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Biomedical subjects

I Okkes

Publications and source records attributed to I Okkes.

8 recordsLinked to original sources
PubMed2000

ICPC-2-E: the electronic version of ICPC-2. Differences from the printed version and the consequences.

BACKGROUND: In 1998, ICPC-2 was published as a book. In the process of translating the book, and preparing an electronic version of chapter 10 (the actual classification), ICPC-2 proved to contain many errors and inconsistencies. Particularly, major problems were identified in the conversion between ICPC-2 and ICD-10, which could lead to major errors when used in electronic patient records. OBJECTIVES: We prepared an electronic version of chapter 10 of ICPC-2, ICPC-2-E, with all necessary corrections, to be published on the Oxford University Press web site as a part of this article. METHODS: Errors and inconsistencies were redressed, including particularly those in the con-version structure with all consequences on the level of inclusion and exclusion criteria, through a process of careful checking. RESULTS AND CONCLUSION: ICPC-2-E, the electronic version of chapter 10 of ICPC-2, is specifically to be used in an electronic patient record and for research purposes. It is to be used together with the first nine chapters of ICPC-2, since the book is indispensable to make a correct use of ICPC.

Bias↗
PubMed1998

Gender differences in general practice consultations: methodological challenges in epidemiological research.

BACKGROUND: Women consult their GP more often than men do. The distribution of complaints and diagnoses are different for women and men patients. Although several findings on gender differentials on mortality and health care consumption are rather consistent across studies, detailed findings and subsequent conclusions diverge in several important fields. OBJECTIVES: Our aim was to explore methodological aspects of research on gender differences in general practice. METHODS: We reviewed empirical studies within this field, aiming to identify methodological and interpretative intricacies which deserve special attention in epidemiological research on GP consultations. RESULTS AND CONCLUSIONS: We found that descriptive and explanatory levels of research are frequently confused. Simple questions, answers and explanations are commonly raised for complex issues within a poorly defined theoretical explanatory framework. There is a need to assess relevant approaches for various purposes, and to develop more uniform conceptual terms. Findings from one level are often transferred to another, incompatible level. Epidemiological issues must be considered, especially matters related to denominator level and standardization/confounders-not in order to decide which level represents 'reality', but to clarify the consequences of different measures for different research questions. The contents of the core variables and the potentials for bias should be discussed in order to provide a sound basis for future explanatory studies.

Epidemiologic Research Design↗
PubMed1998

Mental health problems in primary care: a research agenda.

PURPOSE: The NAPCRG Task Force on Mental Health Problems was commissioned to explore critical research and policy issues in mental health and to develop a primary care research agenda for review and action by NAPCRG. This "White Paper" presents the key findings and recommendations of the Task Force. METHODS: A comprehensive review of the primary care mental health literature, using MEDLINE searches with manual follow up, and personal communications with many active researchers in the field were performed by the authors; Task Force members participated in the editing and refinement of the White Paper in a series of email and face-to-face meetings. SUMMARY AND CONCLUSIONS: Although primary care researchers have made major contributions to our growing understanding of mental health problems as they exist in the "real world" of primary care, rapid changes in the U.S. health care environment threaten to undo the integration of mental and physical health that is at the heart of primary care. It will be necessary for the primary care leaders in this field to step forward to guide policy-makers, purchasers, and the public as primary care is reengineered for the next generation. Efforts to operationalize episode of care and comorbidity recording with EMR systems, particularly in cooperation with managed care corporations and/or primary care research networks, may represent the most effective strategy for promoting the integration of mental health services into primary care. The most promising area for research in the immediate future may be descriptive studies that capture and explore the clinical epidemiology of common mental health problems as they occur in routine practice.

Comorbidity↗
PubMed1998

The classification of mental disorders in primary care: a guide through a difficult terrain.

