Chronic non-specific abdominal complaints in general practice: a prospective study on management, patient health status and course of complaints

BACKGROUND: While in general practice chronic non-specific abdominal complaints are common, there is insufficient data on the clinical course and the management of these complaints. Aim of this study was to present a primary care based profile of these chronic complaints including health care involvement, health status and clinical course. METHODS: Thirty general practitioners (GPs) and patients from their practices participated in a prospective follow-up study. All patients and GPs were asked to complete questionnaires at baseline and at 6, 12 and 18 months of follow-up. The GPs provided information on diagnostic and therapeutic management and on referral concerning 619 patients with chronic non-specific abdominal complaints, while 291 patients provided information about health status and clinical course of the complaints. RESULTS: When asked after 18 months of follow-up, 51,7% of the patients reported an equal or worsened severity of complaints. General health perception was impaired and patients had high scores on SCL-anxiety and SCL-depression scales. Diagnostic tests other than physical examination and laboratory tests were not frequently used. Medication was the most frequent type of treatment. The persistence of chronic non-specific abdominal complaints was quite stable. CONCLUSION: Once non-specific chronic abdominal complaints have become labelled as chronic by the attending physician, little improvement can be expected. The impact on patients' physiological and psychological well-being is large. GPs use a variety of diagnostic and therapeutic strategies. Research into the evidence base of currently applied management strategies is recommended

Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting

The aim of the present study was to determine whether a diagnosis of diabetes mellitus (DM) in a primary setting is associated with an increased risk of subsequent depression. A retrospective cohort design was used based on the Registration Network Family Practice (RNH) database. Patients diagnosed with diabetes mellitus at or after the age of 40 and who were diagnosed between 01-01-1980 and 01-01-2007 (N = 6,140), were compared with age-matched controls from a reference group (N = 18,416) without a history of diabetes. Both groups were followed for an emerging first diagnosis of depression (and/or depressive feelings) until January 1, 2008. 2.0% of the people diagnosed with diabetes mellitus developed a depressive disorder, compared to 1.6% of the reference group. After statistical correction for confounding factors diabetes mellitus was associated with an increased risk of developing subsequent depression (HR 1.26; 95% CI: 1.12–1.42) and/or depressive feelings (HR 1.33; 95% CI: 1.18–1.46). After statistical adjustment practice identification code, age and depression preceding diabetes, were significantly related to a diagnosis of depression. Patients with diabetes mellitus are more likely to develop subsequent depression than persons without a history of diabetes. Results from this large longitudinal study based on a general practice population indicate that this association is weaker than previously found in cross-sectional research using self-report surveys. Several explanations for this dissimilarity are discussed

Health status and management of chronic non-specific abdominal complaints in general practice

BACKGROUND: While chronic non-specific abdominal complaints are common in general practice, data on patients' perspective and management of these complaints are lacking. Knowledge of these data is important for the development of guidelines for management and assessment of the burden of chronic non-specific abdominal complaints on society. AIM: To draw a comprehensive picture of chronic non-specific abdominal complaints in general practice, including volume, patients' perspective, and health care involvement. METHOD: In a retrospective study, 644 patients were selected in 16 general practices. Patients and general practitioners (GPs) received a questionnaire regarding the nature of complaints and health care management during the previous 12 months. RESULTS: Overall, 619 questionnaires were returned and 291 patients participated. Of the study population, 15% of patients were diagnosed as suffering from non-ulcer dyspepsia, 39% from irritable bowel syndrome, and 45% from other abdominal complaints. Over 50% of patients suffered from chronic non-specific abdominal complaints on a daily or weekly basis. In these patients, general health perception is impaired and above norm scores on SCL-anxiety and SCL-depression scales were recorded. Only 4% of patients showed complete resolution of complaints during the previous 12 months. Fifty-two per cent of patients consulted their GP for abdominal complaints. Diagnostic modalities were used frequently. Medication was prescribed in 83% of patients with abdominal complaints. Twenty per cent of patients were referred to secondary or tertiary care. There was a considerable inter-doctor variation in the management of chronic non-specific abdominal complaints. CONCLUSION: Once non-specific abdominal complaints have become chronic they are mainly managed by the GP. The impact on patients' physiological and psychological well being is large. Diagnostic and therapeutic modalities are frequently used. Given the considerable inter-doctor variation, research into the evidence base of management strategies is recommended

Routinely collected general practice data: Goldmines for research?

