ICPC-3 International Classification of Primary Care

User Manual and Classification

Kees van Boven, Huib Ten Napel, Kees van Boven, Huib Ten Napel

• Publisher: CRC Press
• Year: 2021
• ISBN:
  9781000486575
• Edition: 3
• Topic: Medicina
• Subtopic: Medicina di famiglia e medicina generale

This third edition of the International Classification of Primary Care (ICPC-3) is indispensible for anyone wishing to use the international classification system for classification of morbidity data in a primary care setting. Distilling the many standards that are applied internationally in primary & community care and public health to offer a telescopic view, the classification has been completely rewritten to reflect the continued shift in the health paradigm of primary care and public health towards the person rather than the disease or provider. The content of ICPC-3 remains closely 'linked' to relevant related international classifications. The ICPC-3 also contributes to the United Nations' Sustainable Development Goals, specifically to Goal 3 and its target of ensuring healthy lives and promoting well-being for all at all ages.

Chapter 1 Introduction

DOI: 10.1201/9781003197157-1

Welcome to the third version of the International Classification of Primary Care (ICPC).

This manual is intended to give insight into the underlying principles of how and why the ICPC-3 has been built and offers detailed guidance in the use of its contents.

The ICPC-3 is developed in the first place for online electronic application and use. For this purpose, the ICPC-3 is available in an online browser on the ICPC-3 website. The website contains all relevant information on the ICPC-3, including educational material: www.ICPC-3.info.

This manual contains a condensed part of the ICPC-3, without the electronic features offered by the ICPC-3 browser (as explained in Chapter 2).

Overview of the ICPC-3

The content of the classification has changed, and it now has a Framework and contains new chapters.

• The classification has a Framework that underlines the importance of interrelations between all chapters of the ICPC from a person-centred perspective.
• The classification has a systematic list with a new structure for the sequence of chapters:
  • a new chapter entitled Visits for general examination, routine examination, family planning, prevention and other visits, for non-problem-related reasons for encounter and episodes
  • chapters on body/organ systems have new components relating to Symptoms, complaints and abnormal findings, and Diagnoses and diseases
  • a new chapter on Social problems, covering social and environmental factors
  • a chapter headed Interventions and processes, subdivided into Diagnostic and monitoring interventions, Therapeutic and preventive interventions, Programmes related to reported conditions (a new component), Results, Consultation, referral and other reasons for encounter, and Administrative
  • a new chapter entitled Functioning, consisting of Activities and participation, and Functions
  • a new chapter called Functioning related, covering Environmental factors and Personality functions
  • a new chapter entitled Regional extensions, with national or regional classes
  • a new chapter entitled Emergency codes, on codes for emergency use with epidemiological importance in relation to risk of (national or international) spreading of infections
  • a chapter called Extension codes, covering codes provided as supplementary codes or additional positions to give more detail or meaning to the initial code, if so desired
• The codes have been expanded from three to four digits, giving more scope for additional classes and for corrections of classification of classes. Along with the two new components in the chapters on body/organ systems, this new structure allows for new demands to be addressed in future updates.

Acceptance of the ICPC-3

The Executive response is as follows:

• After consideration of the proposals prepared by the ICPC-3 Consortium members and brought forward by the ICPC-3 Steering Group on the International Classification for Primary Care – Third Edition, WONCA executives ACCEPTED and ENDORSED the ICPC-3 on 16 April, 2021.
• The Executive RECOMMENDS the use and implementation of the full ICPC-3 for all primary health care professionals on a global scale.
• The Executive REQUESTS the ICPC-3 Consortium publishes the ICPC-3 manual.

History of the ICPCⁱ

Until the mid-1970s, most morbidity data collected in primary care research were classified using the International Classification of Diseases (ICD).^[1,2]

This had the important advantage of international recognition, aiding comparability of data from different countries. However, there was the disadvantage that the many symptoms and non-disease conditions that were present in primary care were difficult to code with the ICD, originally designed for application to mortality statistics and with a disease-based structure.

