Reasons for encounter and diagnoses of new outpatients at a small community hospital in Japan: an observational study

Abstract

Taro Takeshima,1,2 Maki Kumada,3,4 Junichi Mise,5 Yoshinori Ishikawa,6 Hiromichi Yoshizawa,4 Takashi Nakamura,3,4 Masanobu Okayama,1 Eiji Kajii11Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 2Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; 3Division of The Project for Integration of Community Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 4Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan; 5Division of Human Resources Development for Community Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 6Department of Surgery, Chikusei City Hospital, Chikusei, JapanPurpose: Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE) and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods.Methods: This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, “Symptoms/Complaints”, and component 7, “Diagnosis/Diseases”, of the International Classification of Primary Care, 2nd edition (ICPC-2). We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship.Results: We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter) and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for 80% of all diagnoses, and the top 90 codes accounted for 90%. Of the 2,252 RFEs, 1,408 (62.5%) included at least one of the 36 symptoms listed in the Model Core Curriculum and 1,443 (64.1%) included at least one of the 35 symptoms in the Goals of Clinical Clerkship. On the other hand, “A91 Abnormal result investigation”, “R21 Throat symptom/complaint”, and “R07 Sneezing/nasal congestion”, which were among the top 10 RFEs, were not included in these two guidelines.Conclusion: We identified the common RFEs and diagnoses at a small hospital in Japan and revealed the inconsistencies between the RFEs observed and common symptoms listed in the guidelines. Our findings can be useful in improving the general practice medical education curricula.Keywords: general practice, primary care, medical education, International Classification of Primary Care