Table 2: Characteristics of the included studies
| Study | Country | Setting | Time of recruite-ment | Data assessment |
Study population: number female |
Age in sample (years) | Inclusion (IN) / Exclusion (EX) criteria | Out-come |
|---|---|---|---|---|---|---|---|---|
| Ajmi 2011 [16] | Tunisia | 86 primary health care centres | 06/2002–05/2003 | prospectively |
16,271 consultations 24,882 RFE ♀ 62% |
0–103 Ø 24 | IN: medical records randomly selected | pre |
| Albert 2011 [17] | USA | Internet-based medical visits on the University of Pittsburgh Medical Center HealthTrak e-Visit system, users receiving care from a large family medicine practice | 08–11/2009 | prospectively |
121 e-visits ♀ 71% | 18–60 + | IN: adult users of an e-visit-system | pre |
| BEACH Program [18] | Australia | 965 randomly selected GPs | 04/2015–03/2016 | prospectively |
97,398 consultations 149,084 RFE ♀ 57% | 0–75 + | IN: doctor-patient encounters of all types | pre |
| Ben Abdelaziz 2004 [19] | Tunisia | 6 primary healthcare facilities in the Tunisian Sahel (Sousse) | 02/2000–01/2001 | prospectively |
4022 consultations 6576 RFE ♀ 66,6% |
0–100 + Ø 27 | IN: all patient-doctor encounters in a randomly chosen 30-day period | pre |
| Coenen 2004 [20] | Belgium | 85 Flemish GPs | 02–04/2000 and 02–04/2001 | prospectively |
810 patients (514 after follow-up) ♀ 57% | Ø 40.9 | IN: immunocompetent patients, 18–65 years, new or worsening coughing less than 30 days as (one of) the most important complaint(s) and reason for first encounter | prog |
| CONTENT Project [21, 22] | Germany | 17 general practices in 4 federal states resp. 1 rural out of hours-care centre with 41 GPs |
04/2005– 12/2006 resp. 07/2008–06/2011 | prospectively |
42,469 patients 27,871 RFE resp. 9542 patients 15,886 consultations ♀ 59,7–66% |
0–104 Ø 42–48.6 | IN: (main) RFE were coded |
pre aet |
| French 2005 [23] | USA | 1 walk-in primary care clinic of an academic, tertiary care medical centre | n.r. | prospectively |
62 patients ♀ 51,6% |
19–88 ♀ Ø 42 ♂ Ø 48 |
IN: cough < 3 weeks duration EX: none | aet |
| GRACE Study [24,25,26,27,28,29,30,31,32,33,34] | Belgium, France, Germany, Italy, Netherlands, Poland, Spain, Slovakia, Slovenia, Sweden, UK | 294 – 387 GPs in 125 general practices from 16 primary care networks |
10/2007–04/2010 resp. 10/2006–03/2007 | prospectively |
1801 – 3368 patients ♀60–70% |
18–61 + Ø45-50 |
IN: ≥ 18 years, acute or worsened cough (≤ 28 days duration) as main/dominant symptom, or suggested LRTI, consulting for the first time for this illness episode EX: immune deficiency |
aet prog |
| Hamre 2005 [35] | Austria, Germany, Netherlands, UK, USA | 29 primary care practices with 37 GPs | 04/1999–03/2000 | prospectively |
318 patients (301 after follow-up) ♀ 60% |
< 5–65 + 64.9% ≥ 18 |
IN: age ≥ 1 month, chief complaint of cough ≤ 7 days EX: dementia, renal failure, severe hepatic disease, ongoing immunosuppressive treatment, chemotherapy or radiotherapy, alcohol or drug abuse | prog |
| Harding 1980 [36] | Colombia, India, Sudan, Philippines | several primary care health facilities | n.r. | prospectively |
1624 patients ♀ 75% | n.r. |
IN: attending patients ≥ 16 years EX: seriously ill (e.g. coma), requiring urgent medical care | pre |
| Hofmans-Okkes 1993 Dutch Study [37] | Netherlands | 6 practices with 10 physicians | n.r. | prospectively |
385 RFE 200 consultations ♀ 62% | Ø 40 | IN: doctors coded RFE during encounters | pre |
| Hofmans-Okkes 1993 International Study [37] | Belgium, Denmark, Israel, Italy, Netherlands, Portugal, Spain, UK, USA | 22 physicians | 01/1990–02/1991 | prospectively |
943 RFE 497 consultations ♀ 64% | Ø 38 | IN: consecutive routine encounters | pre |
| Hull 1969 [38] | UK | 1 rural general practice with 2 GPs | 10/1966–02/1967 | prospectively |
1000 incidental consultations ♀ 54% | n.r. |
IN: consecutive new cases presenting in practice EX: consultations for antenatal, immunization or contraceptive care | pre |
| Liu 2017 [39] | China | 14 community health service centers with 100 GPs in 6 suburban districts of Beijing | 12/2014–01/2015 | prospectively |
10,000 consultations 13,705 RFE ♀ 52,5% | < 35–55 + | IN: consecutive patients’ encounters | pre |
| Martin 1984 [40] | Saudi Arabia | 1 primary care department of a hospital serving a military community in Riyadh | n.r. | prospectively |
1000 incidental consultations ♀ 42% | 0–45 + | IN: patients presenting for the first time with a problem | pre |
| Mash 2012 [41] | South Africa | 83 primary care clinics, 17 mobile clinics, 12 community health centres; nurse-led with support from doctors | 1 year | prospectively |
