Most Health Interview Surveys (HIS) include questions that gather information on health problems ... more Most Health Interview Surveys (HIS) include questions that gather information on health problems of the respondents. Often these are closed ended questions (e.g., respondents are asked if they suffer from a specific disease). Yet, in quite some surveys respondents are also asked in an open ended question to indicate the health problem that they are suffering from, or for which they have contacted a health professional. In order to analyse this information, the answers need to be classified. Often this is done with “ad hoc” classifications or with the International Statistical Classification of Diseases and Related Health Problems (ICD), now available in its 10th edition: ICD-10 (WHO 1992). Apart form the ICD there are a number of other classifications that are used in medicine and public health (Lagasse et al. 2001), one of which is the International Classification of Primary Care (ICPC). The ICPC was developed in primary care and has received increasing recognition during the past few years. It was first published by WONCA (World Organisation of Family Doctors) in 1987 (Lamberts & Wood 1987). The main purpose was to fit better the frequency distributions of family/general practice. The new classification departed from the traditional ICD chapter format where the axes of the several chapters vary, from body systems to aetiology and to others. This mixture of axes creates confusion, since diagnostic entities can with equal logic be classified in more than one chapter, for example influenza in either the infections chapter or the respiratory chapter, or both. Instead of conforming to this format, the ICPC chapters are based on body systems, following the principle that localization has precedence over aetiology. The components that are part of each chapter permit considerable specificity for all elements of a medical encounter, yet their symmetrical structure and frequently uniform numbering across all chapters facilitate usage even in manual recording systems (WONCA International Classification Committee 1998). The ICPC is based on a simple bi-axial structure: 17 chapters based on body systems on one axis, each with a letter code, and seven identical components with rubrics bearing a twodigit numeric code as the second axis (see Fig. 1). Since its first publication in 1987 the ICPC has been used extensively as an epidemiological tool for the description of family/general practice in countries all over the world 1. A second edition of the ICPC has been prepared for two main reasons: to relate it to the 10th edition of the ICD, ICD-10, published by WHO in 1992, and to add inclusion criteria and cross-referencing (lists of synonyms, similar conditions which should be coded elsewhere and alternatives if the particular patient’s condition does not meet the inclusion criteria) for many of the rubrics (WONCA International Classification Committee 1998; Jamoulle et al. 2000). The complete ICPC-2 classification in its electronic form can be downloaded from the internet (http://www.ulb.ac.be/esp/ wicc/ceo.html). The use of the ICPC-2 classification in national/local coding systems is subject to a copyright by the WICC (WONCA International Classification Committee). Although the ICPC is primarily aimed for use in general practice it has also been used in other settings in various European countries (http://www.ulb.ac.be/esp/wicc/icpc2001.html). The ICPC is very useful for the classification of medical terms in health interview surveys for the following reasons: – ICPC was developed for the primary care setting, making it less technical and more appropriate for classification of lay terms than the ICD, the language of which is essentially medical/diagnostic. – Classification of health problems with the ICPC is straightforward and less confusing than with the ICD. – In the ICPC specific rules are applied for recording reasons for encounters (RFE). – Because of the direct link between the ICPC and the ICD it is always possible to link an ICPC code with a corresponding ICD-code.
To investigate socio-economic differences in the use of health services in Belgium and to explore... more To investigate socio-economic differences in the use of health services in Belgium and to explore to what extent eventual socio-economic inequalities are explained by differences in demographic determinants and health needs. Data was obtained from the 1997 Belgian national Health Interview Survey. In this survey information was collected on the health status, the life style and the medical consumption of a representative sample of the Belgian non-institutionalised population consisting of 8560 Belgian inhabitants aged 15 years and over. Lower socio-economic groups make more often use of the general practitioner and nursing care at home and are more often admitted to hospital than persons with a high socio-economical status. There is, however, no socio-economic gradient when the health status is taken into account. On the opposite, persons with a higher socio-economic status report more often a visit to a specialist, a physiotherapist or a dentist. For the health services for which this was investigated no association was found between socio-economic status and the volume of the use of health services. There are in Belgium still important socio-economic gradients in the use of some health services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services. Further research needs to focus on socio-economic differences in the reasons, the outcome and the quality of the provided care.
