An International Glossary for Primary Care

Report of the Classification Committee of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA)

THE JOURNAL OF FAMILY PRACTICE, VOL. 13, NO. 5: 671-681, 1981 671 1

The WONCA Classification Committee

Dennis Aloysius, MD—Sri Lanka Bent Guttorm Bentsen, MD—Norway Charles Bridges-Webb, MD—Australia Boz Fehler, MD—Republic of South Africa Jack Froom, MD (Editor)—United States Klaus-Dieter Haehn, MD—West Germany Erik Flagman, MD—Finland Pille Krogh-Jensen, MD—Denmark Henk Lamberts, MD—Netherlands David Metcalfe, MD—England Bill Patterson, MD—Scotland M.K. Rajakumar, MD—Malaysia Philip Sive, MD—Israel Gerhart Tutsch, MD—Austria Robert Westbury, MD (Chairman)—Canada Bert Herries Young, MD—New Zealand

672 THE JOURNAL OF FAMILY PRACTICE, VOL. 13, NO. 5, 1981 An International Glossary for Primary Care

Precise definitions of terms that describe the process of pri mary care are essential to the collection of primary health care data. Whenever possible, these definitions should be uniform and unambiguous. Research workers who wish to collaborate with or interpret work of colleagues from other countries can benefit from a standard glossary of commonly used health terms. In response to these needs, the Classification Committee of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Phy sicians present this international glossary for primary care. Consensus on the definitions was reached by the Classifica tion Committee with consultation from general practice-family practice organizations and individuals. Existing primary care glossaries from several countries and the World Health Organ ization were also consulted. The definitions provided are intended as guidelines, rather than absolute dicta, for primary care providers and researchers who desire comparability. New knowledge, drifts in use of language with time, and new processes will inevitably require revision of definitions and the addition of new terms. A com prehensive dictionary is not intended, but rather terms most commonly used are included. Equivalent terms are enclosed in parentheses with the coun try of origin bracketed. It should be understood, however, that exact equivalence may not be present. It was not always pos sible to include fine shades of differences of meaning. For convenience, the male pronouns have been used throughout.

cation Committee of the World Research activity in family medicine ings in different countries. For ex Organization of National Colleges, and general practice has increased ample, the terms “surgery” and Academies and Academic Associ exponentially in recent years, with “consultation” have very different ations of General Practitioners/ reports in medical journals and connotations in the United King Family Physicians developed this presentations at medical meetings dom and in North America. Even glossary for family practice re often receiving international atten within the same country, terms like searchers to facilitate reporting tion. It has become apparent that “patient population” and “ stand their findings in a standard fashion some terms have different mean- ard age groups” receive different interpretations from different in and to help readers interpret these vestigators. reports. The glossary can be espe The need for standard definitions cially helpful for research collabo and a delineation of terms with rators from different countries. The Requests for reprints should be ad Classification Committee intends dressed to Dr. Jack Froom, Health Sci equivalent meanings in different ences Center, State University of New countries prompted the develop this glossary to be a dynamic instru York-Stony Brook, Stony Brook, NY ment subject to periodic revisions. 11794. ment of this glossary. The Classifi-

