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1 First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study Nobuyuki Kajiwara 1, Kazuyuki Hayashi 1, Masahiro Misago 2, Shinichiro Murakami 2, Takato Ueoka 2 Int J Gen Med 2017, 10: e-department-of-internal--peer-reviewed-article-ijgm 1) 1) 2) 2) 2) 1) 2) Corresponding author 1/27

2 Abstract reason for encounter 2 international classification of primary care revised second edition (ICPC-2-R) "Digestive" D: ICPC-2-R chapter "General and unspecified" A "Respiratory" R "Digestive" D "Respiratory" R "General and unspecified" A "Muscloskeletal" L 27.6% "Cough" R05 ICPC-2-R 64.7% "Fever" A % 62.4% 4.3% 60.5% 11.5% ICPC-2-R Keywords medium-scale hospital general internal medicine general practice reason for encounter (RFE) international classification of primary care (ICPC) antibiotic overuse 2/27

3 Introduction [1, 2] [3] [4] = ( + ) / ( - + ) = / ( ) % 3/27

4 Patients and Methods NK Ethics approval A international classification of primary care revised second edition ICPC-2-R [5] 1 Component 1 - Complaint and symptom component ICPC-2-R 7 Component 7 - Diagnosis/disease component 4/27

5 1 2 1 Results ICPC-2-R chapters 1 "Digestive" D 1 ICPC-2-R chapter "General and unspecified" A "Respiratory" R "Neurological" N 30 1 "Cough" R ICPC-2-R "Fever" A03 "Abdominal pain, epigastric" D02 "Abdominal pain, localized, other" D06 "Abdominal pain, epigastric" D02 "Abdominal pain, localized, other" D06 "Abdominal pain/cramps, general" 5/27

6 D % 2 "Digestive" D "Respiratory" R "General and unspecified" A "Muscloskeletal" L 50 2 "Upper respiratory infection, acute" R74 Gastroenteritis, presumed infection D73 "Stomach function disorder" D87 "Influenza" R80 Gastroenteritis, presumed infection D73 "Stomach function disorder" D87 "Oesophagus disease" D % 211 "Headache" N01 14 "Abdominal pain, localized, other" D06 13 "Cough" R05 12 "Abdominal pain, epigastric" D02 10 "Back symptom/complaint" L02 8 "Vertigo/dizziness" N % 3 "Respiratory" R % "Endocrine, metabolic and nutritional" T % "Muscloskeletal" L % "Digestive" D % "General and unspecified" A % "Respiratory" R /27

7 52.9% "General and unspecified" A % 50% "Cough" R % % 88 "Upper respiratory infection, acute" R74 35 "Asthma" R96 14 "Cough" R05 12 "Sinusitis acute/chronic" R75 5 "Pneumonia" R81 4 "Oesophagus disease" D84 3 "Acute bronchitis/bronchiolitis" R78 3 "Influenza" R80 3 "Fever" A % % 85 "Upper respiratory infection, acute" R74 29 "Influenza" R80 22 "Pneumonia" R81 6 "Fever" A03 4 "Pyelonephritis/pyelitis" U70 4 "Infectious mononucleosis" A75 3 "Lymphadenitis, acute" B70 3 Gastroenteritis, presumed infection D % 28 "Abnormal results investigation NOS (not otherwise specified)" A % % % % 7/27

8 % % % % % % % Discussion 1 ICPC-2-R ICPC-2-R [5] [6, 7] ICPC-2-R Takeshima 90 international classification of primary care second edition (ICPC-2)[8] [9] "Respiratory" R "General and unspecified" A "Digestive" D "Digestive" D "Respiratory" R "General and unspecified" A "General and unspecified" A "Fever" A03 R74 "Influenza" R80 "Abnormal results investigation NOS" A91 8/27

9 "Liver disease NOS" D97 "Digestive" D 2 Takeshima [9] [6, 7] 1 4 "Respiratory" R "General and unspecified" A "Cough" R05 "Fever" A03 "Cough" R05 "Fever" A03 9/27

10 [10] Higashi [11] US Choosing Wisely Avoid prescribing antibiotics for upper respiratory infections. US [12] 2016 [13] UK % [14] [1] 11.1% evidence-based medicine Takeshima A91 [9] A91 [15, 16] A % 10/27

11 4.7% Wooldridge [17] 60.5% 11.5% Ishikawa 12.4% psychiatric disorders [20] 1 11/27

12 [6, 7, 9, 11, 17, 20] Conclusions ICPC-2-R D02, D06, D01 "Cough" R05 "Fever" A03 "Upper respiratory infection, acute" R74 Gastroenteritis, presumed infection D73 "Stomach function disorder" D87 "Influenza" R80 "Cough" R05 "Fever" A03 Acknowledgement Dr. Masaki Amenomori Mieko Maeyama Eriko Okiie Authors' contributions NK 12/27

13 KH, MM SM, TU MM Disclosure References 1. Ikeda N, Saito E, Kondo N, Inoue M, Ikeda S, Satoh T, Wada K, Stickley A, Katanoda K, Mizoue T, Noda M, Iso H, Fujino Y, Sobue T, Tsugane S, Naghavi M, Ezzati M, Shibuya K: What has made the population of Japan healthy? Lancet 2011, 378(9796): Hashimoto H, Ikegami N, Shibuya K, Izumida N, Noguchi H, Yasunaga H, Miyata H, Acuin JM, Reich MR: Cost containment and quality of care in Japan: is there a trade-off? Lancet 2011, 378(9797): Mark Britnell: Fragmentation. In: Mark Britnell. In search of the perfect health system. London, United Kingdom: Palgrave MacMillan; p Fee for Treatment of Patients' Choice pdf Accessed 13 Nov WONCA International Classification Committee (WICC): ICPC-2-R: International Classification of Primary Care. Revised Second Edition. Oxford, United Kingdom: Oxford Medical Publications; /27

