First-visit patients without a referral to the Department of Internal Medicine at a medium-sized acute care hospital in Japan: an observational study

Figures & data

Figure 1 Frequency of RFEs classified by the ICPC-2-R for 765 first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016.

Notes: A = general and unspecified; B = blood, blood-forming organs, and immune mechanisms; D = digestive; F = eye; H = ear; K = circulatory; L = musculoskeletal; N = neurological; P = psychological; R = respiratory; S = skin; T = endocrine, metabolic, and nutritional; U = urological; W = pregnancy, child-bearing, and family planning; X = female genital; Y = male genital; Z = social problems.
Abbreviations: ICPC-2-R, International Classification of Primary Care, Revised Second edition; RFE, reason for encounter.

Table 1 Top 30 ICPC-2-R RFE codes of first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016

Ranking	ICPC-2-R code	ICPC-2-R title	Number of cases	Percentage	Cumulative percentage
1	R05	Cough	88	11.5	11.5
2	A03	Fever	85	11.1	22.6
3	D02	Abdominal pain, epigastric	55	7.2	29.8
4	D06	Abdominal pain, localized, other	39	5.1	34.9
5	A91	Abnormal result investigation NOS	34	4.4	39.3
5	N01	Headache	34	4.4	43.8
7	D11	Diarrhea	26	3.4	47.2
8	N17	Vertigo/dizziness	23	3.0	50.2
9	A04	Weakness/tiredness general	19	2.5	52.7
10	R02	Shortness of breath/dyspnea	16	2.1	54.8
11	D08	Flatulence/gas/belching	15	2.0	56.7
12	D09	Nausea	13	1.7	58.4
12	L01	Neck symptom/complaint	13	1.7	60.1
12	R01	Pain, respiratory system	13	1.7	61.8
15	L02	Back symptom/complaint	12	1.6	63.4
15	U98	Abnormal urine test NOS	12	1.6	65.0
17	D01	Abdominal pain/cramps, general	11	1.4	66.4
17	R21	Throat symptom/complaint	11	1.4	67.8
19	A11	Chest pain NOS	10	1.3	69.2
19	K07	Swollen ankles/edema	10	1.3	70.5
21	K02	Pressure/tightness of heart	8	1.0	71.5
21	R07	Sneezing/nasal congestion	8	1.0	72.5
21	T81	Goiter	8	1.0	73.6
24	D12	Constipation	7	0.9	74.5
24	L03	Low back symptom/complaint	7	0.9	75.4
26	B84	Unexplained abnormal white cells	6	0.8	76.2
26	D03	Heartburn	6	0.8	77.0
26	D10	Vomiting	6	0.8	77.8
26	D78	Neoplasm of digestive system, benign/unspecified	6	0.8	78.6
26	K04	Palpitations/awareness of heart	6	0.8	79.3
26	K86	Hypertension, uncomplicated	6	0.8	80.1
26	T03	Loss of appetite	6	0.8	80.9
		Others	146	19.1	100.0
Total			765	100.0

Abbreviations: ICPC-2-R, International Classification of Primary Care, Revised Second edition; NOS, not otherwise specified; RFE, reason for encounter.

Figure 2 Frequency of diagnoses classified by the International Classification of Primary Care, Revised Second edition (ICPC-2-R) for 765 first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016.

Notes: A = general and unspecified; B = blood, blood-forming organs, and immune mechanisms; D = digestive; F = eye; H = ear; K = circulatory; L = musculoskeletal; N = neurological; P = psychological; R = respiratory; S = skin; T = endocrine, metabolic, and nutritional; U = urological; W = pregnancy, child-bearing, and family planning; X = female genital; Y = male genital; Z = social problems.

Table 2 Top 50 ICPC-2-R diagnosis codes of first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016

