Examining the symptom of fatigue in primary care: a comparative study using electronic medical records.

Kathryn Nicholson,Amardeep Thind,Moira Stewart

doi:10.14236/jhi.v22i1.91

Abstract

The symptom of fatigue is one of the top five most frequently presented health complaints in primary care, yet it remains underexplored in the Canadian primary care context. The objective of this study was to examine the prevalence and impact of patients presenting with fatigue in primary care, using the only known electronic database in Canada to capture patient-reported symptoms. Data were extracted from the Deliver Primary Healthcare Information (DELPHI) database, an electronic medical record database located in Ontario, Canada. Patients were identified using the International Classification of Primary Care, Revised Second Edition coding system. Two groups of patients (fatigue or non-fatigue symptom) were followed for one year and compared. Both descriptive and multivariable analyses were conducted. A total of 103 fatigue symptom patients, and 103 non-fatigue symptom patients, were identified in the DELPHI database. The period prevalence of fatigue presentation was 8.2%, with the majority of patients being female and over 60 years of age. These patients experienced numerous co-occurring morbidities, in addition to the fatigue itself. During the one year follow-up period, fatigue symptom patients had significantly higher rates of subsequent visits (IRR = 1.19, p = 0.038) and investigations (IRR = 1.68, p < 0.001), and markedly high levels of referrals following their index visit. This research used an electronic database to examine the symptom, fatigue. Using these data, fatigue symptom patients were found to have higher rates of health care utilisation, compared to non-fatigue symptom patients.

Highlights

This study found that 8.2% of the ICPC-2-R-coded patients over a one year period had at least one in-office visit in which the reason for their encounter was fatigue
This study examined the period prevalence, demographic characteristics, co-occurring morbidity and health care use patterns of patients who presented to their primary care provider with the symptom of fatigue
Our study demonstrated that almost one in 10 primary care patient visits were for the symptom of fatigue

Summary

Introduction

MethodsFatigue is one of the most frequently presented symptoms in primary care.[1,2] The prevalence of fatigue symptoms among primary care encounters has been estimated to be between 5% and 7%, depending on the definition of fatigue, with substantial associated health system costs.[2,3,4,5,6,7,8,9,10] This common, yet complex, complaint represents a challenge for the primary care provider.[3,4,5] Often, fatigue symptoms can be a non-specific indicator of underlying physiological pathology, psychosocial distress or a combination of causes.[11]. Objective The objective of this study was to examine the prevalence and impact of patients presenting with fatigue in primary care, using the only known electronic database in Canada to capture patient-reported symptoms. Two groups of patients (fatigue or non-fatigue symptom) were followed for one year and compared. The period prevalence of fatigue presentation was 8.2%, with the majority of patients being female and over 60 years of age. These patients experienced numerous co-occurring morbidities, in addition to the fatigue itself. Conclusions This research used an electronic database to examine the symptom, fatigue Using these data, fatigue symptom patients were found to have higher rates of health care utilisation, compared to non-fatigue symptom patients

Objectives

Results

Conclusion