Most Health Interview Surveys (HIS) include questions that gather information on health problems ... more Most Health Interview Surveys (HIS) include questions that gather information on health problems of the respondents. Often these are closed ended questions (e.g., respondents are asked if they suffer from a specific disease). Yet, in quite some surveys respondents are also asked in an open ended question to indicate the health problem that they are suffering from, or for which they have contacted a health professional. In order to analyse this information, the answers need to be classified. Often this is done with “ad hoc” classifications or with the International Statistical Classification of Diseases and Related Health Problems (ICD), now available in its 10th edition: ICD-10 (WHO 1992). Apart form the ICD there are a number of other classifications that are used in medicine and public health (Lagasse et al. 2001), one of which is the International Classification of Primary Care (ICPC). The ICPC was developed in primary care and has received increasing recognition during the past few years. It was first published by WONCA (World Organisation of Family Doctors) in 1987 (Lamberts & Wood 1987). The main purpose was to fit better the frequency distributions of family/general practice. The new classification departed from the traditional ICD chapter format where the axes of the several chapters vary, from body systems to aetiology and to others. This mixture of axes creates confusion, since diagnostic entities can with equal logic be classified in more than one chapter, for example influenza in either the infections chapter or the respiratory chapter, or both. Instead of conforming to this format, the ICPC chapters are based on body systems, following the principle that localization has precedence over aetiology. The components that are part of each chapter permit considerable specificity for all elements of a medical encounter, yet their symmetrical structure and frequently uniform numbering across all chapters facilitate usage even in manual recording systems (WONCA International Classification Committee 1998). The ICPC is based on a simple bi-axial structure: 17 chapters based on body systems on one axis, each with a letter code, and seven identical components with rubrics bearing a twodigit numeric code as the second axis (see Fig. 1). Since its first publication in 1987 the ICPC has been used extensively as an epidemiological tool for the description of family/general practice in countries all over the world 1. A second edition of the ICPC has been prepared for two main reasons: to relate it to the 10th edition of the ICD, ICD-10, published by WHO in 1992, and to add inclusion criteria and cross-referencing (lists of synonyms, similar conditions which should be coded elsewhere and alternatives if the particular patient’s condition does not meet the inclusion criteria) for many of the rubrics (WONCA International Classification Committee 1998; Jamoulle et al. 2000). The complete ICPC-2 classification in its electronic form can be downloaded from the internet (http://www.ulb.ac.be/esp/ wicc/ceo.html). The use of the ICPC-2 classification in national/local coding systems is subject to a copyright by the WICC (WONCA International Classification Committee). Although the ICPC is primarily aimed for use in general practice it has also been used in other settings in various European countries (http://www.ulb.ac.be/esp/wicc/icpc2001.html). The ICPC is very useful for the classification of medical terms in health interview surveys for the following reasons: – ICPC was developed for the primary care setting, making it less technical and more appropriate for classification of lay terms than the ICD, the language of which is essentially medical/diagnostic. – Classification of health problems with the ICPC is straightforward and less confusing than with the ICD. – In the ICPC specific rules are applied for recording reasons for encounters (RFE). – Because of the direct link between the ICPC and the ICD it is always possible to link an ICPC code with a corresponding ICD-code.
To investigate socio-economic differences in the use of health services in Belgium and to explore... more To investigate socio-economic differences in the use of health services in Belgium and to explore to what extent eventual socio-economic inequalities are explained by differences in demographic determinants and health needs. Data was obtained from the 1997 Belgian national Health Interview Survey. In this survey information was collected on the health status, the life style and the medical consumption of a representative sample of the Belgian non-institutionalised population consisting of 8560 Belgian inhabitants aged 15 years and over. Lower socio-economic groups make more often use of the general practitioner and nursing care at home and are more often admitted to hospital than persons with a high socio-economical status. There is, however, no socio-economic gradient when the health status is taken into account. On the opposite, persons with a higher socio-economic status report more often a visit to a specialist, a physiotherapist or a dentist. For the health services for which this was investigated no association was found between socio-economic status and the volume of the use of health services. There are in Belgium still important socio-economic gradients in the use of some health services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services. Further research needs to focus on socio-economic differences in the reasons, the outcome and the quality of the provided care.
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