基层医疗国际分类对城市全科医疗门诊老年患者就诊原因及服务需求的评价

A study on application of International Classification of Primary Care in the clinic of General Practice in Urban Area

目的 了解北京和天津城市全科医疗诊所中老年患者的患病情况和就诊原因 ;探索以基层医疗国际分类 (ICPC)方法客观评价居民医疗服务需求的状况。方法 采用典型抽样的方法 ,选取在 1999年 11月～ 2 0 0 0年 2月间、每个月前 2周中因不同原因到上述全科医疗门诊就诊的≥ 6 5岁的老人作为研究对象 ,共获得样本量为 2 85 9人次 ;由全科医生对其就诊情况进行记录 ,并使用基层医疗国际分类 (ICPC - 2 )对所记录的就诊原因和健康问题进行分类和编码。进而将分析结果与香港的研究结果进行比较。结果 老年人的首位就诊原因是头晕 ;就诊原因中的 4 1 6 %和健康问题 (诊断 )中的 6 0 3%属于心血管系统 ;2 4 6 %的患者患有高血压和相关疾病 ;研究地区与香港地区老年人的健康问题有所不同。结论 ICPC是研究居民就诊原因和医疗服务需求的有效而实用的工具。研究地区中老年人的主要健康问题是慢性疾患 ,特别是心血管疾病 ,此提示慢性病是目前及今后全科医疗服务的主要内容 ,而全科医生的继续教育亦应顺应患者的需求。

Objective To survey the health problems of the elderly patients,and their reasons for encounter (RFE),seen in the General Practice(GP) clinics in Urban Area in Beijing and Tianjin.To assess the need of health service by using the International Classification of Primary Care(ICPC).Methods A survey was done by General Practitioner in 1999-2000 in the clinic of GP in Urban Area.All patients aged 65years old and above seen in the first two weeks every month were recruited.Their RFE and the doctors′diagnoses were coded with the International Classification of Primary Care (ICPC-2).The findings were compared with the similar survey done in Hong Kong.Results The most the RFE of Patients was the dizziness;41.6% of the RFE and 60.3% of the diagnoses belonged to the cardiovascular system;24.6% of the patients suffered from hypertension-related problems;The patients from different areas had different health problems.Conclusion ICPC is an effective and practical tool for study the reason for encounter and the needs of health service of the resident.General practice in these two cities attended elderly patients mainly for chronic illness,particularly cardiovascular diseases.This clue will prompt the General Practitioners put the care of chronic diseases as their main content of service at the present time.And the continuing medical training for GPs,should be oriented by the need of patients′ health service.