The core concept within FaMe-Net is the Episode of Care (EoC): all data in FaMe-Net are ordered into Episodes of Care. It can be defined as ‘a health problem presented by an individual to a healthcare provider, from the first presentation until the last encounter’. EoCs have a title, the episode diagnosis, classified with ICPC-2. The episode diagnosis can be modified during the EoC. An example: an EoC is first labelled as fatigue, but the diagnosis (episode title) is changed to iron deficiency anaemia, and it later appears to be caused by colon cancer, which will be the final diagnostic label. All contact elements related to this health problem are comprised in this EoC, including specialist reports to the GP. 

Presented data from ‘Episodes of Care’ are abbreviated to ‘Episodes’ on this website.

Another essential concept used in FaMe-Net is the Reason for Encounter (RFE). 

Patients normally start the consultation with a spontaneous statement on why they visit the doctor: the Reason For Encounter. This reflects the initial presentation of the illness. This statement precedes the interaction between patient and GP, and the GP’s interpretation. RFEs are recorded regardless of the final diagnosis. FaMe-Net routinely and systematically registers all RFEs in all encounters during regular consultations, taking GPs less than a minute of time. 

The RFE(s) can be presented as a symptom (e.g. abdominal pain, a rash, cough), but also as a self-diagnosed disease (‘I’ve got the flu’; ‘I think I have migraine’; ‘I hope it’s not pneumonia again’) or a request for a particular intervention (‘I would like to have a blood test’). When multiple RFEs are presented, all are registered. The RFE(s) should be recognised by the patient as an acceptable description of the demand for care. RFE registration enables research studying associations between RFE and (final) diagnosis. RFEs in themselves have important prognostic value, for example in diagnosing cancer. (3, 4)

All presented symptoms, complaints, diseases, and problems in FaMe-Net are classified by the GP in accordance with the International Classification of Primary Care (ICPC-2) at the highest level of accuracy and understanding. In addition to ICPC-2, diagnoses are also coded with the International Classification of Diseases and Related Health Problems (ICD-10).

Transfer to ICPC version 3 is planned, now that it has been released in December 2020. This will allow for additional recording of functioning (activities and participation) and personal preferences linked to morbidity. 

All interventions (processes) are also coded with ICPC-2. Diagnostic and therapeutic interventions may be distinguished. Diagnostic interventions include measurements in physical examination (e.g. blood pressure measurement). Therapeutic interventions include referrals, prescriptions, vaccination or surgical procedure.

Prescriptions are coded according to the Anatomical Therapeutic Chemical (ATC) coding system maintained by the World Health Organization.5 

Prescription data provide detail and are a particularisation of the intervention type ‘medication’ (ICPC-2 code *50). 

Prescription data are shown by the first five characters of the ATC code by default. If desired this may be changed to a less detailed level with the first four characters of the ATC code so that prescriptions are studied in larger groups of medication. This can be changed in the report showing Relations between a chosen episode (ICPC code) and its percentage with a prescription.

FaMe-Net distinguishes referrals to primary care professionals and to secondary (specialist) care, and the specialisms among these referral types (primary or secondary). 

Referral data are a particularisation of the intervention type ‘referral primary care’ (ICPC-2 code *66) and ‘referral secondary care’ (ICPC-2 code *67).

Synonym: contact, consultation. 

An encounter is the professional interchange between a patient and a GP. Healthcare provided to patients by other team members of the general practice (practice assistants, practice nurses (Dutch: POH’s), GPs and doctors (in training) are also recorded in encounters. Patients can have contact with their general practice in different ways: physical consultation, telephone consultation, home visit or e-consultation.

We distinguish different types of encounters (encounter types). The majority concerns consultations during office hours. Other encounter types distinguished are home visits, telephone and email consultations (by the GP or the practice assistant), out-of-hours consultations, repeat prescriptions and administrative contacts (specialist letters). They all contribute to the registered morbidity, ordered in EoCs.
One or more Episodes of Care may be dealt with at an encounter. When more than one episode is dealt with during an encounter, there are two or more sub-encounters.Every (sub)encounter has at least one RFE. The only exemption are reports (letters) from other healthcare professionals, which do not have an RFE recorded.

Every encounter results in an (initial) diagnostic label, which is named Encounter diagnosis in FaMe-Net. This Encounter diagnosis may or may not be the final diagnosis (EoC). An Encounter diagnosis could be tiredness, changing later in the Episode to iron deficiency anaemia, and still later to colon cancer. In FaMe-Net’s Episode registration, all these encounters contribute to the Episode (EoC) colon cancer, but we are still able to review the (temporal/preliminary) Encounter diagnoses. In general practice, many Episodes of Care consist of only one encounter.

GPs receive letters from other healthcare providers in primary and in secondary care concerning a patient’s health problem. These letters are added to the patient’s Electronic Medical Record and are assigned to an episode of care.
The information in the letter may result in modifying the diagnosis of the episode of care. A letter may also contain information on a health problem that was not yet known by the GP. In that case, it results in the start of a new episode of care.

General practice emergency care after office hours is provided by a GP medical post. All encounters (physical consultation, telephone consultation, home visit) with this GP post are reported to the GP and recorded in the patient’s electronic medical record. FaMe-Net GPs add the codes for diagnosis, RFE, measurements, interventions performed and medication prescribed during out-of-hours encounters to the patient record.

FaMe-Net has started to collect contextual and personal characteristics of all the enlisted adult patients in a structured way since 2016. Upon invitation by email, patients complete a questionnaire about personal and contextual characteristics, including for example level of education, country of birth of patient and parents, intoxications, psychotraumatic life events, and information on the family history for diabetes, cardiovascular disease and several cancer types.

Patients are invited to update the context survey periodically.

FaMe-Net derives the socio-economic status (SES) from the highest completed educational level, in accordance with Statistics Netherlands’ advice.