Recognising the problems of the ICD and the need for an internationally recognised classification for general practice, the WONCA Classification Committee designed the International Classification of Health Problems in Primary Care (ICHPPC), first published in 1975^[3] and with a second edition in 1979^[4] related to the ninth revision of the ICD. Although this provided a section for the classification of some undiagnosed symptoms, it was still based on the ICD structure and remained inadequate. A third edition in 1983 added to its criteria for the use of most of the classes,^[5] greatly adding to the reliability with which it could be used but not overcoming its deficiencies for primary care. A new classification was needed for both the patient’s reason for encounter (RFE) and the provider’s record of the patient’s problems.

At the 1978 World Health Organization (WHO) International Conference on Primary Health Care in Alma Ata,^[6] adequate primary health care was recognised as the key to the goal of ‘health for all by the year 2000’. Subsequently, both WHO and WONCA recognised that the building of appropriate primary care systems to allow the assessment and implementation of health care priorities was only possible if the right information was available to health care planners. This led to the development of new classification systems.

Later in 1978, WHO appointed what became the WHO Working Party for Development of an International Classification of Reasons for Encounter in Primary Care.^[7] This group, most of whose members were also members of the WONCA Classification Committee, developed the Reason for Encounter Classification (RFEC),^[7,8,9] which later became the ICPC.

An RFE is the agreed statement of the reason(s) why a patient enters the health care system, representing the demand for care by that person. This may be symptoms or complaints (e.g. headache or fear of cancer), a known disease (e.g. flu or diabetes), a request for preventive or diagnostic services (e.g. a blood pressure check or an ECG), a request for treatment (e.g. a repeat prescription), to get test results, or an administrative purpose (e.g. to get a medical certificate). These reasons are usually related to one or more underlying problems that the doctor formulates at the end of the encounter as the conditions that have been treated, which may or may not be the same as the RFE.

Disease classifications are designed to allow the health care provider’s interpretation of a patient’s health care problem to be coded in the form of an illness, disease or injury. In contrast, the RFEC focuses on data elements from the patient’s perspective.^[7,10,11,12] In this respect, it is patient oriented rather than disease oriented or provider oriented. The RFE, or demand for care, given by the patient has to be clarified by the physician or other primary care health worker before there is an attempt to interpret and assess the patient’s health problem in terms of a diagnosis or to make any decision about the process of management and care.

The working group developing the RFEC tested several versions in field trials. In the course of this feasibility testing, it was noted that the RFEC could easily be used to classify simultaneously the RFEs and two other elements of problem-oriented care: the process of care and the health problems diagnosed. Thus, this conceptual framework allowed for the evolution of the RFEC into the ICPC.

Problems in relation to the concurrent development of the ICD-10 prevented WHO from publishing the RFEC. However, WONCA was able to use it to develop the ICPC and published the first edition in 1987.^[13] While the ICPC-1 was much more appropriate for primary care than previous classifications based on the ICD framework, it did not provide inclusion criteria for the classes or any cross-referencing. It was, in this respect, less useful than the previous publication, ICHPPC-2-Defined, though it referred to the latter as a source of inclusion criteria.

In 1980 WONCA became a non-government organisation in official relations with WHO, and joint work since then has led to a better understanding of the requirements of primary care for its own information systems and classifications within an overall framework encompassing all health services.

In 1985 a project began in several European countries to use the new classification system to produce morbidity data from general practice for national health information systems. This involved translations of the classification and comparative studies across countries. The results were published in 1993 in a book including an update of the ICPC.^[14]

ICPC-1

The first edition of the ICPC broke new ground in the world of classification when it was published in 1987 by WONCA, the World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians, now known as the World Organization of Family Doctors. For the first time, health care providers could classify, using a single classification, three important elements of the health care encounter: RFEs; diagnoses or problems; and process of care. Linkage of elements per...