The general practitioners perspective regarding registration of persistent somatic symptoms in primary care: a survey

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Abstract

Background

Persistent somatic symptoms (PSS) are common in primary care and often accompanied by an increasing disease burden for both the patient and healthcare. In medical practice, PSS is historically considered a diagnosis by exclusion or primarily seen as psychological. Besides, registration of PSS in electronic health records (EHR) is unambiguous and possibly does not reflect classification adequately. The present study explores how general practitioners (GPs) currently register PSS, and their view regarding the need for improvements in classification, registration, and consultations.

Method

Dutch GPs were invited by email to participate in a national cross-sectional online survey. The survey addressed ICPC-codes used by GPs to register PSS, PSS-related terminology added to free text areas, usage of PSS-related syndrome codes, and GPs’ need for improvement of PSS classification, registration and care.

Results

GPs (n = 259) were most likely to use codes specific to the symptom presented (89.3%). PSS-related terminology in free-text areas was used sparsely. PSS-related syndrome codes were reportedly used by 91.5% of GPs, but this was primarily the case for the code for irritable bowel syndrome. The ambiguous registration of PSS is reported as problematic by 47.9% of GPs. Over 56.7% of GPs reported needing additional training, tools or other support for PSS classification and consultation. GPs also reported needing other referral options and better guidelines.

Conclusions

Registration of PSS in primary care is currently ambiguous. Approximately half of GPs felt a need for more options for registration of PSS and reported a need for further support. In order to improve classification, registration and care for patients with PSS, there is a need for a more appropriate coding scheme and additional training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12875-021-01525-6.

Related collections

Most cited references 25

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Management of functional somatic syndromes.

Wolfgang Herzog, Peter Henningsen, Stephan Zipfel (2007)

Although functional somatic syndromes (FSS) show substantial overlap, treatment research is mostly confined to single syndromes, with a lack of valid and generally accepted diagnostic criteria across medical specialties. Here, we review management for the full variety of FSS, drawn from systematic reviews and meta-analyses since 2001, and give recommendations for a stepped care approach that differentiates between uncomplicated and complicated FSS. Non-pharmacological treatments involving active participation of patients, such as exercise and psychotherapy, seem to be more effective than those that involve passive physical measures, including injections and operations. Pharmacological agents with CNS action seem to be more consistently effective than drugs aiming at restoration of peripheral physiological dysfunction. A balance between biomedical, organ-oriented, and cognitive interpersonal approaches is most appropriate at this truly psychosomatic interface. In view of the iatrogenic component in the maintenance of FSS, doctor-centred interventions and close observation of the doctor-patient relationship are of particular importance.

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Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders.

J Eekhof, Hilde van Herk, José L Maza … (2004)

General practitioners play a pivotal part in the recognition and treatment of psychiatric disorders. Identifying somatoform disorders is important for the choice of treatment. To quantify the prevalence of, and functional impairment associated with, somatoform disorders, and their comorbidity with anxiety/depressive disorders. Two-stage prevalence study: a set of questionnaires was completed by 1046 consecutive patients of general practitioners (aged 25-80 years), followed by a standardised diagnostic interview (SCAN 2.1). The prevalence of somatoform disorders was 16.1% (95% CI 12.8-19.4). When disorders with only mild impairment were included, the prevalence increased to 21.9%. Comorbidity of somatoform disorders and anxiety/depressive disorders was 3.3 times more likely than expected by chance. In patients with comorbid disorders, physical symptoms, depressive symptoms and functional limitations were additive. Our findings underline the importance of a comprehensive diagnostic approach to psychiatric disorders in general practice.

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Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management

Kurt Kroenke (2003)

Somatic symptoms are the leading cause of outpatient medical visits and also the predominant reason why patients with common mental disorders such as depression and anxiety initially present in primary care. At least 33% of somatic symptoms are medically unexplained, and these symptoms are chronic or recurrent in 20% to 25% of patients. Unexplained or multiple somatic symptoms are strongly associated with coexisting depressive and anxiety disorders. Other predictors of psychiatric co‐morbidity include recent stress, lower self‐rated health and higher somatic symptom severity, as well as high healthcare utilization, difficult patient encounters as perceived by the physician, and chronic medical disorders. Antidepressants and cognitive‐behavioural therapy are both effective for treatment of somatic symptoms, as well as for functional somatic syndromes such as irritable bowel syndrome, fibromyalgia, pain disorders, and chronic headache. A stepped care approach is described, which consists of three phases that may be useful in the care of patients with somatic symptoms. Copyright © 2003 Whurr Publishers Ltd.

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Author and article information

Contributors

Willeke M. Kitselaar: w.m.kitselaar@fsw.leidenuniv.nl

Journal

Journal ID (nlm-ta): BMC Fam Pract

Journal ID (iso-abbrev): BMC Fam Pract

Title: BMC Family Practice

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2296

Publication date (Electronic): 11 September 2021

Publication date PMC-release: 11 September 2021

Publication date Collection: 2021

Volume: 22

Electronic Location Identifier: 182

Affiliations

[1 ]GRID grid.5132.5, ISNI 0000 0001 2312 1970, Health, Medical and Neuropsychology Department, , Leiden University, Faculty of Social and Behavioral Sciences, ; Leiden, the Netherlands

[2 ]GRID grid.10419.3d, ISNI 0000000089452978, Public Health and Primary Care Department / LUMC-Campus Den Haag, , Leiden University Medical Center, ; The Hague, the Netherlands

Article

Publisher ID: 1525

DOI: 10.1186/s12875-021-01525-6

PMC ID: 8436507

SO-VID: 187d7d38-4383-4cbb-b752-42b6ddda3910

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 13 January 2021

Date accepted : 18 August 2021

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: clinical coding,electronic health records,general practitioners,medically unexplained symptoms,persistent somatic symptoms,primary health care,classification of disease

Data availability:

ScienceOpen disciplines: Medicine

Keywords: clinical coding, electronic health records, general practitioners, medically unexplained symptoms, persistent somatic symptoms, primary health care, classification of disease

The general practitioners perspective regarding registration of persistent somatic symptoms in primary care: a survey

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Abstract

Background

Method

Results

Conclusions

Supplementary Information

Related collections

Chinese Journal of General Practice

Most cited references 25

Management of functional somatic syndromes.

Somatoform disorders in general practice: prevalence, functional impairment and comorbidity with anxiety and depressive disorders.

Patients presenting with somatic complaints: epidemiology, psychiatric co-morbidity and management

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