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I. General H. Diagnostic Index (Morbidity In to meet those needs, the com dex, Problem Index, E Book)—A munity physician will generally A. Health—A state of optimal system in which the diseases, ill not render primary health care physical, mental, and social well nesses, and social problems in a except for specific disease being, and not merely the absence patient population are recorded by entities such as selected com of disease or infirmity (Modified diagnosis or problem, date of pre municable diseases. The role of World Health Organization defini sentation, patient name, age, and a community physician varies tion). sex. This index helps in retrieval of from country to country, but he B. Health Care—Assessment, medical records for cohorts of pa or she is usually employed by a health maintenance, therapy, edu tients with similar health problems, government agency. cation, promotion of health, pre and it may be used to facilitate 5. Locum Tenens—A practitioner vention of illness, and related ac follow-up. employed for a stated period of tivities (provided by qualified pro time by a physician to assume fessionals) to improve or maintain responsibility for the care of health status. the practice population during C. Health Care System—The or an absence. Responsibility re ganizational structure through which verts to the principal physician health care is provided. upon the physician’s return. II. Provider Descriptors D. Primary Care (Primary Health 6. Specialist—A physician with Care)—Health care that empha A. Health Care Provider—A quali special competence and ap sizes responsibility for the patient, fied person who renders health care proved training in a particular beginning at the time of the first en services. field of medicine. counter and continuing thereafter. 1. Family Physician/General Prac 7. Consultant—A physician with This includes overall management titioner—A physician who pro special competence in a par and coordination of health care, vides and coordinates personal, ticular area of medicine who such as appropriate use of consult primary, and continuing com provides services related to ants, specialists, and other medical/ prehensive health care to indi this area at the request of an health care resources. In addition, viduals and families. This phy other health care provider. maintenance of continuity on a long sician provides care for both 8. District Physician—A primary term basis, including coordination sexes of all ages, for physical, physician who accepts continu of secondary and tertiary care, is behavioral, and social problems. ing responsibility for the gen required. 2. Physician of First Contact— eral health care of all persons E. Recorder—The person who re The first physician seen by a living in a defined geographic cords or supervises the recording patient during an episode of area. In addition to functioning of information under study. illness or injury, or for pre as a general practitioner/family F. Practice Register— The list of ventive and/or health education physician, the district physician all registered patients in a practice. matters. often functions as a community See Section IV-B-1 for the defini 3. Primary Physician (Primary physician, and is usually em tion of a registered patient. Care Physician)—A family phy- ployed by a government agency G. Age-Sex Register—The list of sician/general practitioner or either on a full- or part-time all registered patients by age and other specialist who practices basis. sex. The primary purpose of this primary care. 9. Physician in Training (Trainee register is to provide a defined 4. Community Physician —The pri Assistant/Trainee/Assistant) — population against which rates of ob mary concern of the commu The terms undergraduate, grad served occurrence of phenomena in nity physician is the health uate, postgraduate, vocational, a practice may be calculated. It can status of the population within and continuing medical educa also be used to monitor immuniza a defined geographic area. Usu tion have different meanings in tion programs, identify groups at ally responsible for assessment different countries and at times special risk, monitor practice size, and evaluation of the commu are used inconsistently within a plan physician education priorities, nity’s health needs and for the single country. Table 1 approx as well as be used for other purposes. organization of health services imates common usages.

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Table 1. Physicians in Training

United Kingdom New Zealand Australia Continental Training Level North America South Africa Europe

1. Basic sciences Undergraduate Underg raduate Undergraduate 2. Medical school Graduate Undergraduate Undergraduate 3. Initial postm edical Internship Preregistration Prelicense or school training (also used in (House man, postgraduate A u s t r a l i a ) (junior intern) 4. Specialization R e s i d e n c y V o c a t i o n a l G r a d u a t e 5. Lifelong education C o n t i n u i n g C o n t i n u i n g Postgraduate C o n t i n u i n g

10. Ancillary Staff— Nonmedical represent several disciplines, and groups of the population may be personnel working in a practice, ancillary staff working cooperative assigned to one or more physi including nurse or practice sis ly to provide health care. cians, but the group accepts the ter, health visitor, medical so responsibility for continuity of cial worker, secretary, practice patient care. In a legal sense, aide, receptionist, administra however, the individual physi tor, business manager, book cian usually has the ultimate re keeper, and others. The ancil sponsibility for each patient. lary staff differs from practice a. Single-Specialty Group—A III. Practice Descriptors group practice in which all to practice and from country to Practice—The organizational physician members belong to country. structure in which one or more the same specialty. 11. Other Health Care Providers— physicians provide and supervise Qualified graduates (profession b. Multi-Specialty Group—A health care for a population of als and paraprofessionals) of group practice in which the patients. disciplines other than medicine physician members belong to more than one specialty. who also render health care. A. Manpower Classification of These include, for example, 3. Association of Practices (Group Practice dentist, pharmacist, physician Practice [Netherlands])—Prac associate, medex, physiother 1. Solo Practice (Single-Handed)— tices of physicians who share apist, nurse practitioner, grad A practice in which a single premises, but not patients. uate nurse, public health nurse, physician provides and super B. Geographic Classification of Practice Populations—European psychologist, social worker, vises health care for a popula recommendations for the 1970 minister of religion, and others. tion of patients. population censuses (United Na (The Classification Committee 2. Group Practice (Cooperative tions publication No. ST/CES.13 invites these provider groups to Practice [Denmark])—A practice 1969) suggest that a distinction be submit definitions that describe in which the patient population made between urban, semiurban, their discipline.) is cared for by a number of asso- and rural areas. “Since conditions B. Health Care Team—A group of ciated/affiliated physicians. The vary considerably between coun- health care providers, who may principal responsibility for sub

