Search PubMed⌕ Search

Biomedical subjects

H Lamberts

Publications and source records attributed to H Lamberts.

At least 37 records · Page 2Linked to original sources
PubMed1996

The International Classification of Primary Care (ICPC): new applications in research and computer-based patient records in family practice.

The international Classification of Primary Care (ICPC) has now been available to the family medicine community for a decade as the main ordering principle of its domain. Research data and practical experiences with ICPC, as well as the development of new concepts in family medicine, have resulted in new applications. The structure of episodes of care to be included in a computer-based patient record has been further developed and refined. ICPC as the ordering principle of patient data is now available in 19 languages. Its conversion structure with the International Classification of Diseases (ICD-10) allows the highest possible level of specificity in a patient's problem list necessary in patient care, while the compatibility of the ICPC drug codes with the Anatomic Therapeutic Chemical Classification Index allows the systematic inclusion of data on prescription.

Abstracting and Indexing↗
PubMed1996

Classification of severity of health problems in family/general practice: an international field trial.

BACKGROUND: A methodology is needed for classification of health problems by severity. OBJECTIVES: We aimed to test the Duke Severity of Illness Checklist (DUSOI) for feasibility and usefulness. METHOD: The DUSOI was field tested internationally by 22 family/general practitioners in 9 countries. RESULTS: The DUSOI was found to be feasible for rating severity of illness of health problems in family/general practice. The measure was shown to be clinically useful in older patients and those with chronic and more severe health problems. Variability of severity ratings was less within the same rater than between different raters (i.e. higher intrarater than interrater reliability). Clinical face validity was supported by the finding that DUSOI ratings classified patients with the same diagnosis and those with different diagnoses according to the severity differences that would be expected clinically. CONCLUSIONS: Although research is needed to improve reliability and to test validity further, the DUSOI was shown in the present study to be a methodology that is reasonable for consideration as an international classification of health problems by their severity in primary care patients.

Adolescent↗
PubMed1996

[Defensive behavior in medical care. A lesson for the dentist?].

Defensive behaviour in medical care is defined as a clear deviation from the physicians (dentists) usual behaviour and from what he/she considers to be good practice in order to prevent problems in the contact with patients and their families. General practitioners behave defensively in substantial proportion of their referrals to a specialist (15%) and of their ordering diagnostic tests (25%). In both instances varying (clinical and non-clinical) reasons can prompt the physician to refer or to test. Defensive considerations can play an equally varying role within all these reasons, which shed more light on the nature of the daily work in primary care. It is concluded that no reason exists to presume that Dutch dentists are more free either from non-clinical considerations and from defensive behaviour when they treat their patients than general practitioners.

Attitude of Health Personnel↗
PubMed1996

Episode of care: a core concept in family practice.

The new Institute of Medicine definition of primary care requires that primary care clinicians address the large majority of personal health care needs of their patients. The unit of assessment for this is the episode of care, defined as a health problem from its first encounter with a health care provider through the completion of the last encounter. An episode of care is distinct from an episode of disease or illness. In this article, episode-of-care date from Dutch family practice, classified with the International Classification of Primary Care, illustrate this approach. Data on women 25 to 44 years of age are presented. The top 20 new reasons for encounter and new episodes of care as well as the relations between a reason for encounter (headache) and disease (sinusitis) support the potential of episode-oriented epidemiology and some important clinical considerations in family practice.

Adult↗
PubMed1996

Values and roles in primary care.

Discussions about research priorities and criteria for quality assessment in primary care are confusing when the differences in the underlying models and value systems are unclear. This article presents a simple grid that can facilitate discussions involving the roles of primary care physicians. One axis of the grid includes three value systems that are important to the understanding of different goals in primary care. The second axis includes three practice roles that are important to the evaluation of the actual delivery of primary care. Examples are used to illustrate how the grid can be used in discussion about the mission of primary care.

Adult↗
PubMed1993

An international perspective on the cholesterol debate.

For the past 5 years there has been an intensive debate and a number of conflicting guidelines suggesting what general practitioners (GPs) should do to screen and manage hyperlipidaemia. At a WONCA seminar in Vancouver in 1992, policies and guidelines from Canada, the UK, The Netherlands, New Zealand, Hong Kong and the USA were reviewed. It was concluded that cholesterol policy and guidelines tend to be influenced more by political and economic factors than by evidence of health benefit. International guidelines for cholesterol screening and management would be of minimal value, as GPs would have to interpret the epidemiological evidence of benefit from lipid screening and lipid lowering strategy in the context of each patient to arrive at optimum management.

Adult↗
PubMed1992

Use of symptoms and signs to diagnose maxillary sinusitis in general practice: comparison with ultrasonography.

