Classification of reasons why persons seek primary care: pilot study of a new system

In 1978, the World Health Organization formed a group to begin work on the Reason for Encounter Classification (RFEC), which is designed to classify the reasons why patients seek care at the primary level. The relatively simple classification is based on two axes--chapters and components--and uses a three-character alpha-numeric code. Chapters, which are named by body systems or more general terms, are the reasons that health care was sought. Five of the seven components, or subdivisions of chapters, contain rubrics identified by the same two-digit numerical code. A pilot study with a training exercise was carried out in The Netherlands by nine family physicians to confirm the feasibility of using the new classification system in primary care settings. Training consisted of viewing videotapes of encounters and an exercise of coding 76 vignettes by the RFEC. Within 2 months, the physicians in the subsequent pilot study had collected and coded 7,503 reasons for encounters. Results of the pilot study confirm that the RFEC is feasible, easy to use in practice, and different from disease-oriented classifications in its system of classifying the reasons for encounter. The pilot study results have been used to modify the RFEC in preparation for a field trial in ambulatory care settings worldwide.