[Diagnosis and treatment in general practice. 3. Reasons for contact and diagnoses in episodes of medical care].

The object of this article is to describe the reasons for contact and the diagnoses in general practice by following the course of health problems in a random sample of patients (group 1 in the National Health Insurance System) for three months. In 55 general practices in the County of Copenhagen, all contacts concerning a given health problem in the single individuals were registered. This totalled 1,974 episodes of medical care in approximately 1,200 persons who formed 47% of the random sample. This investigation assessed the various classifications of reasons for encounter with primary health care as regards employability for central coding, information value and agreement with the general medical disease model. Employing the Reason for Visit Classification (USA) supplemented by classifications elaborated by the authors, three dimensions of the concept of "reasons for encounter" could be described: symptoms, the patient's wishes for contact with the doctor and reasons for the current problem. Health problems are described as episodes of one or more contacts. In single-contact episodes, the symptoms and diagnoses are most frequently those of respiratory diseases whereas multi-contact episodes are most frequently found where musculo-skeletal diseases are concerned. It is concluded that a multi-dimensional description of the reasons for contact and a description of the disease pattern on the basis of episodes of medical care can provide more differentiated knowledge about health problems in general practice.