Symptoms as the main problem in primary care: A cross-sectional study of frequency and characteristics

Figures & data

Figure 1. Flow of patient inclusion.

Figure 2. Encounters in general practice (type of contact and GP diagnoses of health problems).

Table I. Characteristics of symptoms without diagnosis (compared with specific diagnoses).

	Symptom n (%)	Disease/disorder diagnosed n (%)	Total n (%)
	1871	3361	5232
Gender:
Female	1167 (62.4)	2003 (59.6)	3170 (60.6)	0.049^1
Male	704 (37.6)	1358 (40.4)	2062 (39.4)
Age:
0–18 years	293 (15.7)	529 (15.7)	822 (15.7)	0.001^1
> 18 and < 65 years	1179 (63.0)	1968 (58.6)	3147 (60.2)
65 + years	399 (21.3)	864 (25.7)	1263 (24.1)
Consultation type:*
First consultation	1162 (66.6)	1746 (55.3)	2908 (59.4)	< 0.001^2
Follow-up consultation	582 (33.4)	1410 (44.7)	1992 (40.7)
Reason for encounter according to the GP:*
Symptom	1627 (92.2)	1484 (48.0)	3111 (64.0)	< 0.001^2
Disease/disorder	137 (7.8)	1609 (52.0)	1746 (36.0)
Concomitant chronic disorder:
No	1146 (61.3)	1808 (53.8)	2954 (56.5)	< 0.001^2
Yes	725 (38.7)	1553 (46.2)	2278 (43.5)
GP assessment of final outcome:*
Specific diagnosis	925 (50.8)	2535 (77.8)	3460 (68.1)	< 0.001^2
Resolving symptom	718 (39.4)	561 (17.2)	1279 (25.2)
Persistent (medically unexplained) symptom	179 (9.8)	164 (5.0)	343 (6.7)
Length of consultation:*
< = 5 minutes	188 (10.2)	491 (14.8)	679 (13.1)	< 0.001^2
5–15 minutes	1281 (69.5)	2251 (67.7)	3532 (68.4)
15–30 minutes	338 (18.4)	545 (16.4)	883 (17.1)
> 30 minutes	35 (1.9)	37 (1.1)	72 (1.4)
Burden*
1–2 (0–20 centile)	510 (27.9)	1236 (37.3)	1746 (34.0)	< 0.001^2
3–6 (20–80 centile)	943 (51.5)	1574 (47.6)	2517 (49.0)
7–10 (80–100 centile)	377 (20.6)	501 (15.1)	878 (17.1)

Notes: *Missing values in GP questionnaire were: RFE (n = 375), consultation type (n = 332), GP assessment (n = 150), length of consultation (n = 66), burden (n = 91).

Statistical tests: 1 = chi-squared test, 2 = Wald test adjusted for gender, age, chronic disorder, and GP clusters.

Table II. The 10 most frequent symptoms without diagnosis (according to age).

Symptom	ICPC code	All	0–18 years	18–65 years	> = 65 years
		n (%)	n (%)	n (%)	n (%)
Lower limb	L13–L17	128 (6.8)	20 (6.8)	78 (6.6)	30 (7.5)
Cough	R05	107 (5.7)	39 (13.3)	50 (4.2)	18 (4.5)
Back symptom	L02–L03	93 (5.0)	9 (3.1)	68 (5.8)	16 (4.0)
Acute stress reaction	P02	68 (3.6)		58 (4.9)
Upper limb	L08–L12	64 (3.4)	2 (0.7)	53 (4.5)	9 (2.3)
Rash localized	S06	47 (2.5)	12 (4.1)	27 (2.3)
Muscle pain	L18	47 (2.5)		33 (2.8)	12 (3.0)
Weakness/tiredness	A04	42 (2.2)	6 (2.0)	25 (2.1)	11 (2.8)
Vertigo/dizziness	N17	39 (2.1)			16 (4.0)
Headache	N01	35 (1.9)		27 (2.3)
Fever	A03		18 (6.1)
Abdominal pain	D01		9 (3.1)
Constipation	D12		8 (2.7)
Diarrhoea	D11		7 (2.4)
Bedwetting/enuresis	P12		7 (2.4)
Feeling anxious/nervous/tense	P01			25 (2.1)
Sleep disturbance	P06				13 (3.3)
Swollen ankles/oedema	K07				9 (2.3)
Shortness of breath/dyspnoea	R02				9 (2.3)
Total for all diagnoses (n)		1871	293	1179	399

Note: Top three most common symptoms in each column have been marked in bold.

Figure 3. Distribution of symptoms and specific diagnoses according to localization.