The presentation and treatment of Dupuytren’s disease in Dutch general practitioner care

TL;DR

This study explores how Dupuytren’s disease is diagnosed and managed by Dutch general practitioners, showing most patients are diagnosed on first contact and often receive watchful waiting or referral.

Contribution

This is the first study to map the trajectory of Dupuytren’s disease in general practitioner care using electronic health records.

Findings

93% of Dupuytren’s disease patients received a diagnosis at their first GP contact.

Watchful waiting and referral to secondary care were the most common management options.

Less than half of patients were referred to secondary care, suggesting potential for preventive treatment in primary care.

Abstract

When research and management of Dupuytren’s disease (DD) shift from symptom relief to preventing contractures, general practitioner (GP) care may become more central to treatment. However, the presentation and course of DD in GP care are underexplored and this has been recognized as a knowledge gap that hinders effective treatment decisions. This study is the first to map the trajectory of DD patients in GP care.

Using electronic health records from Dutch general practices in a regional research network, we conducted a registration-based cohort study in a dynamic population. Descriptive statistics detailed patient demographics, number of contacts, and symptoms per contact. The time and number of contacts before diagnosis were also analysed. Sankey diagrams illustrated the relationship between management options and symptoms.

Over a 16-year period, 84% of patients with a DD diagnosis had visited their GP for this reason, with 73% only having one GP contact. The diagnosis was made at first contact for 93% of patients. Initial contacts often reported a lump (57.3%), but this symptom was less frequent in subsequent visits. ‘Daily life impairment’ increased after the first contact. The most common management options were referral to secondary care (37.7%) and watchful waiting (35.1%).

The diagnosis and management of DD in GP care are in line with the current guidelines. Less than half of the DD patients were referred to secondary care during follow-up. This may give room for preventive treatment that limits progression. Future studies should focus on the accuracy of diagnosis and the feasibility of effective treatments in GP care.

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