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

Asma Chaabouni; Juul Houwen; Iris Walraven; Kees van Boven; Hans Peters; Henk Schers; Tim olde Hartman

doi:10.3122/jabfm.2022.220335R1

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Figure 1.
Proportion of patients with (persistent) symptom diagnosis in primary care (per 1000 patients, n = 28,590, contact year: 2018, study period: 1978 to 2020).
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Figure 2.
Frequencies of the top 10 symptom diagnoses in general practice (contact year: 2018, study period: 1978 to 2020).

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Table 1.

Patient Characteristics of Non-Persistent and Persistent Groups Symptom Diagnosis (Contact Year: 2018, Study Period: 1978 to 2020)

	Non-Persistent Symptom Diagnosis^{^a} (N, % of total)	Persistent Symptom Diagnosis^{^a} (N, % of total)	Sig^**
Number of patients	11696 (84.3%)	2172 (15.7%)	–
Sex (Males)	5024 (43.0%)	787 (36.2%)	p < .001
Age in years (mean [SD])	36 [23]	49 [22]	p < .001***
Marital status^b^{,^c}
Single	1311 (23.6%)	353 (28.5%)
Couple	1022 (29.0%)	259 (20.9%)	p < .001
Married	1596 (47.2%)	626 (50.6%)
Level of education^b^{,^c}
No/primary school	185 (3.5%)	65 (5.6%)	p < .001
Secondary school	2089 (39.4%)	529 (45.2%)
High school/university	3022 (57.1%)	576 (49.2%)
Employment ^b^{,^c}	3765 (74.6%)	697 (64.5%)	p < .001
Comorbidities (≥ 5)^d	5723 (48.9%)	1541 (70.9%)	p < .001
Previous psychological, physical, or sexual violence^b^{,^c}	726 (13.1%)	202 (16.4%)	p = .003
Patients with at least one psychological symptom^e	135 (11.5%)	377 (17.4%)	p < .001
Patients with at least one social problem^f	558 (4.8%)	172 (7.9%)	p < .001

↵a Non persistent symptom diagnosis (episodes ≤1 year), persistent symptom diagnosis (episodes >1 year), See Appendix 1 for the full list of included symptom diagnosis related ICPC-2 codes.
↵b age ≥15.
↵c Missing values were: Marital status (51.2%), Level of education (53.3%) Employment (44.8%), Previous psychological, physical, or sexual violence (51.1%).
↵d See Appendix 2 for the full list of included comorbidities.
↵e Episodes with at least one contact in 2018 for a psychological symptom (ICPC-2: P01-P29).
↵f Episodes with at least one contact in 2018 for a social problem (ICPC-2: Z01-Z29).
↵** Comparison tested by Pearson’s χ² tests apart from ***where Student’s t test was performed.
Abbreviation: SD = Standard Deviation.

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Table 2.

Episodes Characteristics and the GP’s Management Strategies for Non-Persistent and Persistent Symptom Diagnosis (Contact Year: 2018, Study Period: 1978 to 2020)

	Non-Persistent Symptom Diagnosis^{^a}	Persistent Symptom Diagnosis^{^a}	Sig^**
Diagnostic interventions^b
Laboratory tests (% of total number)	11486 (80.8%)	2494 (79.5%)
Physical Function Test (% of total number)	319 (2.2%)	93 (3.0%)
Diagnostic Endoscopy (% of total number)	44 (0.3%)	15 (0.5%)
Diagnostic Radiology/ Imaging (% of total number)	2049 (14.4%)	465 (14.8%)
Electrical Tracings (% of total number)	332 (2.3%)	70 (2.2%)
Total number of diagnostic interventions (% of EoC)	14230 (20.2%)	3137(14.8%)
Therapeutic interventions^b
Number of EoC with at least one medical prescription (% of EoC)	5286 (23.1%)	1538 (61.7%)	p < .001
Medical Script/Request/Renew/Injection (% of total number)	7703 (95.1%)	4575 (91.9%)
Counseling (% of total number)	396 (4.9%)	405 (8.1%)
Total number of therapeutic interventions (% of EoC)	8099 (11.5%)	4980 (23.5%)
Referrals^c
Number of EoC with at least one referral (% of EoC)	7000 (30.6%)	1564 (62.7%)	p < .001
Physicians/Specialist/Clinic/Hospital ^d (% of total number)	3590 (67.0%)	187 (67.4%)
Other providers [Excluding medical doctors] (% of total number)	1765 (33.0%)	111 (32.9%)
Total number of referrals (% of EoC)	5355 (7.6%)	2016 (9.5%)

↵a Non persistent symptom diagnosis (episodes ≤1 year), persistent symptom diagnosis (episodes >1 year), See Appendix 1 for the full list of included symptom diagnosis related ICPC-2 codes.
↵b See Appendix 3 for the full list of included diagnostic and therapeutic interventions related ICPC-2 codes.
↵c See Appendix 4 for the full list of included referrals related ICPC-2 codes.
↵d In the Netherlands, all medical specialists work in a hospital.
↵** Comparison tested by Pearson’s χ² tests; P values were reported when Pearson’s χ² tests were performed.
Abbreviations: EoC = Episode of care; GP = general practitioners.