Presentation of respiratory symptoms prior to diagnosis in general - PDF document

Open Access Research Presentation of respiratory symptoms prior to diagnosis in general practice: a case – control study examining free text and morbidity codes Richard A Hayward, Ying Chen, Peter Croft, Kelvin P Jordan To cite: Hayward RA, Chen Y, ABSTRACT Strengths and limitations of this study Croft P, et al . Presentation of Objective: General practitioners can record patients ’ respiratory symptoms prior to presenting symptoms by using a code or free text. We ▪ Previous studies have mainly focussed on the diagnosis in general practice: compared breathlessness and wheeze symptom codes time taken between first recording of symptoms a case – control study and free text recorded prior to diagnosis of ischaemic and diagnosis of several cancers. This novel examining free text and heart disease (IHD), chronic obstructive pulmonary morbidity codes. BMJ Open study investigates the time taken from the disease (COPD) and asthma. 2015; 5 :e007355. recording of respiratory symptoms as code or as Design: A case – control study. doi:10.1136/bmjopen-2014- free text to diagnosis. 007355 Setting: 11 general practices in North Staffordshire, ▪ General practitioner (GP) database research typ- UK, contributing to the Consultations in Primary Care ically focuses on coded information rather than ▸ Prepublication history for Archive consultation database. consultation text. However, searching for this paper is available online. Participants: Cases with an incident diagnosis of symptom codes only identified less than half of To view these files please IHD, COPD or asthma in 2010 were matched to those with a GP record of prior respiratory symp- visit the journal online controls (four per case) with no such diagnosis. All toms in patients newly diagnosed with ischaemic (http://dx.doi.org/10.1136/ prior consultations with codes for breathlessness or heart disease (IHD), chronic obstructive pulmon- bmjopen-2014-007355). wheeze symptoms between 2004 and 2010 were ary disease (COPD) or asthma. identified. Free text of cases and controls were also ▪ Time from first recorded symptom to date of Received 2 December 2014 searched for mention of these symptoms. diagnosis may be substantially shorter when the Revised 2 March 2015 search of databases is restricted to symptom Results: 592 cases were identified, 194 (33%) with Accepted 4 March 2015 codes than when expanded to include text IHD, 182 (31%) with COPD and 216 (37%) with entries as well. asthma. 148 (25%) cases and 125 (5%) controls had a ▪ However, associations between previous respira- prior coded consultation for breathlessness. Prevalence tory symptoms and diagnosis were weaker when of a prior coded symptom of breathlessness or wheeze the analysis included text search as well as was 30% in cases, 6% in controls. Median time from symptom codes. first coded symptom to diagnosis among cases was 57 weeks. After adding symptoms recorded in text, prevalence rose to 62% in cases and 25% in controls. Median time from first recorded symptom increased to patients as early as possible in the course of 144 weeks. The associations between diagnosis of their condition. General practice typically cases and prior symptom codes was strong IHD relative provides the fi rst point of access to non- risk ratio (RRR) 3.21 (2.15 to 4.79); COPD RRR 9.56 emergency UK care; more than 95% of the (6.74 to 13.60); asthma RRR 10.30 (7.17 to 14.90). population is registered with a general practi- Conclusions: There is an association between IHD, tioner (GP) to provide such care, and this COPD and asthma diagnosis and earlier consultation for setting, therefore, provides an important respiratory symptoms. Symptoms are often noted in arena for investigating prognosis and health- free text by GPs long before they are coded. Free text care among patients who fi rst consult in the searching may aid investigation of early presentation of early stages of long-term conditions. Recent long-term conditions using GP databases, and may be an important direction for future research. examples of such studies have been provided by research into the early presenting symp- Research Institute for toms of cancer. 1 2 Primary Care and Health Sciences, Keele University, GPs, however, may not necessarily diagnose Keele, Staffordshire, UK INTRODUCTION or label people with a long-term condition at these fi rst consultations. First, because it may Research into potential bene fi ts and costs of Correspondence to not be obvious that the illness represents the early intervention in people with long-term Dr R A Hayward; presenting symptom of a long-term condition conditions will be helped by identifying such r.hayward@keele.ac.uk 1 Hayward RA, et al . BMJ Open 2015; 5 :e007355. doi:10.1136/bmjopen-2014-007355