The Danish GP-contact registration project

1. 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

2. What’s 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?

3. Background Previousregistrations: 1975, 1983 and 1993 • Patient age and gender • Type of contact, due to symptom orprevention • Reason for encounter and diagnosis • Referralorprescription

4. Background Limitations: Limited information of the contact Clinical staff not involved Patient experiences not involved No knowledge on patient care pathways

5. 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

6. Methods Sources of data: - GP - Clinical staff - Patients - Registries

7. Methods Studyperiod: 2009 Eligible participants: 850 GPs in Central Denmark Region

8. Methods GPs registrate all contacts on one day

9. Methods GPs registrate all contacts on one day About the patient-theuniquepersonalregistrationnumber- chronicdiseases (ICPC codes)

10. Methods GPs registrate all contacts on one day Type of contact-office visit, telephoneencounter, email, orhome visit. - contact due to prevention- contactconcerning a formular due to e.g.sickleaveorinsurance

11. 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

12. Methods GPs registrate all contacts on one day About the contact- degree of biomedical, psycological and social elements - medicallyunexplained symptoms- suspicion of cancer - GP experiencedheaviness of the contact

13. Methods ICPC coding The primaryreason for encounter:Cough - ICPC-code: R05 Diagnosis:Asthma - ICPC-code: R96

14. Methods GPs registrate all contacts on one day The primaryreason for encounter SuspicionOR96 Followup-appointmentK QuestionsQ SequelaS RecurrentR

15. Methods The staff registrates all contacts involving clinical or consulting tasks Type of contact Content of the contact About the contact

16. Methods Patient questionnaire Patients’ experience of: the contact to the GP clinic reason for encounter health

17. Methods Registry data Patients’ carepathwaythrough the healthcare 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

18. 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%

19. Research questions to be addressed: – what is goingonduring the contacts - reasons for encounter and diagnosis? Howoften do the GPsexperiencemedicallyunexplained symptoms and suspicion of cancer? Howoften do encountersrequirefollow up? Do GP registrationsagreewiththe experiences of the patients? Howare the carepathways of the patients? How has the contactpattern to GPsdevelopedthrough the last decades?

20. 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

21. 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

22. Steering group: Peter Vedsted Frede Olesen Marianne Rosendal Kaj Sparle Christensen Bo Christensen Ineta Sokolowski Grete Moth Thank you!