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

Figures & data

Figure 1. Flow chart of the recruitment process.

Table 1. Patients characteristics in the persistent and the control groups.

	Persistent symptoms group (n = 113)	Control group (n = 65)	sig
Mean age in years (SD)	58 (15)	54 (17)	0.150
Sex (Males)	37 (33%)	30 (46%)	0.075
Marital status			0.787
Single	37 (33%)	21 (32%)
In a relationship	16 (14%)	7 (11%)
Married	60 (53%)	37 (57%)
Level of education			<0.001
Primary/secondary school	61 (54%)	18 (27%)
University	52 (46%)	47 (73%)
Employment (Yes)	55 (49%)	42 (65%)	0.040
Tobacco consumption (Yes)	20 (18%)	3 (4%)	0.011
Alcohol consumption (Yes)	68 (60%)	50 (77%)	0.023
Drugs use (Yes)	1 (1%)	1 (2%)	1.000

Chi square was used with the exception of Age where independent sample t-test was used.

Table 2. Primary and Secondary outcome variables in the persistent and control groups.

	Persistent symptoms group (n = 113)	Control group (n = 65)
Primary outcome
PHQ-15 (Mean [SD])	8.8 [5.3]	5. 2 [3.3]
Secondary outcomes
Symtom intesity (Median [IQR])	6 [4 − 7]	–
Symptom interference (Median [IQR])	5 [3 − 7]
PHQ-9 (Mean [SD])	6.9 [5.7]	3.9 [4.5]
GAD-7 (Mean [SD])	4.9 [4.9]	2.6 [2.9]
SF-12
PCS (Mean [SD])	36.4 [8.2]	43.2 [6.8]
MCS (Mean [SD])	37.4 [6.3]	37.0 [4.8]
EQ 5D 5 L
Mobility problems (n, %)	67 (59.0%)	23 (35.0%)
Self-care problems (n, %)	20 (17.7%)	7 (10.6%)
Usual activities problems (n, %)	64 (57.0%)	17 (26.0%)
Pain (n, %)	94 (83.0%)	40 (62.0%)
Anxiety/depression levels (n, %)	49 (43.0%)	21 (32.0%)
Visual Analogue Score for general health status (Mean [SD])	64.9 [22.6]	76.4 [15.8]
Utility score (Mean, [SD])	0.61 [0.3]	0.80 [0.2]
Social Production Function Instrument
Overall (Mean [SD])	39.6 [5.8]	42.0 [6.6]
Affection (Mean [SD])	9.1 [9.0]	9.4 [1.9]
Behavioural Confirmation (Mean [SD])	9.3 [9.0]	9.5 [1.9]
Status (Mean [SD])	6.5 [6.0]	6.8 [1.9]
Comfort (Mean [SD])	6.6 [7.0]	8.1 [1.9]
Stimulation (Mean [SD])	8.0 [8.0]	8.1 [1.4]

PHQ-15: Patient Health Questionnaire-15, higher scores reflect more severe somatic symptoms; PHQ-9: Patient Health Questionnaire-9, higher scores reflect higher level of depression; GAD-7: Generalized Anxiety Disorder-7, higher scores reflect higher levels of anxiety; SF-12: Short Form-12, Higher score reflect better health related quality of life, PCS = Physical Component Summary Score; MCS = Mental Component Summary Score; EQ 5D 5 L: Five Dimensional Five Levels Questionnaire, The proportion reported for each domain for the EQ-5D-5L are those that reported a score of 3 or greater which represents a moderate to extremely severe problem, Affection = positive inputs from caring others, Behavioural Confirmation = approval for doing the ‘right things’. Status = control over scare resources, Comfort = absence of physiological needs, pleasant and safe environment, Stimulation = Activation optimal level of arousal.

Table 3. Severity of symptoms, depression, anxiety, social wellbeing and quality of life levels between the persistent and the control groups.