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tries, it is recognized that countries 4. Other—Additional geographic medical staff largely comprised should be given latitude in selecting population descriptors, such as of specialists, often working in. dividing lines between the three central city population, subur dependently rather than as a categories that are appropriate to ban population, and primitive or team. their own conditions. However, in remote practice population, may 6. Day Hospital—A health care the interest of international com be used, but the population size facility, providing day health parability, countries should en should be specifically defined in care and monitoring facilities deavor to select limits that approx each case. with full medical and param edi imate as closely as possible to 2,000 C. Practice Sites cal services available. and 10,000. The definitions and 1. Private Office (Surgery or Sur D. Mechanisms for limits should be clearly stated in gery Rooms [United Kingdom], Reimbursement the census report.” For the pur Consulting Rooms [New Zea 1. Fee for Service (Private poses of this glossary, the precise land], Consulting Rooms or Fees)—A fee is assessed for populations used to define urban, Surgery [South Africa])—The each service or patient contact semiurban, and rural areas were premises in which a physician provided. Reimbursement may chosen arbitrarily. It is recognized conducts his practice. More be from the patient and/or a that physicians within the various than one practitioner and para third party. countries using this glossary may medical services may be ac 2. Prepayment—The physician re have different requirements. It is commodated in these premises. ceives advance payment to recommended that physicians who 2. Residential Office (Residential provide specified health serv define geographic configurations of Surgery Rooms [New Zealand ices for a particular patient or different population sizes state the and United Kingdom])—An of group of patients during a speci numerical range they have chosen fice (surgery) that is located in a fied time period. to define a geographic area. physician’s home. 3. Capitation (Allowances)—A 1. Urban Practice Population—A 3. Satellite Office (Satellite or form of payment based on the practice serving a population, a Branch Surgery [United King number of registered patients, majority of which are located dom], Satellite Rooms [New usually covering the full range of in a city with a population of Zealand], Suburban Surgery medical services provided. 50.000 or more (20,000 in New [South Africa]—An office (sur 4. Government Sponsored/ Subsi Zealand). For countries with a gery) located at a distance from dized—Participating physicians smaller population, a figure of the main site, office (surgery), receive reimbursement directly 10.000 may be used, but it or health center. Staffing and or indirectly from the govern should be specified. The desig the provision of health services ment for services rendered to nation Metropolitan Population are the responsibility of admin that portion of the population may be used for a conurbation istration of the primary site. covered by the government with population of 250,000 or 4. Health Center—A center that plan. State insurance programs more. emphasizes both total medical include Medicare in North 2. Semi-Urban Practice Popula care and preventive personal America and the National Health tion—A practice serving a popu health services. Staffing is var Service in the United Kingdom. lation, a majority of which is lo ied and may include a group 5. Salary—The physician is an cated in a city with a population of family physicians/general prac employee and receives a fixed between 2,000 and 50,000. For titioners, a multidisciplinary team, wage for rendering medical countries with smaller popula ancillary staff, specialists, and care. tions, the range shall be between other health care providers. The E. Special Function Practices 2.000 and 10,000 population. center may be owned by private 1. Teaching Practice (Training Prac 3. Rural Practice Population—A physicians, government, or pub tice)—A practice in which stu practice serving a discrete pop lic agencies. dents (residents/registrars and ulation, a majority of which is 5. Polyclinic—The definition of medical students) are taught as an located in a town or scattered polyclinic varies in different integral part of the practice. dwellings of less than 2,000 countries. Usually it is a clinic 2. Industrial Practice—A practice population. attached to a hospital with a conducted within the confines of