Background: Much of European primary care is computerised and many groups of practices pool data for research. Technology is making pooled general practice data widely available beyond the domain within which it is collected. Objective: To explore the barriers and opportunities to exploiting routinely collected general practice data for research. Method: Workshop, led by primary care and informatics academics experienced at working with clinical data from large databases, involving 23 delegates from eight countries. Email comments about the write-up from participants. Outputs: The components of an effective process are: • the input of those who have a detailed understanding of the context in which the data were recorded • an assessment of the validity of these data and any denominator used • creation of anonymised unique identifiers for each patient which can be decoded within the contributing practices • data must be traceable back to the patient record from which it was extracted • archiving of the queries, the look-up tables of any coding systems used and the ethical constraints which govern the use of the data. Conclusions: Explicit statements are needed to explain the source, context of recording, validity check and processing method of any routinely collected data used in research. Data lacking detailed methodological descriptors should not be published. © 2006 PHCSG, British Computer Society

Routinely collected general practice data: Goldmines for research?

Background: Much of European primary care is computerised and many groups of practices pool data for research. Technology is making pooled general practice data widely available beyond the domain within which it is collected. Objective: To explore the barriers and opportunities to exploiting routinely collected general practice data for research. Method: Workshop, led by primary care and informatics academics experienced at working with clinical data from large databases, involving 23 delegates from eight countries. Email comments about the write-up from participants. Outputs: The components of an effective process are: • the input of those who have a detailed understanding of the context in which the data were recorded • an assessment of the validity of these data and any denominator used • creation of anonymised unique identifiers for each patient which can be decoded within the contributing practices • data must be traceable back to the patient record from which it was extracted • archiving of the queries, the look-up tables of any coding systems used and the ethical constraints which govern the use of the data. Conclusions: Explicit statements are needed to explain the source, context of recording, validity check and processing method of any routinely collected data used in research. Data lacking detailed methodological descriptors should not be published. © 2006 PHCSG, British Computer Society

Disease-specific comparison of the registered morbidity in four morbidity registrations in general practice: an analysis for Public Health Status and Forecast 1993

In de Volksgezondheid Toekomst Verkenning (VTV) wordt voor het beschrijven van het voorkomen van ziekten en aandoeningen onder andere gebruik gemaakt van gegevens van huisartsgeneeskundige registraties. Een probleem voor VTV is dat de registraties in Nederland, om geheel plausibele redenen, van elkaar verschillen in de doelstelling waarvoor zij zijn opgezet. De consequentie daarvan is dat gebruikte classificatiesystemen, codeerregels en rekenwijzen nogal van elkaar kunnen verschillen en dat gemeten morbiditeit niet op voorhand vergelijkbaar is. Daarom is een vergelijkende analyse tussen de vier belangrijkste huisartsenregistraties gemaakt, zodat een beter inzicht in de betekenis van cijfers uit deze huisartsenregistraties verkregen kon worden. Deze analyse bestond uit drie onderdelen. Ten eerste is een algemene beschrijving van de registratiekenmerken van de vier huisartsenregistraties gemaakt, met speciale aandacht voor prevalentie- en incidentiebepalingen ten behoeve van VTV. Een tweede onderdeel betrof het samenstellen van een tabellarisch overzicht van de empirisch aangetroffen prevalenties en incidenties. Een derde onderdeel betrof de inhoudelijke vergelijking van de registraties per ziekte. Voor de meeste ziekten kon meer inzicht verkregen worden in de betekenis van de cijfers en voor sommige ziekten konden de aangetroffen verschillen in prevalentie en incidentie min of meer verklaard worden. Soms bleken verschillen echter onverklaarbaar groot te zijn. Beschreven zijn enkele alternatieve mogelijkheden voor het presenteren van cijfers uit huisartsenregistraties in VTV. Omdat de bestaande situatie voor VTV verre van optimaal is, wordt ten slotte gepleid voor het verkennen van de mogelijkheden om ten behoeve van VTV-2001 en volgende VTV's tot een beter passende oplossing te komen.To describe the occurrence of diseases (incidence and prevalence rates) in the Public Health Status and Forecast (PHSF) report, data of morbidity registrations in general practice are used. A problem for using these in the PHSF report is that the registrations differ from each other in the aim, the design, the operationalisation of the different concepts and the classification system. The consequence is that the morbidity figures are not at once comparable. That's why an analysis of the four most important morbidity systems was made, so we can get a better understanding of the incidence and prevalence rates. This analysis consisted of three parts. First, a general description was made of the characteristics of the four morbidity registrations, with special attention for the calculation of the incidence and prevalence rates on behalf of the PHSF project. Secondly, a large table was made in which incidence and prevalence rates of the morbidity systems were brought together. Thirdly a disease-specific comparison was made. In general terms it appeared not possible to typify one of the considered registrations as the best for the aims of the PHSF project. For most of the diseases more insight was obtained about the meaning of the figures. Sometimes differences in the figures could be explained more of less. Nevertheless for a number of diseases the differences appeared to be unaccountable large. We described some alternative possibilities for presenting figures from morbidity registrations in general practice in the PHSF report. Because the existing situation in the morbidity registration in general practice is far from ideal, it is recommended to explore the possibilities for coming to a better solution for PHSF-2001 and other PHSFs.VW