چکیده (انگلیسی):

Background:Consultations involving patients with multiple somatic symptoms may be considered as challenging
and time-consuming by general practitioners (GPs). Yet, little is known about the possible links between
consultation characteristics and GP-experienced burden of encounter. We aimed to explore consultation content,
clinical management strategies, time consumption and GP-experienced burden of encounters with patients
suffering from multiple somatic symptoms as defined by the concept of bodily distress syndrome (BDS).
Methods:Cross-sectional study of patient encounters in primary care from December 2008 to December 2009; 387
GPs participated (response rate: 44.4 %). Data were based on a one-page registration form completed by the GP
and a patient questionnaire including the 25-item BDS checklist for somatic symptoms. Using logistic regression
analyses, we compared patients who met the BDS criteria with patients who did not.
Results:A total of 1505 patients were included (response rate: 55.6 %). Health problems were less frequently
reported as ‘new’ in patients with BDS (odds ratio (OR) = 0.73, 95 % confidence interval (CI): 0.54; 0.97). Medical
prescriptions and referral rates were comparable in the two patient groups. Consultations focusing on mainly
biomedical aspects were less frequent among patients with BDS (OR = 0.31, 95 % CI: 0.22; 0.43), whereas additional
biomedical and psychosocial problems were more often discussed. GPs were more likely to ensure continuity of
care in BDS patients by watchful waiting strategies (OR = 2.32, 95 % CI: 1.53; 3.52) or scheduled follow-up visits
(OR = 1.61, 95 % CI: 1.09; 2.37). Patients with BDS were found to be more time-consuming (OR = 1.77, 95 % CI: 1.26;
2.48) and burdensome (OR = 2.54, 95 % CI: 1.81; 3.55) than patients without BDS. However, after adjustments for
biomedical and psychosocial content of the consultation, the identified differences for time consumption and
burden were no longer statistically significant.
Conclusions:Patients with BDS represent higher care complexity in terms of biomedical and psychosocial needs.
GPs seem to allow space and time for discussing these issues and to aim at ensuring continuity in care through
watchful waiting or scheduled follow-up consultations. However, the reported GP-experienced burden call for
professional development.