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an industrial organization. Usu mean either a little hospital or an containing two or more mem ally the physician is reimbursed outpatient department. bers who receive health care by salary or according to the from a practice. terms of a specific contract. An 2. Active Registered Family—Reg cillary staff are usually employ istered family containing at least ees of the industry. one member who has received 3. Hospital Practice—A practice health care at least once in the conducted within the confines of past two years. a hospital. The source of pa 3. Attending Family—A registered tients, method of reimburse family containing at least one ment, and relationships with member who has received health ancillary staff are extremely var care in the past year. iable and should be defined for IV. Patient Descriptors 4. Inactive Registered Family—A each specific instance. Physicians who do not have reg registered family in which no 4. Research Practice—A practice istered or assigned lists of patients member has received health organized and equipped for data and families may require different care within the past two years. collection and research studies. definitions of the following terms, 5. Formerly Registered Family—A F. Characteristics of Practices some of which are based on attend previously registered family that 1. Appointment System—The sys ance frequencies, in order to facili is no longer considered (by the tem used by a physician to plan tate calculations of practice popu practice or by personal determi and regulate the timing of lations. In some countries (ie, nation) to be part of the practice patient encounters. It may be United Kingdom or Denmark) the population and is removed from complete, in which no patients registered lists often reflect the pa the register. other than emergencies are seen tient population with acceptable B. Patient—A person who re except by appointment, or par accuracy. In other countries (ie, ceives or contracts for professional tial, in which there is greater North America, Australia, or Nor advice or services from a health flexibility. way) populations can only be esti care provider. 2. Clinic or Special Sessions—Oc mated from utilization patterns. 1. Registered Patient—A patient casions when patients of a simi Family—A group of persons who receives ongoing health care lar type, or those suffering from sharing a common household. A re from a practice (excludes former, the same condition, are grouped lationship (including, but not nec temporary, or transient patients). together for supervision, exami essarily limited to, blood or mar 2. Visiting Patient—A registered nation, treatment, discussion, or riage ties) is implied. For pur patient who has received serv advice. Appointments may or poses of this definition, persons ices from the practice at least may not be required. The type who temporarily reside away from one time in the last two years. of clinic should be specified. For the household are included. This includes attending patients. instance, use obstetric clinic for Household—Either (a) a one 3. Attending Patient—A registered antenatal and postnatal care, person household, ie, a person liv patient who has personally re child health clinic for care of ing alone in a separate room, suite ceived services from the prac children and babies, or special of rooms, or housing unit; or (b) a tice in the past year. clinics for obesity, geriatrics, multiperson household, ie, a group 4. Nonvisiting Patient—A regis diabetes, and other conditions. of two or more persons who com tered patient who has received The use of the word clinic var bine to occupy the whole or part of no services from the practice ies from country to country. In a housing unit. The group may pool within the last two years. Australia “ special sessions” are their incomes to a greater or lesser 5. Temporary or Transient Pa held, and the term clinic is re extent. The group may be com tient—A patient who receives served for group practices and/ posed of a family or of unrelated one or more services from a or their premises. In North persons, or both, including board practice, but who usually re America clinic may also mean a ers and excluding lodgers. ceives health care elsewhere. charitably operated practice or A. Family 6. Formerly Registered Patient— session. In Norway clinic can 1. Registered Family—A family A patient (excluding temporary

