WHAT ARE THE MOST COMMON CONDITIONS IN PRIMARY CARE?

Finley C, Chan DS, Garrison S, Korownyk C, Kolber MR, Campbell S, Eurich D, Lindblad A,

Vandermeer B, Allan GM.

DISCLOSURE/COI

• Caitlin Finley, University of Alberta

• Relationships with commercial interests:

• Grants/Research Support – None

• Speakers Honoraria – None

• Consulting Fees – None

• Other - None

BACKGROUND

• What do you think are the most common conditions in primary care?

• No systematic review looking at the most common conditions in primary care

• Identify priorities for researchers, administrators, and policy makers

• Planning and allocation of resources, guide training of primary care professionals

OBJECTIVES

• To systematically identify the reasons patients visit primary care globally;

• To compare presentations to primary care between developed & developing countries.

METHODS

• Inclusion:

• 1) Study setting was general practice and/or primary care;

• 2) Minimum of 10 reasons for visits;

• 3) Minimum 20 000 visits (or equivalent)

• Exclusion:

• 1) Focused on a specific type of condition or presentation (e.g. periodic health exam visits);

• 2) Focused on specific conditions or problems (e.g. acute conditions, opioid use);

• 3) Selected specific populations (e.g. adolescents);

• 4) Indicated that study population was referred to primary care (e.g. to pediatrics or internal medicine);

• 5) Were published before 1996 (i.e. 1995 and earlier publication date)

STUDY FLOW

• 18 studies included in final assessment

• 10 reported specific reasons for visits (14 analyses)

• Remaining studies included for subgroup analysis

STUDY CHARACTERISTICS

# of studies Range

Number of visits 16 4,383 – 435,800,000

Number of clinicians 12 9 – 7,400

Population served 7 9,896 – 2,780,270

Sampling duration 15 1 day – 11 years

Years of data collection 18 1990-2015

STUDY CHARACTERISTICS

QUALITY ASSESSMENT

Criteria Low quality High quality

Representative sample of clinicians 7 11Representative sample of patients 1 17Used a defined coding system 3 15Prolonged data collection (³1 year) 4 14Data collected prospectively (vs. retrospectively) 3 15

RESULTS I

Clinician-reported and patient-reported results

Clinician Reported Patient ReportedRank Condition Rank Condition

1Upper Respiratory Tract Infection,

Unspecified1 Cough

2 Hypertension 2 Back Pain/ Spinal Pain

3 Routine Health Maintenance 3 Abdominal unspecified

4 Arthritis (not back) 4 Pharyngitis

5 Diabetes 5 Dermatitis

6 Depression or Anxiety 6 Fever

7 Pneumonia 7 Headache

8 Acute Otitis Media 8 Leg Symptoms

9 Back Pain/ Spinal Pain 9 Respiratory unspecified

10 Dermatitis 10 Fatigue

11 Cough 11 Depression or Anxiety

12 Urinary Tract Infection 12 Arthritis (not back)

Clinician Reported Patient ReportedRank Condition Rank Condition

1Upper Respiratory Tract Infection,

Unspecified1 Cough

2 Hypertension 2 Back Pain/ Spinal Pain

3 Routine Health Maintenance 3 Abdominal unspecified

4 Arthritis (not back) 4 Pharyngitis

5 Diabetes 5 Dermatitis

6 Depression or Anxiety 6 Fever

7 Pneumonia 7 Headache

8 Acute Otitis Media 8 Leg Symptoms

9 Back Pain/ Spinal Pain 9 Respiratory unspecified

10 Dermatitis 10 Fatigue

11 Cough 11 Depression or Anxiety

12 Urinary Tract Infection 12 Arthritis (not back)

RESULTS II

Developed and developing countries results

Developed Countries Developing CountriesRank Condition Rank Condition

1 Hypertension 1Upper Respiratory Tract Infection,

Unspecified

2Upper Respiratory Tract Infection,

Unspecified2 Hypertension

Developed Countries Developing CountriesRank Condition Rank Condition

1 Hypertension 1Upper Respiratory Tract Infection,

Unspecified

2Upper Respiratory Tract Infection,

Unspecified2 Hypertension

3 Depression or Anxiety 3 Pneumonia

4 Back Pain 4 Tuberculosis

5 Routine Health Maintenance 5 Parasites

6 Arthritis (not back) 6 Anemia

7 Dermatitis 7 Diabetes

8 Acute Otitis Media 8 Arthritis (not back)

9 Diabetes 9 Bronchitis/ bronchiolitis

10 Cough 10 Epilepsy

11 Medication 11 Urinary Tract Infection

12 Urinary Tract Infection 12 Tonsillitis

CONCLUSIONS

• Primary care physicians see a wide variety of conditions, involving many body systems and specialties• Differences exist between: • Clinician-reported and patient-reported reasons for

visits, and• Developed and developing countries regarding common

conditions

QUESTIONS?