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Use of non-specific diagnostic codes in out-of-hours services
Insights
Primary care physicians are increasingly using non-specific diagnostic codes, which compromises the accuracy of health statistics and disease surveillance. This trend, particularly evident in out-of-hours services, impacts the reliability of data for public health monitoring.
Area of Science:
- Public Health
- Health Informatics
- Epidemiology
Background:
- Primary care physicians utilize diagnostic codes on reimbursement claims.
- Non-specific diagnostic codes can compromise the validity of health statistics and disease surveillance.
- The study focuses on out-of-hours services data from 2008-2019.
Purpose of the Study:
- To analyze the trend of non-specific diagnostic code usage in primary care.
- To assess the impact of these codes on disease surveillance and statistical validity.
- To highlight concerns regarding data integrity for public health initiatives like COVID-19 monitoring.
Main Methods:
- Analysis of electronic reimbursement card data from out-of-hours services (2008-2019).
- Tracking of consultations and telephone contacts.
- Quantification of diagnostic codes for respiratory infections and non-specific diagnoses.
Main Results:
- Consultations increased by 1%, while telephone contacts surged by 139% between 2008 and 2019.
- Out-of-hours contacts with non-specific diagnoses rose nearly thirteenfold.
- The use of non-specific diagnoses increased significantly for both telephone contacts (19x) and consultations (2.7x).
- Total out-of-hours contacts for respiratory infections decreased by 26%.
Conclusions:
- A significant shift towards non-specific diagnostic codes is observed in out-of-hours services.
- This trend undermines the reliability of disease statistics and research based on reported diagnoses.
- The widespread use of non-specific codes poses a particular challenge for accurate COVID-19 pandemic surveillance.
Background:
Primary care doctors put diagnostic codes on all reimbursement cards. The objective of this study was to map out the use of non-specific diagnostic codes that can undermine the validity of statistics and disease surveillance.
Material And Method:
The material consists of data from all electronic reimbursement cards from out-of-hours services in the period 2008-2019. We registered consultations and telephone contacts and the proportion of these that were supplied with diagnostic codes for respiratory infections and three non-specific diagnostic codes.
Results:
The number of consultations per year increased from 1 402 452 in 2008 to 1 417 395 in 2019, a relative increase of 1 %. The number of telephone contacts per year increased from 286 515 in 2008 to 684 773 in 2019, a relative increase of 139 %. Out-of-hours contacts coded with non-specific diagnoses increased nearly thirteenfold, from 40 280 to 514 715. The use of non-specific diagnoses increased by a factor of 19 for telephone contacts and 2.7 for consultations. The total number of out-of-hours contacts for respiratory infections decreased from 240 037 to 176 909 (a 26 % reduction).
Interpretation:
There is a strong tendency for general, non-specific diagnostic codes to replace specific diagnoses of disease on reimbursement cards from out-of-hours services. This undermines the evidence base for statistics and research based on reported ICPC-2 diagnoses, and this is especially of concern when these diagnoses are to be used for monitoring of the COVID-19 pandemic.
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