Reasons for encounters, investigations, referrals, diagnoses and treatments in general practice in Sweden—a multicentre pilot study using electronic patient records

Abstract

Objective: To investigate reasons for encounters, investigations, referrals, diagnoses and treatments in everyday general practice, using electronic patient records (EPR), and possible related differences concerning gender, socio-economic status (SES) and practice location. Method: Four Swedish primary care centres using EPR participated. Distributions of symptoms, investigations, diagnoses and prescribed drugs were registered. Results: In 1055 encounters, the mean patient age was 53; 59% were women. The most common reasons for the encounter were musculoskeletal (21.5%) and respiratory (15.2%) symptoms. A total of 1534 diagnoses were coded, on average 1.5 per encounter. The predominant diagnostic groups, i.e. ICD-10 chapters, were musculoskeletal (17.2%) and respiratory (12.4%). The most common specific diagnoses were essential hypertension (8.1%) and acute upper respiratory infections (3.7%). A total of 1687 prescriptions were issued, on average 1.6 per encounter. The most frequent pharmaceutical groups were nervous (17.7%), respiratory system (16.2%), and cardiovascular (15.7%). The most frequent drugs were phenoxymethyl penicillin (3.7%), diclofenac (2.9%) and acetylsalicylic acid (2.5%). An average of 1.3 laboratory tests was performed per encounter. In 7.5% of encounters, radiology referrals were made; in 12.3% referrals were made to other specialists/therapists, while sick-list certificates were written in 11.7%. There were significant differences concerning symptoms, diagnoses and investigations between female and male patients, urban and rural practices and SES.

Conclusion: The musculoskeletal, respiratory and circulatory systems predominated, both as reasons for the encounter and in the diagnoses, but with significant differences concerning gender, SES and practice location.

Key words::

• Primary health care
• general practice
• electronic patient record
• reasons for encounter
• symptoms
• health problem
• prescribing

Acknowledgements

This study was supported by grants from the National Board of Health and Welfare, and the Västra Götaland and Halland County Councils. The authors should like to thank Patrik Sjöberg from Tieto Enator and the staff at the following PHCC: Husläkarna i Kungsbacka, Kungsportsläkarna, Ytterby, Åsa.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.