Fulltext

The course of newly presented unexplained complaints in general practice patients: a prospective cohort study

Koch, H. ; van Bokhoven, MA ; Bindels, PJE ; van der Weijden, T. ; Dinant, GJ ; ter Riet, G.

In: Family Practice, 2009, vol. 26, no. 6, p. 455-465

Zum persönliche Liste hinzufügen
    Titel
    • The course of newly presented unexplained complaints in general practice patients: a prospective cohort study
    Autor
    • Koch, H.. Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
    • van Bokhoven, MA. Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
    • Bindels, PJE. Department of general practice, Erasmus Medical Center, Rotterdam, The Netherlands
    • van der Weijden, T.. Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
    • Dinant, GJ. Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
    • ter Riet, G.. Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Family Practice, 2009, vol. 26, no. 6, p. 455-465. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:291427
    Summary
    Objective. Newly presented unexplained complaints (UCs) are common in general practice. Factors influencing the transition of newly presented into persistent UCs have been scarcely investigated. We studied the number and the nature of diagnoses made over time, as well as factors associated with UCs becoming persistent. Finally, we longitudinally studied factors associated with quality of life (QoL). Methods. Prospective cohort study in general practice of patients presenting with a new UC. Data sources were case record forms, patient questionnaires and electronic medical registries at inclusion, 1, 6 and 12 months. Presence of complaints and diagnoses made over time were documented. Potential risk factors were assessed in mixed-effect logistic and linear regression models. Results. Sixty-three GPs included 444 patients (73% women; median age 42) with unexplained fatigue (70%), abdominal complaints (14%) and musculoskeletal complaints (16%). At 12 months, 43% of the patients suffered from their initial complaints. Fifty-seven percent of the UCs remained unexplained. UCs had (non-life-threatening) somatic origins in 18% of the patients. QoL was often poor at presentation and tended to remain poor. Being a male [odds ratio (OR) 0.6; 95% confidence interval (CI) 0.4-0.8] and GPs' being more certain about the absence of serious disease (OR 0.9; 95% CI 0.8-0.9) were the strongest predictors of a diminished probability that the complaints would still be present and unexplained after 12 months. The strongest determinants of complaint persistence [regardless of (un)explicability] were duration of complaints >4 weeks before presentation (OR 2.6; 95% CI 1.6-4.3), musculoskeletal complaint at baseline (OR 2.3; 1.2-4.5), while the passage of time acted positively (OR 0.8 per month; 95% CI 0.78-0.84). Musculoskeletal complaints, compared to fatigue, decreased QoL on the physical domain (4.6 points; 2.6-6.7), while presence of psychosocial factors decreased mental QoL (5.0; 3.1-6.9). Conclusion. One year after initial presentation, a large proportion of newly presented UCs remained unexplained and unresolved. We identified determinants that GPs might want to consider in the early detection of patients at risk of UC persistence and/or low QoL