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.
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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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