The burden of persistent symptom diagnoses in primary care patients: a cross-sectional study

Abstract

Introduction

The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients.

Methods

A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs).

Results

Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (n = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = − 6.8 [95% CI: −8.96, −3.92]).

Conclusion

Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care.

Keywords:

• primary care
• persistent somatic symptoms
• quality of life
• disease burden

Acknowledgement

Special thanks to Hans Peters for his help in data creation, to all General Practitioners from the Family-Medicine Network for their participation in collecting data for this study, and all participants who took part in the survey for their time and generosity. We thank Anouk Peters for her help in developing the survey, Dr Peter Lucassen for the valuable discussions on how to study symptoms burden, and Brodie McGhie Fraser for his help in translating the symptom interference and symptom severity questionnaires. We also thank all contributors from USUMA Markt- und Sozialforschung GmbH for their help and advice in this study. Finally, we thank Professor Jos Twisk for his advice on the choice of the control group.

Ethical approval

The study has been carried out following to the Dutch non-WMO research guidelines as assessed by the Radboud University Medical Ethics Review committee in Nijmegen in the Netherlands (registration number: 2022-15747). The Radboudumc Medical Ethics Review Committee has also approved the use of the FaMe-Net data for scientific research (CMO declaration number: 2020-6871).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 956673 and is part of the Training Network Encompassing Training in fUnctional Disorders across Europe (ETUDE). The funding source had no role in study design, collection, analysis or interpretation of data, in the writing of the report and in the decision to submit the article for publication.