基层医疗中最常见的病症有哪些？系统综述。
What are the most common conditions in primary care? Systematic review.
机构信息
Medical student, at the University of Alberta in Edmonton.
Family medicine resident, at the University of Alberta in Edmonton.
出版信息
Can Fam Physician. 2018 Nov;64(11):832-840.
OBJECTIVE
To identify the most commonly presenting conditions in primary care globally, and to compare common reasons for visits (RFVs) as reported by clinicians and patients, as well as among countries of different economic classifications.
DATA SOURCES
Twelve scientific databases were searched up to January 2016, and a dual independent review was performed to select primary care studies.
STUDY SELECTION
Studies were included if they contained 20 000 visits or more (or equivalent volume by patient-clinician interactions) and listed 10 or more RFVs. Dual independent data extraction of study characteristics and RFV rankings was performed. Data analysis was descriptive, with pooled rankings of RFVs across studies.
SYNTHESIS
Eighteen studies met inclusion criteria (median 250 000 patients or 83 161 visits). Data were from 12 countries across 5 continents. The 10 most common clinician-reported RFVs were upper respiratory tract infection, hypertension, routine health maintenance, arthritis, diabetes, depression or anxiety, pneumonia, acute otitis media, back pain, and dermatitis. The 10 most common patient-reported RFVs were symptomatic conditions including cough, back pain, abdominal symptoms, pharyngitis, dermatitis, fever, headache, leg symptoms, unspecified respiratory concerns, and fatigue. Globally, upper respiratory tract infection and hypertension were the most common clinician-reported RFVs. In developed countries the next most common RFVs were depression or anxiety and back pain, and in developing countries they were pneumonia and tuberculosis. There was a paucity of available data, particularly from developing countries.
CONCLUSION
There are differences between clinician-reported and patient-reported RFVs to primary care, as well as between developed and developing countries. The results of our review are useful for the development of primary care guidelines, the allocation of resources, and the design of training programs and curricula.
目的
确定全球初级保健中最常见的就诊病症，并比较临床医生和患者报告的常见就诊原因（RFV），以及不同经济分类国家之间的常见就诊原因。
资料来源
截至 2016 年 1 月，共检索了 12 个科学数据库，并进行了双重独立审查以选择初级保健研究。
研究选择
如果研究包含 20000 次就诊或更多（或通过医患互动等效的患者数量），并列出 10 种以上的 RFV，则将其纳入研究。对研究特征和 RFV 排名进行了双重独立的数据提取。数据分析采用描述性方法，对研究间 RFV 排名进行汇总。
综合结果
符合纳入标准的研究有 18 项（中位数为 25 万例患者或 83161 次就诊）。数据来自五大洲 12 个国家。临床医生报告的 10 种最常见 RFV 为上呼吸道感染、高血压、常规健康维护、关节炎、糖尿病、抑郁或焦虑、肺炎、急性中耳炎、背痛和皮炎。10 种最常见的患者报告 RFV 为症状性疾病，包括咳嗽、背痛、腹部症状、咽炎、皮炎、发热、头痛、腿部症状、未明确呼吸道问题和疲劳。全球范围内，上呼吸道感染和高血压是临床医生报告的最常见 RFV。在发达国家，下一个最常见的 RFV 是抑郁或焦虑和背痛，在发展中国家则是肺炎和肺结核。来自发展中国家的可用数据尤其匮乏。
结论
临床医生报告的 RFV 和患者报告的 RFV 之间以及发达国家和发展中国家之间存在差异。我们的综述结果有助于制定初级保健指南、分配资源以及设计培训计划和课程。
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