Post on 24-Mar-2019
transcript
WHAT ARE THE MOST COMMON CONDITIONS IN PRIMARY CARE?
Finley C, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich D, Lindblad A,
Vandermeer B, Allan GM.
DISCLOSURE/COI
• Caitlin Finley, University of Alberta
• Relationships with commercial interests:
• Grants/Research Support – None
• Speakers Honoraria – None
• Consulting Fees – None
• Other - None
BACKGROUND
• What do you think are the most common conditions in primary care?
• No systematic review looking at the most common conditions in primary care
• Identify priorities for researchers, administrators, and policy makers
• Planning and allocation of resources, guide training of primary care professionals
OBJECTIVES
• To systematically identify the reasons patients visit primary care globally;
• To compare presentations to primary care between developed & developing countries.
METHODS
• Inclusion:
• 1) Study setting was general practice and/or primary care;
• 2) Minimum of 10 reasons for visits;
• 3) Minimum 20 000 visits (or equivalent)
• Exclusion:
• 1) Focused on a specific type of condition or presentation (e.g. periodic health exam visits);
• 2) Focused on specific conditions or problems (e.g. acute conditions, opioid use);
• 3) Selected specific populations (e.g. adolescents);
• 4) Indicated that study population was referred to primary care (e.g. to pediatrics or internal medicine);
• 5) Were published before 1996 (i.e. 1995 and earlier publication date)
STUDY FLOW
• 18 studies included in final assessment
• 10 reported specific reasons for visits (14 analyses)
• Remaining studies included for subgroup analysis
STUDY CHARACTERISTICS
# of studies Range
Number of visits 16 4,383 – 435,800,000
Number of clinicians 12 9 – 7,400
Population served 7 9,896 – 2,780,270
Sampling duration 15 1 day – 11 years
Years of data collection 18 1990-2015
QUALITY ASSESSMENT
Criteria Low quality High quality
Representative sample of clinicians 7 11Representative sample of patients 1 17Used a defined coding system 3 15Prolonged data collection (³1 year) 4 14Data collected prospectively (vs. retrospectively) 3 15
Clinician Reported Patient ReportedRank Condition Rank Condition
1Upper Respiratory Tract Infection,
Unspecified1 Cough
2 Hypertension 2 Back Pain/ Spinal Pain
3 Routine Health Maintenance 3 Abdominal unspecified
4 Arthritis (not back) 4 Pharyngitis
5 Diabetes 5 Dermatitis
6 Depression or Anxiety 6 Fever
7 Pneumonia 7 Headache
8 Acute Otitis Media 8 Leg Symptoms
9 Back Pain/ Spinal Pain 9 Respiratory unspecified
10 Dermatitis 10 Fatigue
11 Cough 11 Depression or Anxiety
12 Urinary Tract Infection 12 Arthritis (not back)
Clinician Reported Patient ReportedRank Condition Rank Condition
1Upper Respiratory Tract Infection,
Unspecified1 Cough
2 Hypertension 2 Back Pain/ Spinal Pain
3 Routine Health Maintenance 3 Abdominal unspecified
4 Arthritis (not back) 4 Pharyngitis
5 Diabetes 5 Dermatitis
6 Depression or Anxiety 6 Fever
7 Pneumonia 7 Headache
8 Acute Otitis Media 8 Leg Symptoms
9 Back Pain/ Spinal Pain 9 Respiratory unspecified
10 Dermatitis 10 Fatigue
11 Cough 11 Depression or Anxiety
12 Urinary Tract Infection 12 Arthritis (not back)
Developed Countries Developing CountriesRank Condition Rank Condition
1 Hypertension 1Upper Respiratory Tract Infection,
Unspecified
2Upper Respiratory Tract Infection,
Unspecified2 Hypertension
Developed Countries Developing CountriesRank Condition Rank Condition
1 Hypertension 1Upper Respiratory Tract Infection,
Unspecified
2Upper Respiratory Tract Infection,
Unspecified2 Hypertension
3 Depression or Anxiety 3 Pneumonia
4 Back Pain 4 Tuberculosis
5 Routine Health Maintenance 5 Parasites
6 Arthritis (not back) 6 Anemia
7 Dermatitis 7 Diabetes
8 Acute Otitis Media 8 Arthritis (not back)
9 Diabetes 9 Bronchitis/ bronchiolitis
10 Cough 10 Epilepsy
11 Medication 11 Urinary Tract Infection
12 Urinary Tract Infection 12 Tonsillitis
CONCLUSIONS
• Primary care physicians see a wide variety of conditions, involving many body systems and specialties• Differences exist between: • Clinician-reported and patient-reported reasons for
visits, and• Developed and developing countries regarding common
conditions