ORIGINAL RESEARCH
Asma Chaabouni, MD, MSc; Juul Houwen, MD, PhD; Iris Walraven, PhD; Kees van Boven, MD, PhD; Hans Peters; Henk Schers, MD, PhD; Tim olde Hartman, MD, PhD
Corresponding Author: Asma Chaabouni, MD, MSc; Department of Primary Care and Community Care - Radboud Institute of Health Sciences - Radboud University Medical Centre.
Email: asma.chaabouni@radboudumc.nl
DOI: 10.3122/jabfm.2022.220335R1
Keywords: Epidemiology, Family Medicine, Morbidity, Retrospective Studies, Signs and Symptoms
Dates: Submitted: 09-27-2022; Revised: 01-23-2023; Accepted: 01-27-2023
FINAL PUBLICATION: |HTML| |PDF|
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 one year. It is largely unknown how often symptoms diagnoses occur, which symptoms persist, and how general practitioners (GPs) manage them.
AIM: Explore morbidity rates, characteristics and management of patients with non-persistent (≤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 one contact in 2018. We performed descriptive statistics, Student’s T and χ2 tests to summarize and compare patients’ characteristics and GP management strategies in the non-persistent 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 visited their GPs, 58% had at least one symptom diagnosis, from which 16% were persistent (> 1 year). In the persistent group, we found significantly more females (64% versus 57%), older patients (mean: 49 versus 36 years of age), patients with more comorbidities (71% versus 49%), psychological (17% versus 12%) and social (8% versus 5%) problems. Prescriptions (62% versus 23%) and referral (62.7% versus 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. Future research should focus on identifying which patients Abstract have symptoms that are at risk of evolving into persistent symptoms as this may help GPs in their clinical-decision making to target their interventions within a stepped care process.