Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations
Background: Iron deficiency anaemia (IDA) may be a sign of significant gastrointestinal disease, and delayed diagnosis may result in chronic morbidity. Studies in patients referred to hospital for investigation of their anaemia have shown that 5%–15% have a gastrointestinal cancer but there are few...
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| Veröffentlicht in: | Postgraduate medical journal 2004-07, Vol.80 (945), p.405-410 |
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| description | Background: Iron deficiency anaemia (IDA) may be a sign of significant gastrointestinal disease, and delayed diagnosis may result in chronic morbidity. Studies in patients referred to hospital for investigation of their anaemia have shown that 5%–15% have a gastrointestinal cancer but there are few studies of patients presenting to primary care. Factors influencing further investigation in these patients have not previously been identified. Patients and methods: A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. Logistic regression was used to determine which factors influenced GPs to investigate the anaemia. Results: 43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. Independent predictors of non-investigation were a mild anaemia (odds ratio (OR) 0.38, confidence interval (CI) 0.23 to 0.61, p |
| doi_str_mv | 10.1136/pgmj.2003.015677 |
| format | Article |
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Studies in patients referred to hospital for investigation of their anaemia have shown that 5%–15% have a gastrointestinal cancer but there are few studies of patients presenting to primary care. Factors influencing further investigation in these patients have not previously been identified. Patients and methods: A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. Logistic regression was used to determine which factors influenced GPs to investigate the anaemia. Results: 43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. Independent predictors of non-investigation were a mild anaemia (odds ratio (OR) 0.38, confidence interval (CI) 0.23 to 0.61, p<0.001), female gender (OR 0.49, CI 0.3 to 0.8, p = 0.004), a previous history of anaemia (OR 0.39, CI 0.24 to 0.64, p<0.001), and age <65 years (OR 0.44, CI 0.26 to 0.74, p = 0.002). During the entire study period gastrointestinal cancer was diagnosed in 48 patients (11%); 17% of men had colorectal cancer. Of 263 patients alive at 12 months without a confirmed diagnosis, 113 (43%) had recurrent or persistent anaemia during the study period. Conclusion: Although the overall prevalence of gastrointestinal cancer in patients presenting to primary care is similar to that seen in secondary care, the diagnosis may be delayed due to lack of appropriate investigations resulting in significant morbidity.</description><identifier>ISSN: 0032-5473</identifier><identifier>EISSN: 1469-0756</identifier><identifier>DOI: 10.1136/pgmj.2003.015677</identifier><identifier>PMID: 15254305</identifier><language>eng</language><publisher>London: The Fellowship of Postgraduate Medicine</publisher><subject>Adult ; Aged ; Anemia, Iron-Deficiency - etiology ; Anemia, Iron-Deficiency - mortality ; Anemia, Iron-Deficiency - therapy ; Anemias. Hemoglobinopathies ; Biological and medical sciences ; British Society of Gastroenterology ; BSG ; Cancer ; Celiac disease ; clinical outcomes ; colorectal cancer ; confidence interval ; Confidence intervals ; Diseases of red blood cells ; Family medical history ; Family Practice ; Female ; Follow-Up Studies ; Gastrointestinal Diseases - diagnosis ; Gastrointestinal Diseases - etiology ; Gastrointestinal Diseases - mortality ; General aspects ; general practice ; general practitioner ; Hematologic and hematopoietic diseases ; Humans ; IDA ; iron deficiency anaemia ; Laboratories ; Male ; Medical sciences ; Metabolic diseases ; Metals (hemochromatosis...) ; Middle Aged ; odds ratio ; Original ; Other metabolic disorders ; Patients ; Studies ; Treatment Outcome</subject><ispartof>Postgraduate medical journal, 2004-07, Vol.80 (945), p.405-410</ispartof><rights>Copyright 2004 The Fellowship of Postgraduate Medicine</rights><rights>2004 INIST-CNRS</rights><rights>Copyright: 2004 Copyright 2004 The Fellowship of Postgraduate Medicine</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b456t-70018fc00c11b06875a4deb30118c8692a0825dc2ba8c1e3cf5e1882c08d243f3</citedby><cites>FETCH-LOGICAL-b456t-70018fc00c11b06875a4deb30118c8692a0825dc2ba8c1e3cf5e1882c08d243f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743059/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743059/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15970045$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15254305$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yates, J