Patients’ Characteristics and General Practitioners’ Management of Patients with Symptom Diagnoses

Abstract

Introduction: Symptom diagnoses are diagnoses used in primary care when the relevant diagnostic criteria of a disease are not fulfilled. Although symptom diagnoses often get resolved spontaneously without a clearly defined illness nor treatment, up to 38% of these symptoms persist more than 1 year. It is largely unknown how often symptom diagnoses occur, which symptoms persist, and how general practitioners (GPs) manage them.Aim: Explore morbidity rates, characteristics and management of patients with nonpersistent (≤1 year) and persistent (>1 year) symptom diagnoses.Methods: A retrospective cohort study was performed in a Dutch practice-based research network including 28,590 registered patients. We selected symptom diagnosis episodes with at least 1 contact in 2018. We performed descriptive statistics, Student's T and x 2 tests to summarize and compare patients' characteristics and GP management strategies in the nonpersistent and persistent groups.Results: The incidence rate of symptom diagnoses was 767 episodes per 1000 patient-years. The prevalence rate was 485 patients per 1000 patient-years. Out of the patients who had a contact with their GPs, 58% had at least 1 symptom diagnosis, from which 16% were persistent (>1 year). In the persistent group, we found significantly more females (64% vs 57%), older patients (mean: 49 vs 36 years of age), patients with more comorbidities (71% vs 49%), psychological (17% vs 12%) and social (8% vs 5%) problems. Prescriptions (62% vs 23%) and referral (62.7% vs 30.6%) rates were significantly higher in persistent symptom episodes.Conclusion: Symptom diagnoses are highly prevalent (58%) of which a considerable part (16%) persists more than a year. ( J Am Board Fam Med ;

The burden of persistent symptom diagnoses in primary care patients: a cross-sectional study

“…A contact with the GP could include face-to-face encounters, encounters during out-of-service hours, telephonic consultations, and e-consultations. The threshold of a duration of 1 year for persistent symptom diagnoses was determined based on the distribution of symptom duration in the FaMe-Net database combined with the opinions of practicing GPs experts in the field of symptom research [ 12 ]. An overview of all included ICPC-2 codes for symptom diagnoses, and the top 10 included ICPC-2 codes for symptom diagnoses in the persistent group in this study are summarized in the Appendices 1 and 2 .…”

“…Symptom diagnoses are defined as a wide range of symptoms when the relevant diagnostic criteria of a disease are not (yet) fulfilled [ 10–12 ]. Based on the ecology in primary care, symptom diagnoses are highly prevalent and constitute more than half of the total number of primary care diagnoses [ 12 ]. One in six patients have more than one contact with the GP for symptoms that persist for more than one year [ 12 ].…”

“…Based on the ecology in primary care, symptom diagnoses are highly prevalent and constitute more than half of the total number of primary care diagnoses [ 12 ]. One in six patients have more than one contact with the GP for symptoms that persist for more than one year [ 12 ]. Most primary care guidelines on management of persistent symptoms target symptoms burden, more specifically symptoms severity as an indicator for a stepped care approach [ 3 ].…”

Research Addressing the Ongoing Changes in the Practice of Family Medicine

“…Every practice has some patients with at least 1 persistent symptom diagnosis, that is, a symptom with no specific disease diagnosis. The Chaabouni et al 13 report from the Netherlands (a primary care system with comprehensive patient databases but a different diagnostic classification scheme) demonstrates that such diagnoses are very common. The types of patients discussed in this report from a practice-based research network would be familiar to many clinicians throughout the world.…”