Diego Schrans1, Dirk Avonts2, Thierry Christiaens2, Sara Willems2, Kaat de Smet2, Kees van Boven3, Pauline Boeckxstaens2, Thomas Kühlein4. 1. Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium, diego.schrans@ugent.be. 2. Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium. 3. Department of Primary and Community Care, Radboud University Nijmegen, Nijmegen, The Netherlands and. 4. Allgemeinmedizinisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany.
Abstract
BACKGROUND: General practice is person-focused. Contextual information influences the clinical decision-making process in primary care. Currently, person-related information (PeRI) is neither recorded in a systematic way nor coded in the electronic medical record (EMR), and therefore not usable for scientific use. AIM: To search for classes of PeRI influencing the process of care. METHODS: GPs, from nine countries worldwide, were asked to write down narrative case histories where personal factors played a role in decision-making. In an inductive process, the case histories were consecutively coded according to classes of PeRI. The classes found were deductively applied to the following cases and refined, until saturation was reached. Then, the classes were grouped into code-families and further clustered into domains. RESULTS: The inductive analysis of 32 case histories resulted in 33 defined PeRI codes, classifying all personal-related information in the cases. The 33 codes were grouped in the following seven mutually exclusive code-families: 'aspects between patient and formal care provider', 'social environment and family', 'functioning/behaviour', 'life history/non-medical experiences', 'personal medical information', 'socio-demographics' and 'work-/employment-related information'. The code-families were clustered into four domains: 'social environment and extended family', 'medicine', 'individual' and 'work and employment'. CONCLUSION: As PeRI is used in the process of decision-making, it should be part of the EMR. The PeRI classes we identified might form the basis of a new contextual classification mainly for research purposes. This might help to create evidence of the person-centredness of general practice.
BACKGROUND: General practice is person-focused. Contextual information influences the clinical decision-making process in primary care. Currently, person-related information (PeRI) is neither recorded in a systematic way nor coded in the electronic medical record (EMR), and therefore not usable for scientific use. AIM: To search for classes of PeRI influencing the process of care. METHODS: GPs, from nine countries worldwide, were asked to write down narrative case histories where personal factors played a role in decision-making. In an inductive process, the case histories were consecutively coded according to classes of PeRI. The classes found were deductively applied to the following cases and refined, until saturation was reached. Then, the classes were grouped into code-families and further clustered into domains. RESULTS: The inductive analysis of 32 case histories resulted in 33 defined PeRI codes, classifying all personal-related information in the cases. The 33 codes were grouped in the following seven mutually exclusive code-families: 'aspects between patient and formal care provider', 'social environment and family', 'functioning/behaviour', 'life history/non-medical experiences', 'personal medical information', 'socio-demographics' and 'work-/employment-related information'. The code-families were clustered into four domains: 'social environment and extended family', 'medicine', 'individual' and 'work and employment'. CONCLUSION: As PeRI is used in the process of decision-making, it should be part of the EMR. The PeRI classes we identified might form the basis of a new contextual classification mainly for research purposes. This might help to create evidence of the person-centredness of general practice.
Authors: Marc Jamoulle; Melissa Resnick; Julien Grosjean; Ashwin Ittoo; Elena Cardillo; Robert Vander Stichele; Stefan Darmoni; Marc Vanmeerbeek Journal: Eur J Gen Pract Date: 2017-12-15 Impact factor: 1.904