Ranking	ICPC-2-R code	ICPC-2-R title	Number of cases	Percentage	Cumulative percentage
1	R74	Upper respiratory infection, acute	86	11.2	11.2
2	D73	Gastroenteritis, presumed infection	49	6.4	17.6
3	D87	Stomach function disorder	33	4.3	22.0
4	R80	Influenza	28	3.7	25.6
5	D84	Esophagus disease	20	2.6	28.2
6	R96	Asthma	19	2.5	30.7
7	A97	No disease	15	2.0	32.7
7	D06	Abdominal pain, localized, other	15	2.0	34.6
9	D12	Constipation	14	1.8	36.5
9	N01	Headache	14	1.8	38.3
11	D78	Neoplasm of digestive system, benign/unspecified	13	1.7	40.0
12	R05	Cough	12	1.6	41.6
13	R81	Pneumonia	11	1.4	43.0
14	B80	Iron-deficiency anemia	10	1.3	44.3
14	D02	Abdominal pain, epigastric	10	1.3	45.6
16	D97	Liver disease NOS	9	1.2	46.8
16	K86	Hypertension, uncomplicated	9	1.2	48.0
16	L85	Acquired deformity of spine	9	1.2	49.2
16	N95	Tension headache	9	1.2	50.3
16	T90	Diabetes, non-insulin dependent	9	1.2	51.5
21	L02	Back symptom/complaint	8	1.0	52.5
21	N17	Vertigo/dizziness	8	1.0	53.6
23	A11	Chest pain NOS	7	0.9	54.5
23	D75	Malignant neoplasm colon/rectum	7	0.9	55.4
23	L01	Neck symptom/complaint	7	0.9	56.3
23	L03	Low back symptom/complaint	7	0.9	57.3
23	R01	Pain, respiratory system	7	0.9	58.2
23	T81	Goiter	7	0.9	59.1
29	A91	Abnormal result investigation NOS	6	0.8	59.9
29	D98	Cholecystitis/cholelithiasis	6	0.8	60.7
29	K90	Stroke/cerebrovascular accident	6	0.8	61.4
29	R75	Sinusitis acute/chronic	6	0.8	62.2
29	R78	Acute bronchitis/bronchiolitis	6	0.8	63.0
29	U70	Pyelonephritis/pyelitis	6	0.8	63.8
29	U88	Glomerulonephritis/nephrosis	6	0.8	64.6
36	B70	Lymphadenitis, acute	5	0.7	65.2
36	D70	Gastrointestinal infection	5	0.7	65.9
36	H82	Vertiginous syndromes	5	0.7	66.5
36	K96	Hemorrhoids	5	0.7	67.2
36	L14	Leg/thigh symptom/complaint	5	0.7	67.8
36	P74	Anxiety disorder/anxiety state	5	0.7	68.5
36	P76	Depressive disorder	5	0.7	69.2
36	T85	Hyperthyroidism/thyrotoxicosis	5	0.7	69.8
44	A03	Fever	4	0.5	70.3
44	A75	Infectious mononucleosis	4	0.5	70.8
44	A76	Viral exanthem, other	4	0.5	71.4
44	A85	Adverse effect medical agent	4	0.5	71.9
44	B02	Lymph gland(s) enlarged/painful	4	0.5	72.4
44	D01	Abdominal pain/cramps, general	4	0.5	72.9
44	D08	Flatulence/gas/belching	4	0.5	73.5
44	D11	Diarrhea	4	0.5	74.0
44	D86	Peptic ulcer, other	4	0.5	74.5
44	D92	Diverticular disease	4	0.5	75.0
44	L99	Musculoskeletal disease, other	4	0.5	75.6
44	N06	Sensation disturbances, other	4	0.5	76.1
44	P75	Somatization disorder	4	0.5	76.6
44	R72	Strep throat	4	0.5	77.1
44	R99	Respiratory disease, other	4	0.5	77.6
44	U99	Urinary disease, other	4	0.5	78.2
		Others	167	21.8	100.0
Total			765	100.0

Abbreviations: ICPC-2-R, International Classification of Primary Care, Revised Second edition; NOS, not otherwise specified.

Figure 3 First-visit patients (n=765) who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016, who visited another medical institution, and who were or were not prescribed antibiotics.

Notes: Results are categorized by reason for encounter fields classified by the International Classification of Primary Care, Revised Second edition (ICPC-2-R) and whether or not patients who visited another medical institution before presenting to our hospital were prescribed antibiotics by that institution. RFEs on the far right edge exhibit an A03 and R05 overlap with the number of cases of A and R on the left. Legend (n=the number of patients who did not visit another medical institution, the number of patients who visited another medical institution and did not receive an antibiotics prescription, and the number of patients who were prescribed antibiotics at another medical institution, respectively.): A = general and unspecified (n=113, 21, 21); B = blood, blood-forming organs, and immune mechanisms (n=14, 2, 0); D = digestive (n=152, 55, 3); F = eye (n=3, 0, 0); H = ear (n=0, 0, 0); K = circulatory (n=35, 6, 1); L = musculoskeletal (n=44, 19, 0); N = neurological (n=53, 16, 0); P = psychological (n=4, 0, 0); R = respiratory (n=95, 24, 27); S = skin (n=8, 1, 0); T = endocrine, metabolic, and nutritional (n=18, 9, 0); U = urological (n=16, 4, 1); W = pregnancy, child-bearing, and family planning (n=0, 0, 0); X = female genital (n=0, 0, 0); Y = male genital (n=0, 0, 0); Z = social problems (n=0, 0, 0); A03 = fever (n=60, 7, 18); R05 = cough (n=54, 12, 22).
Abbreviation: RFE, reason for encounter.

Figure 4 Antibiotics prescribed at another medical institution to 765 first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016 (n=53).

Table 3 Outcomes of first-visit patients who presented to the Department of Internal Medicine at the Ikeda City Hospital without a referral on Fridays between April 2012 and March 2016

Outcome	Number of cases	Percentage
End of treatment	301	39.3
Appointment for internal medicine treatment	310	40.5
Referral to another medical institution	64	8.4
Appointment for internal medicine treatment + referral to another medical institution	19	2.5
Admission to our hospital on that day	15	2.0
Planned admission to our hospital	3	0.4
Emergency outpatient → return home	7	0.9
Emergency outpatient → admission to our hospital on that day	15	2.0
Emergency outpatient → transfer for admission at another hospital	3	0.4
Treatment at another department within the hospital	23	3.0
Treatment at another department within the hospital + appointment for internal medicine treatment	4	0.5
Treatment at another department within the hospital + referral to another medical institution	1	0.1
Total	765	100.0