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Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics.

Rosendal M, Carlsen AH, Rask MT, Moth G - Scand J Prim Health Care (2015)

Bottom Line: GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients.Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made.More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.

View Article: PubMed Central - PubMed

Affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University , Denmark.

ABSTRACT

Objective: The aim was to study symptoms managed as the main problem by the general practitioner (GP) and to describe the frequencies and characteristics of presented symptoms when no specific diagnosis could be made.

Design: Cross- sectional study.

Setting: General practices in the Central Denmark Region.

Subjects: In total, 397 GPs included patients with face-to-face contacts during one randomly assigned day in 2008-2009; 7008 patients were included and 5232 presented with a health problem.

Main outcome measures: GPs answered a questionnaire after each patient contact. Symptoms and specific diagnoses were subsequently classified using the International Classification of Primary Care (ICPC). Symptom frequency, comorbidity, consultation length, and GP-assessed final outcome and burden of consultations were analysed.

Results: The GPs could not establish a specific diagnosis in 36% of patients with health problems. GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients. Musculoskeletal (lower limb and back) and respiratory (cough) symptoms were most frequent. More GPs had demanding consultations when no specific diagnosis could be made. Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made.

Conclusion: Interpretation and management of symptoms is a key task in primary care. As symptoms are highly frequent in general practice, symptoms without a specific diagnosis constitute a challenge to GPs. Nevertheless, symptoms have been given little priority in research. More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.

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Encounters in general practice (type of contact and GP diagnoses of health problems).
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Figure 2: Encounters in general practice (type of contact and GP diagnoses of health problems).

Mentions: A total of 7008 patients with face-to-face contacts formed the population of the present study. Of these, 5232 (74.7%) consulted for a health problem, with 5059 practice consultations and 173 home visits (see Figures 1 and 2). On average, each GP had 8.3 (standard deviation [SD] 5.5) contacts regarding a health problem during one day (median 7; interquartile range [IQR] 4–12); 61% were consultations with women, 59% were first-contact consultations, and 35% of the patients presented more than one health problem in the consultation.


Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics.

Rosendal M, Carlsen AH, Rask MT, Moth G - Scand J Prim Health Care (2015)

Encounters in general practice (type of contact and GP diagnoses of health problems).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834508&req=5

Figure 2: Encounters in general practice (type of contact and GP diagnoses of health problems).
Mentions: A total of 7008 patients with face-to-face contacts formed the population of the present study. Of these, 5232 (74.7%) consulted for a health problem, with 5059 practice consultations and 173 home visits (see Figures 1 and 2). On average, each GP had 8.3 (standard deviation [SD] 5.5) contacts regarding a health problem during one day (median 7; interquartile range [IQR] 4–12); 61% were consultations with women, 59% were first-contact consultations, and 35% of the patients presented more than one health problem in the consultation.

Bottom Line: GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients.Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made.More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.

View Article: PubMed Central - PubMed

Affiliation: Research Unit for General Practice, Department of Public Health, Aarhus University , Denmark.

ABSTRACT

Objective: The aim was to study symptoms managed as the main problem by the general practitioner (GP) and to describe the frequencies and characteristics of presented symptoms when no specific diagnosis could be made.

Design: Cross- sectional study.

Setting: General practices in the Central Denmark Region.

Subjects: In total, 397 GPs included patients with face-to-face contacts during one randomly assigned day in 2008-2009; 7008 patients were included and 5232 presented with a health problem.

Main outcome measures: GPs answered a questionnaire after each patient contact. Symptoms and specific diagnoses were subsequently classified using the International Classification of Primary Care (ICPC). Symptom frequency, comorbidity, consultation length, and GP-assessed final outcome and burden of consultations were analysed.

Results: The GPs could not establish a specific diagnosis in 36% of patients with health problems. GPs expected that presented symptoms would not result in a future specific diagnosis for half of these patients. Musculoskeletal (lower limb and back) and respiratory (cough) symptoms were most frequent. More GPs had demanding consultations when no specific diagnosis could be made. Higher burden was associated with age, comorbidity, and GP expectancy of persistent symptoms when no diagnosis could be made.

Conclusion: Interpretation and management of symptoms is a key task in primary care. As symptoms are highly frequent in general practice, symptoms without a specific diagnosis constitute a challenge to GPs. Nevertheless, symptoms have been given little priority in research. More attention should be directed to evidence-based management of symptoms as a generic phenomenon to ensure improved outcomes in the future.

Show MeSH
Related in: MedlinePlus