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The Prevalence of Symptoms in Medical Outpatients and the Adequacy of Therapy
Abstract
Common symptoms account for substantial patient disability and health services utilization. To determine the prevalence of 15 symptoms and the adequacy of therapy, 500 medical outpatients were surveyed. The 410 respondents indicated which symptoms were "major problems" and what therapy, if any, had been helpful. Each symptom was present in at least 10% of patients, with the most prevalent symptoms being fatigue (33%) and back pain (32%). Patients were clustered into three groups: (1) 140 were asymptomatic or monosymptomatic, (2) 135 reported 2 or 3 symptoms, and (3) 135 had 4 or more symptoms. The majority (77%) of these symptoms had been previously reported to a physician. Whereas 80% of patients with pain syndromes and gastrointestinal complaints had obtained some therapeutic benefit, only 39% of the individuals with fatigue, dyspnea, dizziness, insomnia, sexual dysfunction, depression, and anxiety reported any relief. Better therapy is needed for these common outpatient complaints.
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“Kroenke et al. [4] found further that these complaints are chronic.”
From Treatment of somatization in primary care (1997) · cites this paper as [4]
In the citing paper
“Thus, in the absence of treatment, complaints of somatization, anxiety, and depression tend to remain fairly stable over time in our study sample, consistent with Kroenke et al.'s findings [4].”
From Treatment of somatization in primary care (1997) · cites this paper as [4]
In the citing paper
“Kroenke et al. [4] suggest that this group of patients is poorly treated in primary care, related to the perceived unavailability of effective treatment options.”
From Treatment of somatization in primary care (1997) · cites this paper as [4]
In the citing paper
“Unexplained syncope, dizziness, and palpitations are among the most common reasons that patients present to internists and cardiologists. 1, 2”
In the citing paper
“where currently these conditions account for up to one-fifth of all referrals) [30], [31], [32], [33]”
From Multi-centre Randomised Controlled Trial of a Smartphone-based Event Recorder Alongside Standard Care Versus Standard Care for Patients Presenting to the Emergency Department with Palpitations and Pre-syncope: The IPED (Investigation of Palpitations in the ED) study (2019) · cites this paper as [32]
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BackgroundInfluentialDistinctive Patterns of Medical Care Utilization in Patients Who Somatize
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Cardiac Syndrome X and Microvascular Coronary Dysfunction
Jones, E., Eteiba, W., & Merz, C. N. B. (2012) · Trends in Cardiovascular Medicine · doi:10.1016/j.tcm.2012.07.014 · Cited by 74
“Chest pain evaluation remains a challenge in medical practice, comprising 7%–24% of the primary care population visits (Kroenke et al. 1990).”
Panic disorder in the general medical setting
Zaubler, T. S., & Katon, W. J. (1998) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(97)00134-7 · Cited by 74
Treatment of somatization in primary care
McLeod, C. C., Budd, M. A., & McClelland, D. C. (1997) · General Hospital Psychiatry · doi:10.1016/s0163-8343(97)00047-9 · Cited by 73
Ang, D. C., Bair, M. J., Damush, T. M., Wu, J., Tu, W., & Kroenke, K. (2010) · Pain Medicine · doi:10.1111/j.1526-4637.2009.00759.x · Cited by 72
Heart-focused anxiety before and after cardiac surgery
Hoyer, J., Eifert, G. H., Einsle, F., Zimmermann, K., Krauss, S., Knaut, M., Matschke, K., & Köllner, V. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.09.009 · Cited by 97
“Studies from the United States show that approximately 15–20% of all general medical visits are precipitated by cardiopulmonary symptoms [4].”
BackgroundBair, M. J., Brizendine, E. J., Ackermann, R. T., Shen, C., Kroenke, K., & Marrero, D. G. (2010) · Diabetic Medicine · doi:10.1111/j.1464-5491.2010.02971.x · Cited by 75
Roy, S., Sherman, A., Monari-Sparks, M., Schweiker, O., & Hunter, K. M. (2014) · North American Journal of Medical Sciences · doi:10.4103/1947-2714.139291 · Cited by 78
“The study was reviewed and approved by the Institutional Review Board of the Cooper Health System, Camden, New Jersey, USA.”
