from the Netherlands, Malta and Serbia. Diagnostic associations between common reasons for encounter (RfEs) and episodes titles are compared and similarities and differences are described and analysed.
Participating family doctors (FDs) recorded details of all their patient contacts in an 'episode of care (EoC)' structure using the International Classification of Primary Care (ICPC). RfEs presented by the patient and episode titles (diagnostic labels of EoCs) were classified with ICPC. The relationships between RfEs and episode titles were studied with Bayesian methods.
Distributions of diagnostic odds ratios (ORs) from the three population databases are presented and compared.
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.
本研究为国际性研究，旨在调查荷兰、马耳他和塞尔维亚三地家庭医学的流行病学。通过比较常见就诊原因（RfE）与发病标题之间的诊断关联，并对相似点和差异进行描述和分析，对三种不同的实践人群进行了研究。
参与研究的家庭医生（FD）采用国际初级保健分类（ICPC），在“医疗护理事件（EoC）”结构中记录所有患者接触的详细信息。患者提出的 RfE 和发病标题（EoC 的诊断标签）使用 ICPC 进行分类。使用贝叶斯方法研究 RfE 与发病标题之间的关系。
呈现并比较了来自三个人群数据库的诊断比值比（OR）分布。
ICPC、RfE 和 EoC 数据模型是研究 FM 诊断过程的合适工具。过渡项目国际人群的 RfE 和发病标题之间的诊断关联分布表明，从 RfE 和发病标题两个角度来看，诊断过程存在显著的相似性和一致性。人群之间诊断关联的一致性支持将一个人群的数据用于为另一个人群的诊断决策提供信息。这些诊断关联的差异在幅度上是显著的，因此需要特定于人群的数据。我们提出，国际（通用）和当地（医疗保健系统特定）的 FM 内容都存在，本文提出的诊断关联的经验分布反映了这两种效应。我们还观察到，接触这些诊断挑战的频率对诊断 OR 的置信区间有很强的影响，反映了这些诊断关联。我们提出，这证明了 FM 专业知识与接触诊断挑战的频率有关。