OBJECTIVE: To establish the incidence of maxillary sinusitis in general practice and the predictive value of symptoms and signs. DESIGN: Population based study. SETTING: 9 general practices with 15,220 patients aged 15 years and older on the list. PATIENTS: 400 patients with 441 episodes in whom practitioners intended to confirm or to exclude sinusitis. MAIN OUTCOME MEASURES: Results of ultrasonography and signs and symptoms associated with positive results. RESULTS: 212 of the 441 episodes were confirmed by ultrasonography. 15.7 episodes occurred per 1000 adults per year. The five symptoms beginning with common cold (beta coefficient = 1.035), purulent rhinorrhoea (0.996), pain at bending (0.950), unilateral maxillary pain (0.640), and pain in teeth (0.606) were associated with positive results on ultrasonography. General practitioners' clinical diagnoses were correct in 177 episodes, false positive in 88, false negative in 22, and uncertain in 154. With an algorithm using the five weighted symptoms 243 of the diagnoses would have been correct, but 110 would remain uncertain and 44 cases would have been missed. CONCLUSION: The five symptoms algorithm would improve diagnostic accuracy of general practitioners, but incorrect and uncertain diagnoses cannot be avoided.

Adolescent↗
PubMed1992

International primary care classifications: the effect of fifteen years of evolution.

To better understand the development of primary care classifications over the past 15 years, 10 primary care databases have been retrospectively analysed using the structure of the International Classification of Primary Care (ICPC) as the basis. All datasets were based on routine data collection using different classification systems by several family physicians during all encounters with their patients over considerable periods of time, in most cases one year. The prevalences or the rates of the available diagnostic--and reason for encounter--classes were distributed over four frequencies. With a few exceptions the distribution of diagnostic labels referring to common diseases is surprisingly similar. The use of ICPC however results in a quantum leap in the use of symptom and complaint diagnoses. Because of this shift primary care physicians now have available a classification with 400 diagnostic classes used with a prevalence of > or = 1/1000 patient-years or per 1000 visiting patients per year. The classification of reasons for encounter allows the physician to identify over 300 reasons for encounter used > or = 1/1000 patient years or per 1000 visiting patients per year. Family physicians have been successful in the development of new primary care classifications. Rag bag rubrics which are the result of the structure of ICPC are used relatively often and deserve more attention from primary care taxonomers.

Humans↗
PubMed1992

The conversion between ICPC and ICD-10. Requirements for a family of classification systems in the next decade.

The International Classification of Primary Care (ICPC) was developed to order medical concepts into classes that have been chosen for their relevance for family medicine. Family physicians use this to label the most prevalent conditions in their practice as well as their patients' symptoms and complaints. At the same time they do not want to be divorced from the needs of the medical community at large as these are reflected in the most recent medical nomenclature: the Tenth Revision of the International Classification of Diseases (ICD-10). A full conversion between all classes in the first and seventh component of ICPC (n = 646) with those of ICD-10 (n = 1983), with the exception of the chapter on external causes, has been prepared. It was concluded that ICD-10 at the three-digit level cannot function as a core classification for an international primary care system. Of the three-digit ICD-10 rubrics only 120 are compatible on a one to one basis with an ICPC rubric. A total of 114 three-digit ICD-10 rubrics have to be broken open into four-digit rubrics to allow at least one compatible conversion to one or more ICPC rubrics. On this basis only 25% of the diagnostic classes in ICPC can be converted to a single three- or four-digit ICD-10 rubric without lumping. The rest of ICD-10, either on the three- or on the four-digit level, has to be grouped into combinations of classes (lumping) to allow compatible conversion to the remaining rubrics of ICPC. Even though ICD-10 cannot serve as a core classification for primary care, a technical conversion between ICPC and ICD-10 is practically always possible which allows primary care physicians to implement ICD-10 as a contemporary nomenclature within the classification structure of ICPC.

Humans↗
PubMed1990

Do our patients receive maximum benefit from preventive care? A North American perspective.

Politicians, their constituents and family physicians believe that preventive medicine is essential if health care is to be improved. Family physicians believe that the majority of their patients are well cared for with preventive health care services but in reality preventive services are provided to less than half the population and some to fewer than 10%. Barriers to providing preventive care include the selection of procedures of unproven effectiveness, public unawareness of the benefits of the procedure and practical obstacles for physicians providing the services. Assessment of each of these barriers indicates how preventive care can be improved. Narrowing the gap between what we believe about preventive care and the level of preventive services we are providing could improve the health of our nations. However, the concept of primum non nocere must dominate the assessment of currently advocated preventive procedures and the consideration of new procedures.

Attitude of Health Personnel↗