	Crude analysis		Adjusted analysis^a
Outcomes	95% CI^b	p values	95% CI^b	p values	Cohen’s size effect
Primary outcome
PHQ-15	3.55, [2.12, 4.98]	<0.001	2.91, [1.41, 4.41]	<0.001	0.9
Secondary outcomes
PHQ-9	2.97, [1.34, 4.58]	<0.001	1.92, [0.24, 3.61]	0.026	0.4
GAD-7	2.32, [0.98, 3.67]	<0.001	1.69, [0.28, 3.10]	0.019	0.6
SF-12
PCS	−6.78, [−9.16, −4.41]	<0.001	−6.44, [−8.96, −3.92]	0.001	1.0
MCS	0.41, [−1.37, −2.19]	0.649	−0.02, [−1.87, 1.90]	0.987	–
EuroQual 5D
Mobility problems	2.66, [1.41, 5.00]	0.002	2.27, [1.14, 4.52]	0.020	-
Self-care problems	1.78, [0.71, 4.48]	0.219	1.20, [0.43, 3.34]	0.734	–
Usual activities problems	3.69, [1.99, 7.18]	0.001	2.95, [1.46, 5.93]	0.002	-
Pain	3.09,[1.53, 6.24]	0.002	2.76, [1.29, 5.88]	0.009	-
Anxiety/depression levels	1.60, [0.85, 3.04]	0.147	1.25, [0.62, 2.50]	0.530	–
The Visual Analogue Score for general health status	−11.56, [−17.82, −5.31]	< 0.001	−8.39, [−14.95, −1.83]	0.012	0.5
Utility score	−0.18, [−0.27, −0.10]	< 0.001	−0.13, [−0.21, −0.05]	0.003	0.8
Social Production Function Instrument
Overall score	−2.32,[−4.19, −0.45]	0.015	−1.33, [−3.28, 0.63]	0.182	-
Affection	−0.28, [−0.86, 0.30]	0.337	−0.20, [−0.82, 0.42]	0.525	–
Behavioural Confirmation	−0.16, [−0.70, 0.37]	0.550	−0.09, [−0.64, 0.47]	0.760	–
Status	−0.32, [−0.92, 0.28]	0.291	−0.02, [−0.65, 0.61]	0.949	–
Comfort	−1.44, [−2.07, −0.80]	<0.001	−1.08, [−1.74, −0.42]	0.001	0.5
Stimulation	−0.12, [−0.59, 0.35]	0.568	−0.06, [−0.43, 0.55]	0.807	–

Linear regression for continuous variables and logistic regression for dichotomized variables; Cohen’s size effect was not calculated for categorical variables nor for after non- significant different after adjusting for confounders;

^a Adjusted for level of education, employment, tobacco and alcohol consumption;

^b estimates were reported for continuous outcome variables and odds ratios were reported for categorical outcomes = variables; PHQ-15: Patient Health Questionnaire-15, higher scores reflect more severe somatic symptoms; PHQ-9: Patient Health Questionnaire-9, higher scores reflect higher level of depression; GAD-7: Generalized Anxiety Disorder-7, higher scores reflect higher levels of anxiety; SF-12: Short Form-12, Higher score reflect better health related quality of life, PCS = Physical Component Summary Score; MCS = Mental Component Summary Score; EQ 5D 5 L: Five Dimensional Five Levels Questionnaire, The proportion reported for each domain for the EQ-5D-5L are those that reported a score of 3 or greater which represents a moderate to extremely severe problem, Affection = positive inputs from caring others, Behavioural Confirmation = approval for doing the ‘right things’. Status = control over scare resources, Comfort = absence of physiological needs, pleasant and safe environment, Stimulation = Activation optimal level of arousal.

Table

Selected ICPC-2 codes: Chapters A to Y: All the codes from 1 to 29

Non-selected ICPC-2 codes: Risk factors and euthanasia Chapter A: A20 (Euthanasia Request/ decision), A21 (Risk factor for malignancy), A23 (Risk factor NOS) Chapter K: K22 (Risk factor cardiovascular disease) Diseases Chapter S: S03 (Warts), S09 (Infected finger/toe) S10 (Boil/carbuncle), S11 (Skin infection post-traumatic), S12 (Insect bite/sting), S13 (Animal/human bite), S14 (burn/scald), S15 (Foreign body in the skin), S16 (Bruise /contusion), S17 (Abrasion/scratch/blister), S18 (Laceration/cut), S19 (Skin injury/other), S20 (Corn/ Collosity) Family planning Chapter W: W10 (contraception postcoital), W11 (Contraception oral), W12 (Contraception Intrauterine), W13 (Sterilization), W14 (Contraception other) Chapter Y: Y13 (Sterilization male), Y14 (family planning male other) Psychological symptoms Chapter P: All codes from 1 to 29 Social problems Chapter Z: All codes from 1 to 29

Table

ICPC-2 codes in the persistent group (Label)	Frequencies (%) (n = 150)
A04 (Weakness/tirdness general)	8 (5%)
K04 (Palpitation/ awarness of heart)	8 (5%)
X11 (Menopausal symptom/ complaint)	8 (5%)
D12 (Constipation)	6 (4%)
L03 (Low back pain complaint)	6 (4%)
R05 (Cough)	6 (4%)
D06 (Abdominal pain localized other)	5 (3%)
L14 (Leg/thigh symptom/complaint)	5 (3%)
L15 Knee symptom/complaint	5 (3%)
R02 Shortness of breath/ dyspnea	5 (3%)
ICPC-2 codes in the control group (Label)	Frequencies (%) (n = 406)
A98 (Health maintenance/ prevention)	62 (15%)
L87 (Bursitis/ tendinitis/synovitis NOS)	13 (3%)
H81 (Excessive ear wx)	10 (2%)
S99 (Skin disease other)	8 (2%)
K86 (Hypertension uncomplicated)	6 (1%)
U71 (Cystitis/urinary infection other)	6 (1%)
L81 (Injury musculoskelatel NOS)	5 (1%)
P78 (Neuroaesthenia/ surmenage)	5 (1%)
S88 (Dermatitis contact/ allergic)	5 (1%)
A20 (Euthanasia request/ discussion)	4 (1%)

ICPC-2: International classification of primary care 2^nd edition, NOS: Not otherwise specified.