Kenter E G H, Okkes I M, Oskam S K, Lamberts H
Department of Family Practice, Division of Clinical Methods and Public Health, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
Fam Pract. 2003 Aug;20(4):434-40. doi: 10.1093/fampra/cmg418.
Research including patients from the entire tiredness spectrum in family practice is needed.
Our aim was to provide routine family practice data on (i) relationships between the RFE (reason for encounter) and the diagnosis "tiredness"; (ii) duration, number of encounters and family physician's (FP's) interventions in episodes of care of tiredness; and (iii) sex/age and co-morbidity of patients diagnosed with "tiredness".
Routine episode of care data from the Transition Project, coded comprehensively with the International Classification of Primary Care (ICPC), were used. (i) A 16 year database (1985-2000, 58 FPs, 504 145 episodes of care, 168 550 patient years) for calculating "prior probabilities" with (diagnostic) odds ratios. (ii) A "basic population" extracted from that 16 year database of patients listed for an entire 4 year period (1997-2000; n = 12 292).
The RFE tiredness resulted in a variety of diagnoses, but most frequently (43%) in "tiredness". Most odds ratios were low or negative. Of episodes of care of tiredness, 90% started with the RFE tiredness; 72% required one encounter only, and 90% lasted <6 months. In the 4 year period, 21% of patients first presented with tiredness, and 12% were diagnosed with tiredness; both groups were skewed towards women. Average co-morbidity in tired patients (16.6) was higher than in other visiting patients (10.4), and contained more tiredness-related conditions. FPs' interventions were mainly blood test, physical exam and advice; few referrals occurred.
For many diagnoses, the RFE tiredness hardly contributes to the Bayesian posterior probability. FPs react differently to the RFE tiredness in cases in which they diagnose the patient with "tiredness" from how they react in other cases. The characteristics of ICPC and the Dutch health care system resulted in a full integration of tiredness as an RFE and as a freestanding episode of care in the context of family practice.
需要开展涵盖家庭医疗中各种疲劳程度患者的研究。
我们的目标是提供关于以下方面的常规家庭医疗数据：（i）就诊原因（RFE）与“疲劳”诊断之间的关系；（ii）疲劳护理期间的时长、就诊次数以及家庭医生（FP）的干预措施；（iii）被诊断为“疲劳”患者的性别/年龄及合并症。
使用了来自过渡项目的常规护理数据，并依据国际初级保健分类法（ICPC）进行了全面编码。（i）一个16年的数据库（1985 - 2000年，58名家庭医生，504145次护理，168550患者年），用于通过（诊断）比值比计算“先验概率”。（ii）从该16年数据库中提取的一个“基础人群”，这些患者在整个4年期间（1997 - 2000年；n = 12292）被列入名单。
因疲劳就诊导致了多种诊断结果，但最常见的（43%）是“疲劳”。大多数比值比为低或为负。在疲劳护理中，90%始于因疲劳就诊；72%仅需就诊一次，90%持续时间<6个月。在这4年期间，21%的患者首次表现为疲劳，12%被诊断为疲劳；两组都以女性居多。疲劳患者的平均合并症（16.6）高于其他就诊患者（10.4），且包含更多与疲劳相关的病症。家庭医生的干预措施主要是血液检查、体格检查和建议；很少有转诊情况。
对于许多诊断而言，因疲劳就诊对贝叶斯后验概率贡献不大。家庭医生在诊断患者为“疲劳”的情况下与在其他情况下对因疲劳就诊的反应不同。ICPC的特点和荷兰医疗保健系统导致疲劳作为就诊原因以及在家庭医疗背景下作为独立护理情况得到了充分整合。
