Psychosomatic medicine in primary care: influence of training.
BACKGROUND
General practitioners (GPs) are often confronted with patients presenting somatic symptoms presumed to be decisively modulated by psychosocial factors.


OBJECTIVE
We aimed to explore GPs' reported clinical routine in dealing with these patients according to the GPs' level of training in psychosomatic medicine.


METHODS
A structured postal questionnaire survey was conducted among all Austrian GPs with a standardized training background in psychosomatic medicine (three levels of training; duration between one and six years) as well as in a random national sample of Austrian GPs without such training, resulting in four study subgroups.


RESULTS
Respondents estimated that between 20% and 40% of their patients presenting somatic symptoms need psychosocial factors to be addressed. Study subgroups differed significantly concerning their reported diagnostic and therapeutic routine behavior patterns. Some diagnostic approaches such as clarification of lay etiology increased linearly with the level of training. The proportion of patients receiving corresponding treatment in the GP's own practice was also reported to increase with the level of training (no training: 35%, levels one and two: 46%, level three: 54%), although all subgroups estimated that over 20% of patients do not receive any corresponding treatment.


CONCLUSIONS
Results point at the clinical relevance of a general training in psychosomatic medicine in primary care. They also suggest specific training effects that need to be substantiated in observational studies.
Fazekas
Christian
C
Department of Medical Psychology and Psychotherapy, Medical University Graz, Austria. christian.fazekas@meduni-graz.at
Matzer
Franziska
F
Greimel
Elfriede R
ER
Moser
Gabriele
G
Stelzig
Manfred
M
Langewitz
Wolf
W
Loewe
Bernd
B
Pieringer
Walter
W
Jandl-Jager
Elisabeth
E
D000328:Adult; D001317:Austria; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011611:Psychosomatic Medicine / Q000193:education*; D011795:Surveys and Questionnaires; D013997:Time Factors