18,856 consultations 31,451 RFE ♀ 66% | < 1–79 | IN: all ambulatory patients seen by the health worker | pre |
| Molony 2016 [42] | Ireland | 1 large general practice with 4 GPs in a primary healthcare centre in North Cork | 10/2010–10/2014 | retrospectively |
5100 patients 52,572 consultations 70,489 RFE | 0–80 + |
IN: doctor-patient face-to-face encounters on all working days and 146 non-working days with documentation of diagnostic code EX: contacts with practice nurse/ practice’s administrative team, telephone or ‘out-of-hours’ contacts | pre |
| Morrell 1971/1972[43, 44] | UK | 1 general practice with 3 GPs | 1 year | prospectively |
4455 patients 21,098 consultations 5323 new symptoms ♀ 52% | 0–65 + |
IN: new patient-initiated consultations with symptoms not presented to any doctor in the previous 12 months EX: doctor-initiated consultations |
pre aet |
| Munyati 2005 [45] | Zimbabwe | 2 primary health care clinics in Harare | n.r. | prospectively |
544 patients ♀ 52% 83% HIV-positive |
16–55 + Ø 33 |
IN: patients ≥ 16 years with cough ≥ 3 weeks consulting on weekdays EX: treatment for tuberculosis; requiring immediate admission to hospital; unwilling to undergo HIV-testing; not resident in region Mbare | aet |
| NAMCS [46, 47] | USA | general internists, family practioners or general practicioners | 1980, 1981, 1985, 1989–1994 resp. 1985–1986 | prospectively |
3416–183,225 consultations ♀ 59–60% |
< 15–75 + resp. 0–75 + | IN: visits by patients with a chief complaint of cough during a randomly assigned 1-week reporting period |
pre aet |
| Nantha 2014 [48] | Malaysia | 1 primary health care clinic | 01–05/2013 | prospectively |
151 patients (117 after follow-up) ♀ 49% | 18–60 + | IN: patients > 18 years presenting with a chief complaint of cough > 2 weeks | aet |
| Njalsson 1992 [49] | Iceland | 12 rural and 4 urban primary care health centres | 01–12/1988 | prospectively |
49,193 patients 284,348 RFE ♀ 60% | 0–75 + | IN: all contacts (including prescriptions, follow-up visits, tests, procedures and administrative visits) | pre |
| Robertson 1991 [50] | USA | 1 GP in 1 Family Medicine Unit at the Medical University of South Carolina | 07/1976–06/1979 | prospectively |
304 patients 956 consultations 1377 RFE | 0–65 + | IN: all patient contacts | pre |
| SESAM 2 Study [51, 52] | Germany | 209 GPs in the federal state of Saxony | 10/1999–09/2000 | prospectively |
8877 patients 13,632 RFE ♀56,9% | 0–75 + |
IN: randomly selected patients presenting in general practice (tenth consultation of the consultation hour) previously known to the practitioner EX: house calls, patients already included in SESAM 2 study |
pre aet |
| Silva 1998 [53] | Sri Lanka | 34 general practioners | 07/1996 | prospectively |
2068 consultations 3448 RFE ♀ 53% | < 12–65 + | IN: consecutive doctor-patient encounters | pre |
| Stefanoff 2014 [54] | Poland | 34 health units with 78 GPs | 07/2009–04/2011 | prospectively |
158,863 patients 197,955 py ♀ 52% | 3–70 + | IN: patients ≥ 3 years, cough 2–15 weeks |
pre aet |
| TRANSITION Project [37, 55] |
Netherlands resp. Netherlands, Malta and Serbia | 54 family physicians in 23 locations in the Netherlands resp. family physicians in the Netherlands, Malta and Serbia | 1985–1995 resp. 1995–2005 | prospectively |
93,297–274,620 py 236,027 EOC 267,897–337,348 consultations | n.r. | IN: episode data for all face-to-face encounters with their listed patients |
pre aet |
| Verzantvoort 2018 [56] | Netherlands | users of the smartphone application “Should I see a doctor?” as a self-triage decision tool for acute primary care | 07/2014–07/2015 | prospectively |
4446 app users 3317 patients with registered symptoms ♀ 66% | 0–66 + | IN: app-users who answered to have used the app for a current medical problem | pre |
| Wong 2016 [57] | China | 19 clinicians in Hong Kong public primary care clinics and private clinics | 11/2011–02/2014 | prospectively |
455 patients (321 after follow-up) ♀ 57% | Ø47.1 | IN: immunocompetent patients ≥ 18 years consulting within normal consulting hours with an acute or worsened cough (≤ 28 days duration) as main symptom, or clinical presentation that suggested LRTI | prog |
| Woolnough 1985 [58] | Canada | 1 family practice | 4 separate months in each season of the year | prospectively |
32 patients ♀ 59% | 20–70 + | IN: all patients whose chief presenting reason was cough | aet |
| Worrall 2008 [59] | Canada | 1 community health centre, 1 GP | fall/winter 2005–2006 | prospectively | 100 patients | 1–90 | IN: consecutive patients with cough ≤ 14 days | aet |