M</creatorcontrib><creatorcontrib>Logan, E C M</creatorcontrib><creatorcontrib>Stewart, R M</creatorcontrib><title>Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations</title><title>Postgraduate medical journal</title><addtitle>Postgrad Med J</addtitle><description>Background: Iron deficiency anaemia (IDA) may be a sign of significant gastrointestinal disease, and delayed diagnosis may result in chronic morbidity. Studies in patients referred to hospital for investigation of their anaemia have shown that 5%–15% have a gastrointestinal cancer but there are few studies of patients presenting to primary care. Factors influencing further investigation in these patients have not previously been identified. Patients and methods: A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. Logistic regression was used to determine which factors influenced GPs to investigate the anaemia. Results: 43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. Independent predictors of non-investigation were a mild anaemia (odds ratio (OR) 0.38, confidence interval (CI) 0.23 to 0.61, p<0.001), female gender (OR 0.49, CI 0.3 to 0.8, p = 0.004), a previous history of anaemia (OR 0.39, CI 0.24 to 0.64, p<0.001), and age <65 years (OR 0.44, CI 0.26 to 0.74, p = 0.002). During the entire study period gastrointestinal cancer was diagnosed in 48 patients (11%); 17% of men had colorectal cancer. Of 263 patients alive at 12 months without a confirmed diagnosis, 113 (43%) had recurrent or persistent anaemia during the study period. Conclusion: Although the overall prevalence of gastrointestinal cancer in patients presenting to primary care is similar to that seen in secondary care, the diagnosis may be delayed due to lack of appropriate investigations resulting in significant morbidity.</description><subject>Adult</subject><subject>Aged</subject><subject>Anemia, Iron-Deficiency - etiology</subject><subject>Anemia, Iron-Deficiency - mortality</subject><subject>Anemia, Iron-Deficiency - therapy</subject><subject>Anemias. Hemoglobinopathies</subject><subject>Biological and medical sciences</subject><subject>British Society of Gastroenterology</subject><subject>BSG</subject><subject>Cancer</subject><subject>Celiac disease</subject><subject>clinical outcomes</subject><subject>colorectal cancer</subject><subject>confidence interval</subject><subject>Confidence intervals</subject><subject>Diseases of red blood cells</subject><subject>Family medical history</subject><subject>Family Practice</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal Diseases - diagnosis</subject><subject>Gastrointestinal Diseases - etiology</subject><subject>Gastrointestinal Diseases - mortality</subject><subject>General aspects</subject><subject>general practice</subject><subject>general practitioner</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>IDA</subject><subject>iron deficiency anaemia</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Metabolic diseases</subject><subject>Metals (hemochromatosis...)</subject><subject>Middle Aged</subject><subject>odds ratio</subject><subject>Original</subject><subject>Other metabolic disorders</subject><subject>Patients</subject><subject>Studies</subject><subject>Treatment Outcome</subject><issn>0032-5473</issn><issn>1469-0756</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc1v1DAQxSMEokvhzglZQnBBWewk_kgPSGgFtFJVivi4Wo4zSb0k9mInK_bIf86sdlUKF04eeX7z9GZelj1ldMlYKV5v-nG9LCgtl5RxIeW9bMEqUedUcnE_W2CjyHkly5PsUUprSlkpK_YwO2G84FVJ-SL7dRGDJy10zjrwdkeMNzA6Q5wnPXiIZiCbaOzkLJwROzjvLH6FebJhhETCFiKZbiIA2YGJCedb0iEfsHa-G2ZUdb4nrTO9Dwl18HsLWPRmcsGnx9mDzgwJnhzf0-zr-3dfVuf55ccPF6u3l3lTcTHlEt2rzlJqGWuoUJKbqoWmpIwpq0RdGKoK3tqiMcoyKG3HgSlVWKraoiq78jR7c9DdzM0IrQU_4XJ6E91o4k4H4_TfHe9udB-2msn9qWoUeHkUiOHHjBvo0SULw2A8hDlpISRaoArB5_-A6zBHj8uhlmK8LupCIEUPlI0hpQjdrRVG9T5dvU9X79PVh3Rx5NndFf4MHONE4MURMAlj6qLB46c7XI1nrPZcfuBcmuDnbd_E71rIUnJ99W2lP4tP1-rqnOpr5F8d-AYd_dfmb-eNzVI</recordid><startdate>20040701</startdate><enddate>20040701</enddate><creator>Yates, J M</creator><creator>Logan, E C M</creator><creator>Stewart, R M</creator><general>The Fellowship of Postgraduate Medicine</general><general>BMJ</general><general>Oxford University Press</general><general>BMJ Group</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20040701</creationdate><title>Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations</title><author>Yates, J M ; Logan, E C M ; Stewart, R M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b456t-70018fc00c11b06875a4deb30118c8692a0825dc2ba8c1e3cf5e1882c08d243f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anemia, Iron-Deficiency - etiology</topic><topic>Anemia, Iron-Deficiency - mortality</topic><topic>Anemia, Iron-Deficiency - therapy</topic><topic>Anemias. Hemoglobinopathies</topic><topic>Biological and medical sciences</topic><topic>British Society of Gastroenterology</topic><topic>BSG</topic><topic>Cancer</topic><topic>Celiac disease</topic><topic>clinical outcomes</topic><topic>colorectal cancer</topic><topic>confidence interval</topic><topic>Confidence intervals</topic><topic>Diseases of red blood cells</topic><topic>Family medical history</topic><topic>Family Practice</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrointestinal Diseases - diagnosis</topic><topic>Gastrointestinal Diseases - etiology</topic><topic>Gastrointestinal Diseases - mortality</topic><topic>General aspects</topic><topic>general practice</topic><topic>general practitioner</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>IDA</topic><topic>iron deficiency anaemia</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Metabolic diseases</topic><topic>Metals (hemochromatosis...)</topic><topic>Middle Aged</topic><topic>odds ratio</topic><topic>Original</topic><topic>Other metabolic disorders</topic><topic>Patients</topic><topic>Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yates, J M</creatorcontrib><creatorcontrib>Logan, E C M</creatorcontrib><creatorcontrib>Stewart, R M</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Science Database (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Postgraduate medical journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yates, J M</au><au>Logan, E C M</au><au>Stewart, R M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations</atitle><jtitle>Postgraduate medical journal</jtitle><addtitle>Postgrad Med J</addtitle><date>2004-07-01</date><risdate>2004</risdate><volume>80</volume><issue>945</issue><spage>405</spage><epage>410</epage><pages>405-410</pages><issn>0032-5473</issn><eissn>1469-0756</eissn><abstract>Background: Iron deficiency anaemia (IDA) may be a sign of significant gastrointestinal disease, and delayed diagnosis may result in chronic morbidity. Studies in patients referred to hospital for investigation of their anaemia have shown that 5%–15% have a gastrointestinal cancer but there are few studies of patients presenting to primary care. Factors influencing further investigation in these patients have not previously been identified. Patients and methods: A cohort of patients presenting to their general practitioners (GPs) with IDA was identified and clinical outcomes recorded. Logistic regression was used to determine which factors influenced GPs to investigate the anaemia. Results: 43% of patients had investigations within three months and serious pathology was found in 30% of these; 13% of patients were considered unfit for further investigation and 8% refused to have any. Independent predictors of non-investigation were a mild anaemia (odds ratio (OR) 0.38, confidence interval (CI) 0.23 to 0.61, p<0.001), female gender (OR 0.49, CI 0.3 to 0.8, p = 0.004), a previous history of anaemia (OR 0.39, CI 0.24 to 0.64, p<0.001), and age <65 years (OR 0.44, CI 0.26 to 0.74, p = 0.002). During the entire study period gastrointestinal cancer was diagnosed in 48 patients (11%); 17% of men had colorectal cancer. Of 263 patients alive at 12 months without a confirmed diagnosis, 113 (43%) had recurrent or persistent anaemia during the study period. Conclusion: Although the overall prevalence of gastrointestinal cancer in patients presenting to primary care is similar to that seen in secondary care, the diagnosis may be delayed due to lack of appropriate investigations resulting in significant morbidity.</abstract><cop>London</cop><pub>The Fellowship of Postgraduate Medicine</pub><pmid>15254305</pmid><doi>10.1136/pgmj.2003.015677</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anemia, Iron-Deficiency - etiology Anemia, Iron-Deficiency - mortality Anemia, Iron-Deficiency - therapy Anemias. Hemoglobinopathies Biological and medical sciences British Society of Gastroenterology BSG Cancer Celiac disease clinical outcomes colorectal cancer confidence interval Confidence intervals Diseases of red blood cells Family medical history Family Practice Female Follow-Up Studies Gastrointestinal Diseases - diagnosis Gastrointestinal Diseases - etiology Gastrointestinal Diseases - mortality General aspects general practice general practitioner Hematologic and hematopoietic diseases Humans IDA iron deficiency anaemia Laboratories Male Medical sciences Metabolic diseases Metals (hemochromatosis...) Middle Aged odds ratio Original Other metabolic disorders Patients Studies Treatment Outcome |
| title | Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations |
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