患者特征与全科医生对症状诊断患者的处理

Patients' Characteristics and General Practitioners' Management of Patients with Symptom Diagnoses.

机构信息

From the Department of primary and community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands (AC, JH, KVB, HP, HS, TOH); Department of health evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands (IW).

出版信息

J Am Board Fam Med. 2023 May 8;36(3):477-492. doi: 10.3122/jabfm.2022.220335R1.

DOI:10.3122/jabfm.2022.220335R1

PMID:37290830

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 χ 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.

摘要

简介

症状诊断是初级保健中使用的诊断方法，当疾病的相关诊断标准不满足时使用。尽管这些症状诊断通常会自行缓解，没有明确的疾病或治疗方法，但其中多达 38%的症状会持续超过 1 年。目前尚不清楚症状诊断的发生频率、持续存在的症状以及全科医生（GP）如何管理这些症状。

目的

探讨非持续性（≤1 年）和持续性（>1 年）症状诊断患者的发病率、特征和管理情况。

方法

在一个荷兰基于实践的研究网络中进行了一项回顾性队列研究，该网络纳入了 28590 名注册患者。我们选择了至少在 2018 年有 1 次就诊记录的症状诊断发作。我们进行了描述性统计分析、学生 t 检验和 χ 检验，以总结和比较非持续性和持续性组患者的特征和 GP 管理策略。

结果

症状诊断的发病率为每 1000 名患者-年 767 例，患病率为每 1000 名患者-年 485 例。在与 GP 有接触的患者中，58%的患者至少有 1 个症状诊断，其中 16%的症状诊断持续时间超过 1 年。在持续性症状组中，我们发现女性患者明显更多（64%比 57%），年龄更大（平均：49 岁比 36 岁），合并症更多（71%比 49%），存在心理（17%比 12%）和社会（8%比 5%）问题。持续性症状发作中，处方（62%比 23%）和转诊（62.7%比 30.6%）的比例明显更高。