Background: Research including patients from the entire tiredness spectrum in family practice is needed.
Objectives: Our aim was to provide routine family practice data on (i) relationships between the RFE (reason for encounter) and the diagnosis "tiredness"; (ii) duration, number of encounters and family physician's (FP's) interventions in episodes of care of tiredness; and (iii) sex/age and co-morbidity of patients diagnosed with "tiredness".
Methods: Routine episode of care data from the Transition Project, coded comprehensively with the International Classification of Primary Care (ICPC), were used. (i) A 16 year database (1985-2000, 58 FPs, 504 145 episodes of care, 168 550 patient years) for calculating "prior probabilities" with (diagnostic) odds ratios. (ii) A "basic population" extracted from that 16 year database of patients listed for an entire 4 year period (1997-2000; n = 12 292).
Results: The RFE tiredness resulted in a variety of diagnoses, but most frequently (43%) in "tiredness". Most odds ratios were low or negative. Of episodes of care of tiredness, 90% started with the RFE tiredness; 72% required one encounter only, and 90% lasted <6 months. In the 4 year period, 21% of patients first presented with tiredness, and 12% were diagnosed with tiredness; both groups were skewed towards women. Average co-morbidity in tired patients (16.6) was higher than in other visiting patients (10.4), and contained more tiredness-related conditions. FPs' interventions were mainly blood test, physical exam and advice; few referrals occurred.
Conclusions: For many diagnoses, the RFE tiredness hardly contributes to the Bayesian posterior probability. FPs react differently to the RFE tiredness in cases in which they diagnose the patient with "tiredness" from how they react in other cases. The characteristics of ICPC and the Dutch health care system resulted in a full integration of tiredness as an RFE and as a freestanding episode of care in the context of family practice.