scholarly journals Diagnostic and treatment barriers to persistent somatic symptoms in primary care – representative survey with physicians

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Lehmann ◽  
Nadine Janis Pohontsch ◽  
Thomas Zimmermann ◽  
Martin Scherer ◽  
Bernd Löwe
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Rating Scales ◽  
Treatment Guidelines ◽  
Somatic Symptoms ◽  
Diagnosis And Treatment ◽  
Treatment Barriers ◽  
Adequate Treatment ◽  
Physical Disease ◽  
Federal States

Abstract Background Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. Methods We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected. Results We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced. Conclusions The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care. Trial registration German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS) https://www.drks.de/drks_web/setLocale_EN.do The date the study was registered: October 2nd 2017 The date the first participant was enrolled: February 9th 2018 DRKS-ID: DRKS00012942

Masked Depression: Its Interrelations with Somatization, Hypochondriasis and Conversion

1988 ◽  
Vol 17 (4) ◽  
pp. 367-379 ◽  
Author(s):  
Robert Z. Fisch
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Diagnosis And Treatment ◽  
Clinical Phenomenon ◽  
Clinical Problems

Masked depression appears to be a common clinical phenomenon. Most depressions present with some somatic complaints in addition to affective and cognitive ones. About one half of all depressions seen by primary care physicians initially present predominantly or exclusively with somatic symptoms. Many of these depressions are not recognized or are misdiagnosed and mistreated. The possible reasons for this are discussed here. The phenomenon of somatization in depressions and other conditions is reviewed and the interface with other related clinical problems like hypochondriasis and conversion is delineated. It is hypothesized that the proportion of depressions that are masked is positively correlated to the patients' tendency to somatize and negatively correlated to the doctors' ability to recognize depressions that hide behind somatic complaints. Suggestions for the diagnosis and treatment of masked depressions are given.

scholarly journals The Role of the Primary-Care Physician in Treating Relapses in Multiple Sclerosis Patients

2009 ◽  
Vol 11 (3) ◽  
pp. 122-126 ◽  
Author(s):  
Sarah A. Morrow ◽  
Marcelo Kremenchutzky
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Tertiary Care ◽  
Care Physician ◽  
Diagnosis And Treatment ◽  
High Prevalence ◽  
Tertiary Care Centers ◽  
Multiple Sclerosis Patients

Multiple sclerosis (MS) is a common disabling neurologic disease with an overall prevalence in Canada of 240 in 100,000. Multiple sclerosis clinics are located at tertiary-care centers that may be difficult for a patient to access during an acute relapse. Many relapses are evaluated by primary-care physicians in private clinics or emergency departments, but these physicians' familiarity with MS is not known. Therefore, a survey was undertaken to determine the knowledge and experience of primary-care physicians regarding the diagnosis and treatment of MS relapses. A total of 1282 licensed primary-care physicians in the catchment area of the London (Ontario, Canada) Multiple Sclerosis Clinic were identified and mailed a two-page anonymous survey. A total of 237 (18.5%) responses were obtained, but only 216 (16.8%) of these respondents were still in active practice. Of these 216 physicians, only 9% reported having no MS patients in their practice, while 70% had one to five patients, 16.7% had six to ten, and 1.9% had more than ten (3.7% did not respond to this question). Corticosteroids were recognized as an MS treatment by 49.5% of the respondents, but only 43.1% identified them as a treatment for acute relapses. In addition, 31% did not know how to diagnose a relapse, and only 37% identified new signs or symptoms of neurologic dysfunction as indicating a potential relapse. Despite the high prevalence of MS in Canada, primary-care physicians require more education and support from specialists in MS care regarding the diagnosis and treatment of MS relapses.

scholarly journals Recommendations for the prevention, diagnosis and treatment of inFLUenza in adults for Primary care physiciAnS: FLU COMPAS PCP – ADULTS

2020 ◽  
Vol 22 (1) ◽  
pp. 81-96 ◽  
Author(s):  
Agnieszka Mastalerz-Migas ◽  
Ernest Kuchar ◽  
Aneta Nitsch-Osuch ◽  
Artur Mamcarz ◽  
Adam Sybilski ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Diagnosis And Treatment

The pathway to diagnosis and treatment for surgically managed lung cancer patients

2019 ◽  
Author(s):  
Victoria White ◽  
Rebecca J Bergin ◽  
Robert J Thomas ◽  
Kathryn Whitfield ◽  
David Weller
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Cancer Patients ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Treatment Time ◽  
Early Stage ◽  
Diagnosis And Treatment ◽  
Early Stage Disease ◽  
Lung Cancer Patients

Abstract Background Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis. Methods Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or ‘investigation’ of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age. Results One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than ‘investigation’ patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant. Conclusion Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

The problem of diagnosis and treatment of depression by primary care physicians

2019 ◽  
Vol 119 (1) ◽  
pp. 55
Author(s):  
G. P. Kostyuk ◽  
A. V. Masyakin ◽  
L. A. Burygina ◽  
I. V. Reverchuk
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Diagnosis And Treatment ◽  
Treatment Of Depression

A strategy for improvement in diagnosis and treatment of bronchial asthma in primary care

2019 ◽  
Vol 29 (4) ◽  
pp. 457-467
Author(s):  
S. N. Avdeev ◽  
S. R. Aisanov ◽  
A. S. Belevskiy ◽  
A. V. Emel’yanov ◽  
O. M. Kurbacheva ◽  
...  
Keyword(s):  
Primary Care ◽  
Bronchial Asthma ◽  
Primary Care Physicians ◽  
Respiratory Symptoms ◽  
Respiratory Diseases ◽  
Diagnosis And Treatment ◽  
Diagnostic Tools ◽  
Chronic Obstructive ◽  
Asthma Diagnosis ◽  
Chronic Respiratory Diseases

Recently, bronchial asthma is considered as a heterogeneous disease characterized by chronic airway inflammation and respiratory symptoms, which vary in time and intensity and manifest together with variable obstruction of the airways. Asthma is one of the most common chronic respiratory diseases in primary care. Patients with certain respiratory symptoms seek for medical aid initially in primary care physicians, such as therapeutists, general practitioners, and family physicians, who can suspect and diagnose chronic respiratory diseases such as bronchial asthma, chronic obstructive pulmonary disease (COPD), allergic rhinitis, etc. Currently, untimely diagnosis of asthma and late initiation of anti-inflammatory treatment are widespread, mainly due to insufficient knowledge of primary care physicians on diagnostic criteria and therapeutic standards for asthma. Feasible and convenient algorithms for asthma diagnosis and treatment in primary care were developed by experts of Russian Respiratory Society and Russian Association of Allergologists and Clinical Immunologists. A therapeutic algorithm for asthma treatment in primary care institutions uses an approach considering symptom severity both in patients with newly diagnosed and previously treated for asthma. Diagnostic tools, such as a questionnaire for asthma diagnosis and an algorithm for differential diagnosis between asthma and COPD are mainly intended to facilitate diagnosis of chronic respiratory disease, particularly bronchial asthma, by a primary care physician and to improve the healthcare quality for these patients.

The Problem of the Diagnosis and Treatment of Depression by Primary Care Physicians

2019 ◽  
Vol 50 (1) ◽  
pp. 45-50 ◽  
Author(s):  
G. P. Kostyuk ◽  
A. V. Masyakin ◽  
L. A. Burygina ◽  
I. V. Reverchuk
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Diagnosis And Treatment ◽  
Treatment Of Depression
Sign in / Sign up

Export Citation Format

Share Document