What are the most common conditions in primary care? Systematic review.

TLDR

The study aimed to identify the most common presenting conditions in primary care worldwide and compare clinician‑ and patient‑reported reasons for visits across countries of varying economic status. A systematic review of 12 databases up to January 2016 identified 18 primary‑care studies with ≥20 000 visits, extracting and descriptively pooling RFV rankings from 12 countries on five continents. Clinician‑reported top RFVs were upper‑respiratory tract infection, hypertension, routine health maintenance, arthritis, diabetes, depression/anxiety, pneumonia, acute otitis media, back pain, and dermatitis, while patient‑reported top RFVs were cough, back pain, abdominal symptoms, pharyngitis, dermatitis, fever, headache, leg symptoms, unspecified respiratory concerns, and fatigue, with URTI and hypertension most common globally and notable differences between developed and developing settings.

Abstract

To identify the most commonly presenting conditions in primary care globally, and to compare common reasons for visits (RFVs) as reported by clinicians and patients, as well as among countries of different economic classifications.Twelve scientific databases were searched up to January 2016, and a dual independent review was performed to select primary care studies.Studies were included if they contained 20 000 visits or more (or equivalent volume by patient-clinician interactions) and listed 10 or more RFVs. Dual independent data extraction of study characteristics and RFV rankings was performed. Data analysis was descriptive, with pooled rankings of RFVs across studies.Eighteen studies met inclusion criteria (median 250 000 patients or 83 161 visits). Data were from 12 countries across 5 continents. The 10 most common clinician-reported RFVs were upper respiratory tract infection, hypertension, routine health maintenance, arthritis, diabetes, depression or anxiety, pneumonia, acute otitis media, back pain, and dermatitis. The 10 most common patient-reported RFVs were symptomatic conditions including cough, back pain, abdominal symptoms, pharyngitis, dermatitis, fever, headache, leg symptoms, unspecified respiratory concerns, and fatigue. Globally, upper respiratory tract infection and hypertension were the most common clinician-reported RFVs. In developed countries the next most common RFVs were depression or anxiety and back pain, and in developing countries they were pneumonia and tuberculosis. There was a paucity of available data, particularly from developing countries.There are differences between clinician-reported and patient-reported RFVs to primary care, as well as between developed and developing countries. The results of our review are useful for the development of primary care guidelines, the allocation of resources, and the design of training programs and curricula.