Oded Hammerman, Daniel Halperin, Daniel Tsalihin, Dan Greenberg, Talma Kushnir, Yacov Ezra
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引用次数: 3
摘要
背景:经常出现医学上无法解释的症状(FA/MUS)在初级保健中很常见，尽管识别和治疗具有挑战性。目的:本研究旨在比较FA/MUS与FA合并器质性疾病(FA/OI)和一般临床人群(Non-FA)，以了解其人口统计学特征和医疗保健利用模式。方法:在这项回顾性观察性研究中，从以色列Be'er-Sheva一家大型初级保健诊所的Clalit Health Services获得电子医疗记录(EMR)。筛选电子病历以确定前5%的FA。根据患者是否患有成骨不全进行分层。无成骨不全的FA随后被医生证实为患有MUS。分析了FA/OI、FA/MUS和非FA的人口统计学、医疗保健利用率和成本。结果:594例FA中FA/OI 305例(53.6%)，FA/MUS 264例(46.4%)。FA/OI患者年龄较大(69.1岁vs. 56.4岁，ppp)。结论:FA/MUS比非FA患者更昂贵，并表现出独特的医疗保健利用和成本模式。FA/OI有更严重的疾病，需要住院治疗和手术干预，而FA/MUS有更多的调查和测试，试图找到他们症状的解释。
Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel.
Background: Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat.
Objectives: This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns.
Methods: For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be'er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA.
Results: Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, p<.001) and costlier (ILS27693 vs. ILS9075, p<.001) than FA/MUS. Average costs for FA/MUS were over four times higher than Non-FA (ILS9075 vs. ILS2035, p<.001). The largest disparities between FA/OI and FA/MUS were in hospitalisations (ILS6998 vs. ILS2033) and surgical procedures (ILS8143 vs. ILS3175). Regarding laboratory tests, differences were smaller between groups of FA but significantly different between FA and Non-FA.
Conclusion: FA/MUS are more costly than Non-FA and exhibit unique healthcare utilisation and costs patterns. FA/OI had more severe illnesses necessitating hospitalisations and surgical interventions, while FA/MUS had more investigations and tests, attempting to find an explanation for their symptoms.
期刊介绍：
The EJGP aims to:
foster scientific research in primary care medicine (family medicine, general practice) in Europe
stimulate education and debate, relevant for the development of primary care medicine in Europe.
Scope
The EJGP publishes original research papers, review articles and clinical case reports on all aspects of primary care medicine (family medicine, general practice), providing new knowledge on medical decision-making, healthcare delivery, medical education, and research methodology.
Areas covered include primary care epidemiology, prevention, diagnosis, pharmacotherapy, non-drug interventions, multi- and comorbidity, palliative care, shared decision making, inter-professional collaboration, quality and safety, training and teaching, and quantitative and qualitative research methods.
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