BackgroundInfluentialKop, W. J., Toussaint, A. C., Mols, F., & Löwe, B. (2018) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2018.10.004 · Cited by 75
The relationship of nausea and dyspnea to pain in seriously ill patients
Desbiens, N. A., Mueller‐Rizner, N., Connors, A. F., & Wenger, N. S. (1997) · Pain · doi:10.1016/s0304-3959(97)03353-8 · Cited by 71
“Introduction Pain is one of the most frequent symptoms in general (Crook et al., 1984; Andersson et al., 1993), outpatient (Kroenke et al., 1990) and hospital (Donovan et al., 1987; Abbott et al., 1992; Desbiens et al., 1996) populations, and the medical literature suggests that pain control in…”
BackgroundTo Treat or Not to Treat Subclinical Hypothyroidism, What Is the Evidence?
Calissendorff, J., & Falhammar, H. (2020) · Medicina · doi:10.3390/medicina56010040 · Cited by 75
The SPADE Symptom Cluster in Primary Care Patients With Chronic Pain
Davis, L. L., Kroenke, K., Monahan, P. O., Kean, J. T., & Stump, T. E. (2015) · Clinical Journal of Pain · doi:10.1097/ajp.0000000000000286 · Cited by 68
Toussaint, A. C., Kroenke, K., Baye, F. M., & Lourens, S. G. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.08.002 · Cited by 69
Baliatsas, C., KAMP, I. V., Hooiveld, M., Yzermans, J. C., & Lebret, E. (2014) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2014.02.008 · Cited by 63
“More than 80% of the general population experiences at least one of such non-specific physical symptoms (NSPS) in any given month [1,2].”
BackgroundPain in the Oldest‐Old During Hospitalization and Up to One Year Later
Desbiens, N. A., Mueller‐Rizner, N., Connors, A. F., Hamel, M. B., & Wenger, N. S. (1997) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1997.tb03765.x · Cited by 64
Depression, anxiety and post-traumatic growth among COVID-19 survivors six-month after discharge
Xiao, X., Yang, X., Zheng, W., Wang, B., Fu, L., Luo, D., Hu, Y., Ju, N., Xu, H., Fang, Y., et al. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2055294 · Cited by 72
Placebo and nocebo effects across symptoms: from pain to fatigue, dyspnea, nausea, and itch
Wolters, F., Peerdeman, K. J., & Evers, A. W. M. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00470 · Cited by 57
The clinical course of palpitations in medical outpatients
Barsky, A. J. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.1995.00430160124012 · Cited by 61
Somatoform Disorders and Recent Diagnostic Controversies
Kroenke, K. (2007) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2007.08.002 · Cited by 65
Frequency and Priority of Pain Patients' Health Care Use
Korff, M. V., Lin, E. H. B., Fenton, J. J., & Saunders, K. W. (2007) · Clinical Journal of Pain · doi:10.1097/ajp.0b013e31804ac020 · Cited by 62
“Prior research has shown that persons with common physical symptoms use ambulatory health care at increased rates,(9) and that persons who seek health care for common physical symptoms usually do not have an underlying condition that is well-defined or medically serious.(10) There may also be individual differences in…”
MethodPrevalence of chronic fatigue among Chinese adults in Hong Kong: A population-based study
Wong, W. S., & Fielding, R. (2010) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.04.029 · Cited by 61
“Previous epidemiologic studies have shown that about 25% to 37% of patients attending primary care practice were affected by prolonged fatigue symptoms (Bates et al., 1993; Buchwald et al., 1987; Kroenke et al., 1990; Kroenke and Price, 1993; Kroenke et al., 1988).”
Background
Metadata
- Authors
- Arrington, M. E.
- Affiliations
- Brooke Army Medical Center (US)
- Corresponding author
- Arrington, Mary E.
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1990-08-01
- Volume
- 150
- Issue
- 8
- Pages
- 1685
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2113252270
- Semantic Scholar
- 63de2f205022589d0f516cda571e061ccb1e8c33
- Cited by
- 367
- References
- 22
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 10 · 2022: 9 · 2021: 10 · 2020: 11 · 2019: 7 · 2018: 15 · 2017: 9 · 2016: 12 · 2015: 11 · 2014: 22 · 2013: 10 · 2012: 11
- FWCI
- 5.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Keywords
- symptom prevalence, medical outpatients, treatment adequacy, fatigue, back pain, symptom clusters, patient-reported outcomes, treatment effectiveness, dyspnea, dizziness, insomnia, sexual dysfunction, depression, anxiety, gastrointestinal problems, pain syndromes
- MeSH terms
- Adult, Aged, Ambulatory Care, Female, Gastrointestinal Diseases, Humans, Internal Medicine, Male, Middle Aged, Morbidity, Pain, Prevalence, Mood Disorders, Pain Management
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