Describing the content of primary care: limitations of Canadian billing data

Study-specific data collection forms were completed by 16 primary care physicians in community health and family practice clinics in Winnipeg, Manitoba, Canada. The data collection forms were completed immediately following the patient encounter and included patient and visit characteristics, such as primary reason for visit, topics discussed, actions taken, degree of complexity as well as diagnosis and ICD-9 codes.Data was collected for 760 patient encounters. The diagnostic codes often did not reflect the dominant topic of the visit or the topic requiring the most amount of time. Physicians often address multiple problems and provide numerous services thus increasing the complexity of care.This is one of the first Canadian studies to critically analyze the content of primary care clinical encounters. The data allowed a greater understanding of primary care clinical encounters and attests to the deficiencies of singular ICD-9 coding which fails to capture the comprehensiveness and complexity of the primary care encounter. As primary care reform initiatives in the U.S and Canada attempt to transform the way family physicians deliver care, it becomes increasingly important that other tools for structuring primary care data are considered in order to help physicians, researchers and policy makers understand the breadth and complexity of primary care.Primary care practice provides comprehensive patient care including assessment, diagnosis and management of both acute and chronic problems. However, the ICD 9 coding system used in Canada does not capture the scope of disease or recognize the complexity of physician patient interactions. Administrative claims data in Canada use a single ICD-9 or ICD-10 code which does not elaborate on the severity of the disease, complexity of care or describe the extent of clinical management provided by the physician [1,2]. Administrative claims data are most useful for providing a picture of the population's health problems and the fun