14 6. 山田隆司吉村学名郷直樹浅井泰博古賀義則井上陽介濱崎圭三三瀬順一 Lamberts H, Okkes IM: 日常病日常的健康問題とは ICPC プライマリケア国際分類を用いた診療統計から日本プライマリケア学会誌 2000, 23(1): 田中勝巳野間口智松村真司福原俊一プライマリケア診療所における症候および疾患の頻度順位の同定に関する研究プライマリケア 2007, 30(4): WONCA International Classification Committee (WICC): ICPC-2: International Classification of Primary Care. Second Edition. Oxford, United Kingdom: Oxford Medical Publications; Takeshima T, Kumada M, Mise J, Ishikawa Y, Yoshizawa H, Nakamura T, Okayama M, Kajii E: Reasons for encounter and diagnoses of new outpatients at a small community hospital in Japan: an observational study. Int J Gen Med 2014, 7: 村木優一田辺正樹渡邉珠代藤本修平八木哲也村上啓雄日本における経口剤注射剤を含む全抗菌薬の使用動向調査 ( 年) 日本環境感染学会誌 2016, 31(Suppl): Higashi T, Fukuhara S: Antibiotic prescriptions for upper respiratory tract infection in Japan. Inter Med 2009, 48(16): Infectious Diseases Society of America; Arlington, VA, USA: Choosing Wisely: Infectious Diseases Society of America. Accessed 14 May 国際的に脅威となる感染症対策閣僚会議 14/27

15 (AMR) Accessed 24 July Japanese. 14. Gulliford MC, Moore MV, Little P, Hay AD, Fox R, Prevost AT, Juszczyk D, Charlton J, Ashworth M: Safety of reduced antibiotic prescribing for self limiting respiratory tract infections in primary care: cohort study using electronic health records. BMJ 2016, 354: i a/ pdf Accessed 14 May htm Accessed 14 May Wooldridge AN, Arató N, Sen A, Amenomori M, Fetters MD: Truth or fallacy? Three hour wait for three minutes with the doctor: Finding from a private clinic in rural Japan. Asia Pacific Family Medicine 2010, 9: Gierk B, Kohlmann S, Kroenke K Spangenberg L, Zenger M, Bre wait folöwe B: The somatic symptom scale-8 (SSS-8): a brief measure of somatic symptom burden. JAMA Intern Med 2014; 174(3): Herzog A, Voigt K, Meyer B, Wollburg E, Weinmann N, Langs G, L): a b Psychological and interactional characteristics of patients with somatoform disorders: Validation of the Somatic Symptoms Experiences Questionnaire (SSEQ) in a clinical 15/27

16 psychosomatic population. J Psychosom Res 2015; 78(6): Ishikawa Y, Takeshima T, Mise J, Ishikawa S, Matsumura M: Physical symptoms in outpatients with psychiatric disorders consulting the internal medicine division at a Japanese university hospital. Int J Gen Med 2015, 8: /27

17 Tables 1 ICPC-2-R 30 ICPC-2-R ICPC-2-R 1 R A D D A N D N A R D D L R L U D R A K K R T D L /27

18 26 B D D D K K T ICPC-2-R, 2 18/27

19 2 ICPC-2-R 50 ICPC-2-R ICPC-2-R 1 R D D R D R A D D N D R R B D D K L N T L N A D L L /27

20 23 R T A D K R R U U B D H K L P P T A A A A B D D D D D L N P R R /27

21 44 U ICPC-2-R, 2 21/27

22 /27

23 Figures ICPC-2-R A = B = D = F = H = K = L = N = P = R = S = T = U = W = X = Y = Z = T (n=28 3.7%) W (n=0 0.0%) U (n=21 X (n=0 2.7%) 0.0%) Y (n=0 0.0%) S (n=9 1.2%) Z (n=0 0.0%) A (n= %) R (n= %) B (n=16 2.1%) P (n=4 9.0%) N (n=69 9.0%) D (n= %) L (n=62 8.1%) K (n=42 H 5.5%) (n=0 0.0%) F (n=3 0.4%) 23/27

24 ICPC-2-R A = B = D = F = H = K = L = N = P = R = S = T = U = W = X = Y = Z = 24/27

25 ICPC-2-R A03 R05 A R (n= ) A = (n=113, 21, 21) B = (n=14, 2, 0) D = (n=152, 55, 3) F = (n=3, 0, 0) H = (n=0, 0, 0) K = (n=35, 6, 1) L = (n=44, 19, 0) N = (n=53, 16, 0) P = (n=4, 0, 0) R = (n=95, 24, 27) S = (n=8, 1, 0) T = (n=18, 9, 0) U = (n=16, 4, 1) W = (n=0, 0, 0) X = (n=0, 0, 0) Y = (n=0, 0, 0) Z = (n=0, 0, 0) A03 = (n=60, 7, 18) R05 = (n=54, 12, 22) 25/27

26 (n=555) (n=157) (n=53) 0 26/27

27 (n=53) (6) (1) (1) (1) (10) (1) (1) (1) (12) (6) (5) (4) (1) (3) 27/27

プライマリ・ケア国際分類第2版教育セッションプログラム

プライマリ・ケア国際分類第2版教育セッションプログラム 1 5 (ICD-10) (WONCA) (ICPC) Problem Oriented Medical Record(POMR) SOAP S O A P ICPC-2 SOAP Evidence Based Medicine ICPC-2 2 WHO ICD-10 CD-ROM ICD-10 2 5 3 A03 2 30 42160 A 42 161216 204 ICPC-2 A Excel