Family Practice Advance Access originally published online on October 13, 2009
Family Practice 2009 26(6):455-465; doi:10.1093/fampra/cmp067
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The course of newly presented unexplained complaints in general practice patients: a prospective cohort study
a Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
b Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
c Department of general practice, Erasmus Medical Center, Rotterdam, The Netherlands
d Horten Centre, University of Zurich, Zurich, Switzerland
Correspondence to: H Koch, Department of General Practice, Division of Clinical Methods and Public Health, Academic Medical Centre-University of Amsterdam, PO Box 22660, 1100 DD Amsterdam, The Netherlands; Email: h.koch{at}amc.uva.nl
Received 7 July 2008; Revised 22 July 2009; Accepted 10 September 2009.
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Abstract |
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Objective. Newly presented unexplained complaints (UCs) are common in general practice. Factors influencing the transition of newly presented into persistent UCs have been scarcely investigated. We studied the number and the nature of diagnoses made over time, as well as factors associated with UCs becoming persistent. Finally, we longitudinally studied factors associated with quality of life (QoL).
Methods. Prospective cohort study in general practice of patients presenting with a new UC. Data sources were case record forms, patient questionnaires and electronic medical registries at inclusion, 1, 6 and 12 months. Presence of complaints and diagnoses made over time were documented. Potential risk factors were assessed in mixed-effect logistic and linear regression models.
Results. Sixty-three GPs included 444 patients (73% women; median age 42) with unexplained fatigue (70%), abdominal complaints (14%) and musculoskeletal complaints (16%). At 12 months, 43% of the patients suffered from their initial complaints. Fifty-seven percent of the UCs remained unexplained. UCs had (non-life-threatening) somatic origins in 18% of the patients. QoL was often poor at presentation and tended to remain poor. Being a male [odds ratio (OR) 0.6; 95% confidence interval (CI) 0.4–0.8] and GPs’ being more certain about the absence of serious disease (OR 0.9; 95% CI 0.8–0.9) were the strongest predictors of a diminished probability that the complaints would still be present and unexplained after 12 months. The strongest determinants of complaint persistence [regardless of (un)explicability] were duration of complaints >4 weeks before presentation (OR 2.6; 95% CI 1.6–4.3), musculoskeletal complaint at baseline (OR 2.3; 1.2–4.5), while the passage of time acted positively (OR 0.8 per month; 95% CI 0.78–0.84). Musculoskeletal complaints, compared to fatigue, decreased QoL on the physical domain (4.6 points; 2.6–6.7), while presence of psychosocial factors decreased mental QoL (5.0; 3.1–6.9).
Conclusion. One year after initial presentation, a large proportion of newly presented UCs remained unexplained and unresolved. We identified determinants that GPs might want to consider in the early detection of patients at risk of UC persistence and/or low QoL.
Keywords. Cohort study, course, general practice, unexplained complaints.
Koch H, van Bokhoven MA, Bindels PJE, van der Weijden T, Dinant GJ and ter Riet G. The course of newly presented unexplained complaints in general practice patients: a prospective cohort study. Family Practice 2009; 26: 455–465.