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

Willeke M Kitselaar; Rosalie van der Vaart; Madelon van Tilborg-den Boeft; Hedwig M M Vos; Mattijs E Numans; Andrea W M Evers

doi:10.1186/s12875-021-01525-6

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

BMC Fam Pract. 2021 Sep 11;22(1):182. doi: 10.1186/s12875-021-01525-6.

Authors

Willeke M Kitselaar^{1

2}, Rosalie van der Vaart³, Madelon van Tilborg-den Boeft⁴, Hedwig M M Vos⁴, Mattijs E Numans⁴, Andrea W M Evers³

Affiliations

¹ Health, Medical and Neuropsychology Department, Leiden University, Faculty of Social and Behavioral Sciences, Leiden, the Netherlands. w.m.kitselaar@fsw.leidenuniv.nl.
² Public Health and Primary Care Department / LUMC-Campus Den Haag, Leiden University Medical Center, The Hague, the Netherlands. w.m.kitselaar@fsw.leidenuniv.nl.
³ Health, Medical and Neuropsychology Department, Leiden University, Faculty of Social and Behavioral Sciences, Leiden, the Netherlands.
⁴ Public Health and Primary Care Department / LUMC-Campus Den Haag, Leiden University Medical Center, The Hague, the Netherlands.

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.

Keywords: Classification of Disease; Clinical Coding; Electronic Health Records; General Practitioners; Medically Unexplained Symptoms; Persistent Somatic Symptoms; Primary Health Care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
General Practitioners*
Humans
Medically Unexplained Symptoms*
Primary Health Care
Referral and Consultation