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or transient) who has previously V. Population Descriptors tient), or both. Problems should be been registered but who is no recorded at the highest level of longer considered (by the prac A. Practice Population—The total specificity determined at the time tice or by personal determina number of active registered pa of that particular visit. The Inter tion) to be part of the practice tients in a practice. national Classification of Health population and is removed from B. Study Population—All patients Problems in Primary Care the register. included in a study during the peri (ICHPPC-2) should be used to 7. For Practices Registering by od of a project. classify and code problems. Families C. Registered Population—The 1. New Problem—The first presen a. Active Registered Patient—A total number of active registered tation of a problem, including registered patient who has re patients in a practice taken at the the first presentation for a recur ceived services from a prac midpoint of a study. It is often dif rence of a previously resolved tice at least once and belongs ficult to count this population with problem, but excluding the pre to a family, one member of precision. It may be possible to sentation of a previously as which has received services calculate the population from en sessed problem to a different within the last two years. counter data; if this is done, the provider. b. Inactive Registered Patient— method used should be specified. 2. Continuing Problem—A previ A registered patient who has D. Standard Age Groups—Less ously assessed problem that re received services from the than 1 year, 1 to 4 years, 5 to 14 quires ongoing care. It includes practice at least once, but years, 15 to 24 years, 25 to 44 follow-up for a problem or an neither the patient nor any years, 45 to 64 years, 65 years and initial presentation to a provider member of the patient’s fam older. These groups may be subdi of a problem previously as ily has received services vided into smaller cohorts (eg, 5 to sessed by another provider. within the last two years. 9 years) provided the standard di B. Episode (Attack, Bout)—A C. Statistics and Analysis—The vision points are retained. problem or illness in a patient over collection of the following demo E. Patients at Risk—Patients from the entire period of time from its graphic data is desirable: the practice population considered onset to its resolution. 1. Patient Identification—Should to be at greater risk for a disease C. Diagnosis—The formal state be unique. than other individuals in the same ment of the provider’s understand 2. Residence—There are several population. ing of the patient’s problem. options for the classification of F. Population at Risk—A popula 1. Principal Diagnosis (Main residence, including address, tele tion of persons with a geographi Diagnosis)—The most impor phone exchange, census tract, cally defined area, a random sam tant problem, as determined by postal or zip code, grid, or munic ple, or a group selected for specific the health care provider. This ipal jurisdiction. criteria from the greater population should be coded to ICHPPC-2. 3. Date of Birth—Should include may be used. At times the regis 2. Associated Diagnosis (Concur month, day, and year. tered patient population may be rent Diagnosis, Subdiagnosis)— 4. Sex of Patient—Male or female. considered the population at risk. Another diagnosis made at the 5. Marital Status—Married (in same time as the principal diag cludes common-law), single, sep- nosis. erated, divorced, or widowed. 3. Diagnostic Criteria—Those signs, 6. Ethnic Origin—Black, white, symptoms, and investigative find other (patient determined). ings that are essential to making a 7. Socioeconomic Status—May be diagnosis. derived by several techniques D. Disease—The failure of the that use occupation, education, adaptive mechanisms of an organ VI. Morbidity Descriptors income, method of payment, ism to counteract adequately the area of residence within census A. Problem—A provider deter stimuli or stresses to which it is tracts, or a combination of two mined assessment of anything that subject, resulting in a disturbance or more of these parameters to concerns a patient, the provider (in in the function or structure of any determine status. relation to the health or the pa part, organ, or system of that body.

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1. Acute Disease (Short-Term Dis one or more members of a health counter, or encounter by mes ease)—An episode of disease care team. One or more problems sage or through a third party. with a duration of four weeks or or diagnoses may be identified at B. Referral—A referral is made less. each encounter. Analyses of en when resources outside of any 2. Subacute Disease—An episode counter data should distinguish en health care provider’s command of disease with a duration of counters from problems. (whether in or outside the practice) between four weeks and six 1. Direct Encounter (Face-to-Face are requested on the patient’s be months. Meeting)—An encounter in half. Patients may be referred for a 3. Chronic Disease (Long-Term which there is a face-to-face specific service, a general opinion, Disease)—An episode of disease meeting of a patient and profes or for other desirable reasons. with a duration of six months or sional. C. Consultation—In the United more. a. Office Encounter (Surgery Kingdom, Australia, and New Zea E. Illness—The patient’s subjec Encounter, Attendance, Con land, a consultation is an occasion tive perception of the disease proc sultation [United Kingdom on which a patient receives profes ess. and South Africa]—A direct sional advice, help, or treatment at F. Impairment—Any reduction of encounter in the provider’s the physician’s premises. A domicili functional, psychological, physio office or surgery. ary consultation occurs when the logical, or anatomical capacity to b. Home Encounter (Housecall, physician and a consultant meet at participate in activities of daily liv Visit [United Kingdom and the patient’s home to assess the ing. Australia], Home visit or patient. In North America a consul 1. Temporary Impairment—Im Housecall [South Africa])—A tation is an exchange of informa pairment with an expected direct encounter occurring at tion between physicians about a pa complete recovery. the patient’s residence (this tient. The consultation may be in 2. Permanent Impairment—Im includes home, a friend’s formal (corridor consultation) or pairment in which a complete home where a patient is visit may involve the examination of the recovery is not expected. ing, a hotel room, and so on). patient by the consultant in a more G. Disability—Any restriction or c. Hospital Encounter—A di formal fashion, either in the pres lack of ability (resulting from im rect encounter in the hospital ence of the primary care physician pairment) to perform an activity in setting. One encounter is or in his absence, with a later ex the manner or within the range counted for each patient visit. change of information by verbal or considered normal for a human be (1) Hospital Inpatient En written communication. ing. counter—A direct encoun D. Time of Encounter—The time H. Handicap—A disadvantage for ter with an inpatient. at which the encounter occurs. a given individual, resulting from (2) Outpatient Encounter— 1. Encounter During Scheduled an impairment or a disability that A direct encounter with Hours—Encounters that occur limits or prevents the fulfillment of an outpatient in either the during usual or posted working a role that is normal (depending on emergency room or the hours of the health care pro age, sex, and social and cultural outpatient clinic. viders. These hours should be factors) for that individual. d. Problem Contact—A patient- clearly stated. provider transaction in regard 2. Encounter During Unscheduled to one problem. There may Hours—Encounters that occur be several problem contacts at times other than the usual during each encounter. working hours of the health care 2. Indirect Encounter—An en providers, but that exclude night counter in which there is no encounters. These hours should physical or face-to-face meeting be clearly stated. between the patient and the pro 3. Night Encounters—Encounters fessional. These encounters made between the hours of 2300 VII. Encounter Descriptors may be subdivided by the mode and 0700. If other time periods A. Encounter—Any professional of communication, such as tele are chosen, these should be interchange between a patient and phone encounter, written en indicated.

