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The Surgical Nosology in Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care

Gruen, Russell L., Knox, Stephanie, Britt, Helena and Bailie, Ross S. (2004). The Surgical Nosology in Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care. BMC Health Services Research,4(1):8-17.

Document type: Journal Article
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Title The Surgical Nosology in Primary-care Settings (SNIPS): a simple bridging classification for the interface between primary and specialist care
Author Gruen, Russell L.
Knox, Stephanie
Britt, Helena
Bailie, Ross S.
Journal Name BMC Health Services Research
Publication Date 2004
Volume Number 4
Issue Number 1
ISSN 1472-6963   (check CDU catalogue open catalogue search in new window)
Start Page 8
End Page 17
Total Pages 10
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
Field of Research 1117 - Public Health and Health Services
HERDC Category C1 - Journal Article (DEST)
Abstract Background:
The interface between primary care and specialist medical services is an important domain for health services research and policy. Of particular concern is optimising specialist services and the organisation of the specialist workforce to meet the needs and demands for specialist care, particularly those generated by referral from primary care. However, differences in the disease classification and reporting of the work of primary and specialist surgical sectors hamper such research. This paper describes the development of a bridging classification for use in the study of potential surgical problems in primary care settings, and for classifying referrals to surgical specialties.

Methods: A three stage process was undertaken, which involved: (1) defining the categories of surgical disorders from a specialist perspective that were relevant to the specialist-primary care interface; (2) classifying the 'terms' in the International Classification of Primary Care Version 2-Plus (ICPC-2 Plus) to the surgical categories; and (3) using referral data from 303,000 patient encounters in the BEACH study of general practice activity in Australia to define a core set of surgical conditions. Inclusion of terms was based on the probability of specialist referral of patients with such problems, and specialists' perception that they constitute part of normal surgical practice.

Results: A four-level hierarchy was developed, containing 8, 27 and 79 categories in the first, second and third levels, respectively. These categories classified 2050 ICPC-2 Plus terms that constituted the fourth level, and which covered the spectrum of problems that were managed in primary care and referred to surgical specialists.

Conclusion: Our method of classifying terms from a primary care classification system to categories delineated by specialists should be applicable to research addressing the interface between primary and specialist care. By describing the process and putting the bridging classification system in the public domain, we invite comment and application in other settings where similar problems might be faced.
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