BACKGROUND: Primary care physicians traditionally have a strong interest in the mental health of their patients. Three classification systems are available for them to diagnose, label, and classify mental disorders: 1) The ICD-10 approach with three options, 2) The DSM-IV approach with two options, and 3) the ICPC approach with two options. This article lists important similarities and differences between the systems to help potential users choose the option that best meets their needs. METHODS: Definitions for depressive disorder, anxiety disorder, and somatization disorder are compared on five characteristics of classification: 1. the domain, 2. the scope, 3. the nature of the definitions, 4. focus on episodes of care, and 5. clinical guidelines. RESULTS: Primary care physicians and psychiatrists have different perspectives, reflected in different classifications. Each system has specific possibilities and limitations with regard to the diagnosis of mental disorders. For common mental disorders it is possible, however, to choose codes from one system while maintaining compatibility with the other two. Comparability as to the diagnostic content of the different classes, however, is more difficult to establish. The available classification systems give both primary care physicians and psychiatrists options to diagnose, label, and to classify mental disorders from their own perspective, but once a system has been chosen the clinical comparability of a patient with the same diagnosis in other systems is limited. CONCLUSION: Compatibility among systems can be optimized by strictly following a number of rules. The conversion between ICPC and ICD-10 (and consequently DSM-IV) allows simultaneous use of ICPC and ICD-10 as a classification and DSM-IV as the standard nomenclature. This is of particular interest for computer based patient records in primary care. The clinical comparability of the same diagnosis in different systems however is limited by the characteristics of the different system.

Anxiety Disorders↗
PubMed1998

Deliberate departures from good general practice: a study of motives among Dutch general practitioners.

BACKGROUND: When general practitioners (GPs) act contrary to their own standards of good practice, they usually cite patient demands as the main reason. However, up until now, studies have relied on doctors' recollections of departures from their own norms, which may be unreliable. AIM: To systematically explore GPs' motives for deliberate departures from their own conception of good practice. METHOD: Forty-nine GPs, over five days, registered to what extent they had deviated from their own norms, and recorded the motives underlying any deviation. RESULTS: Of the 6087 consultations registered, 10% contained some departure from 'good' general practice, the majority (75%) of which was perceived by the doctor concerned as 'slight'. Doctors underpinned their departures mostly by referring to the doctor-patient relationship: the wish to be nice was used, on average, in 42% of deviations, and the wish to prevent a conflict in 30%. The most important non-relational motive was clinical uncertainty, which doctors used in 11% of their cases. DISCUSSION: Contrary to common belief, GPs often comply with patient requests because they wish to, and not because they feel forced to. Whether or not this behaviour affects the quality of care is largely dependent on the model of 'good' general practice used.

Family Practice↗
PubMed1998

Mental health problems in primary care. A research agenda.

BACKGROUND: The North American Primary Care Research Group (NAPCRG) Task Force on Mental Health Problems was commissioned to explore critical research and policy issues in mental health and to develop a primary care research agenda for review and action by NAPCRG. This paper presents the key findings and recommendations of the task force. METHODS: As co-chairpersons of the task force, we performed a comprehensive review of the primary care mental health literature using MEDLINE searches with manual follow-up and personal communications with many active researchers in the field. Task force members participated in the editing and refinement of this paper through electronic mail and a series of face-to-face meetings. CONCLUSIONS: Rapid changes in the US health care environment threaten to undo the integration of mental and physical health that is at the heart of primary care. It will be necessary for the primary care leaders in the mental health field to step forward to guide policymakers, purchasers, and the public as primary care is reengineered for the next generation. Efforts to use episode of care and comorbidity recording within electronic medical record systems, particularly in cooperation with managed care corporations or primary care research networks, may represent the most effective strategy for promoting the integration of mental health services into primary care. The most promising area for original research may be the exploration of common mental health problems in the context of routine primary care practice.

Depressive Disorder↗
PubMedDate not supplied

Patients with chronic alcohol abuse in Dutch family practices.

Routine data from the Dutch Transition project on 236 027 episodes of care collected by 54 family physicians (FPs) for 93 297 patient years in their listed practices and classified with the International Classification of Primary Care, were used to analyse chronic alcohol abuse episodes of care in Dutch family practices. Data on 332 episodes are presented. In a subsample with a 4-year registration period, 70 patients were identified. Important reasons for an encounter are the patient's explicit presentation of the problem and the FPs' initiatives. FPs show considerable sensitivity to psychosocial problems, including alcohol abuse. It is concluded that over the years registered FPs actively deal with chronic alcohol abuse in approximately 2% of all visiting men aged 25-64 years. In an average Dutch family practice with 2200 listed patients, approximately 20 patients are known by the FP to have chronic alcohol abuse. Real life studies in registered family practice populations are necessary to better establish how patients with abundant alcohol consumption as a risk factor develop the chronic alcohol abuse episode of care, and what FPs can do to prevent this effectively.

Adult↗