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E. Duration of Encounter—The physician is off duty or absent fect and prevalence of disease in segment of time occupied by a sin from his or her practice. an individual or population by gle patient encounter. 3. Rehabilitation Service—A serv shortening its course and dura ice that promotes restoration of tion. activities and social functioning 7. Tertiary Prevention—Measures following illness or injury as designed to reduce the effect nearly as possible to the pre- and prevalence of a chronic dis morbid level. ability in an individual or a C. Preventive Services—These in VIII. Service Descriptors population by minimizing the clude immunizations, screening functional impairment conse Service—An action taken by the tests, risk assessment, education, quent to the disease or accident. provider in order to improve or pre- and postnatal checkups, well- 8. Screening—The attempt to iden maintain the health and well-being baby care, family planning, and tify unrecognized disease or de of the patient and/or the family. other services. fect in an individual or popu A. Diagnostic (Investigative) Serv 1. Maternity Services /Care—Com lation by means of tests and/or ices—The assessment of any prob prises the diagnosis of pregnancy, other methods that discriminate lem by history, physical examina antenatal care, delivery, and between those who probably tion, laboratory, x-ray examination, postnatal care, including a final have or are at risk for a given or other examinations performed follow-up examination. disease and those who are not so either inside or outside the office 2. Newborn Care—Routine care of affected. setting. the well baby, including all visits 9. Health Promotion—Services de 1. General Assessment—A full his and necessary instructions to signed to help the patient avoid tory and detailed examination of the mother. The time period illness and maintain good health. those factors that determine the used to designate this care D. Administrative Services—Serv physical, mental, and social should be specified. The peri ices that derive from the responsi well-being of the patient with natal period includes the first 7 ble position accorded to health care appropriate investigations, in days following birth, while the providers by the community, such cluding a complete record of neonatal period includes the as witnessing of signatures, attes findings and advice for the pa first 28 days after birth. tations about character, and certi tient. 3. Well-Baby Care—Periodic of fying fitness for certain functions 2. Specific Assessment—Includes fice encounters with well babies (driving, work, sports) and unfit a full history and detailed exam during the first two years of life ness for certain functions. ination that relates to a specific for routine supervision, assess E. Community Care—The care diagnosis or problem with ap ment of growth and develop and supervision of persons outside propriate investigations, includ ment, and any required parental the hospital by medical and social ing a complete record of findings instructions. These would in agencies that are based in the and advice for the patient. clude measurements and im community. B. Therapeutic Services—These munizations as necessary. include pharmacological therapy, 4. Premature Baby Care—All surgical therapy, physical therapy, hospital encounters with prema psychotherapy, and others. ture babies with a birth weight 1. Supportive Care—Services that of less than 5.5 pounds or 2.5 promote the maintenance of kilograms. bodily functions but are gener 5. Primary Prevention—Measures ally not considered to be cura designed to reduce the incidence IX. Standard Reporting tive. of disease in an individual or a Rates—Rates are defined as the 2. Emergency CalI Service (Depu population by reducing the risk number of events occurring in a tizing Service-Emergency Ros of onset, prevention of occur study population in a given period ter [Australia])—A service that rence, and control of spread. of time divided by the size of provides temporary medical 6. Secondary Prevention—Meas the study population. According to care for patients whose primary ures designed to reduce the ef previous definitions, a study pop-

680 THE JOURNAL OF FAMILY PRACTICE, VOL. 13, NO. 5, 1981 INTERNATIONAL PRIMARY CARE GLOSSARY

ulation may be made up of any of from numerous possible encounter single episode, however far apart the described groups (eg, registered rates. in time the encounters may be. patients, active patients, inactive 1. Patient Encounter Rate— The For conditions such as injuries, patients, and so on). Rates per 100 number of patients who attend it is usually simple to differenti or per 1,000 are typical, but this during the survey (counting ate one episode from another. may change to per 10,000 or per each patient only once) divided Usually episodes of illness are 1 0 0 ,0 0 0 as the frequency of the by the practice population at the recorded by diagnosis, so one event decreases. For som e rates midpoint of the survey. may calculate the number of the study population of patients 2. Workload Rate—The number of episodes of a given illness per may not constitute the denomina encounters (direct, face-to-face) 1,000 patients in a practice tor, which instead may refer to the during the survey divided by the population. provider (eg, the number o f pa practice population at the mid 2. Mortality (Crude Death Rate)— tients seen per w eek per provider). point of the survey. The number of deaths that occur Thus, rates m ay be constructed 3. Late Encounter Rate— The num among a population during a year with one of the following numera ber of visits out of scheduled divided by the average number of tors: problems, encounters or serv hours may be tabulated in sev persons at risk during the same ices, patients, or fam ilies; and one eral ways; for example, (a) per year (expressed per 1,000 per of the following denominators: pro 1,000 active registered patients, sons). vider, team , practice, study popu (b) per 100 direct patient en 3. Fatality Rate—The number of lation, registered patient popula counters, or (c) per 100 patients deaths from a disease recorded tion, census population, or random attending (counting each patient during a defined period divided sample population. only once). by the total number of cases of Adjusted Rates—Two practices 4. Hospitalization or Referral that disease recorded during the may generate different rates for rea Rates—The number of patient same period (expressed per 100 sons unconnected with the under hospitalizations or referrals dur cases per year). lying morbidity or operation o f a ing the survey divided by the 4. Incidence—The number of new practice. Thus, the direct encoun practice population at the mid cases of a given disease arising ter rate per 100 patients in an active point of the survey. within a defined population dur patient population will vary accord B. Morbidity, Mortality, Incidence, ing a defined period of time. ing to the age and sex composition and Prevalence—As with encounter 5. Prevalence—The number of of that population. To compare rates, the content of both the cases of a given disease present crude rates between practices, it numerator and the denominator in a defined population at one point in time (point prevalence) may be necessary to standardize must be specified. or during a defined period of them by age and sex. The “ad 1. Episode of Illness Rate— An ep time (period prevalence). justed rates” become comparable isode of illness may be difficult in spite of age and sex differences (indeed impossible) to define; of the study population. for example, it is difficult to A. Encounter Rates— E ncounter know when an episode of peptic rates may be tabulated using vari ulcer in an individual starts and ous numerators and denominators, ends (ie, did it heal and reacti and it is important to define clearly vate, or did it continue without the content o f each. Thus, for nu symptoms), but this can be cir merators, direct encounters must cumvented for most such con be distinguished from indirect ditions by counting each single encounters, first encounters from diagnosis as an episode, how repeat encounters, active patients ever often during the survey that from inactive patients, and so on. patient may visit for it. Thus, if a Acknowledgement For denominators, the method patient with a peptic ulcer visits a physician on one or more oc This publication was supported in part used to define the practice popula by NIH Grant LM03289 from the National tion should be specified. The fol casions during the survey for Library of Medicine and Rockefeller Foun lowing rates are examples chosen this condition, it is counted as a dation Grant #GAHS 8037.

681 THE JOURNAL OF FAMILY PRACTICE, VOL. 13, NO. 5, 1981