BackgroundPersistent 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... Show moreBackgroundPersistent 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 ambiguous 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.MethodDutch 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.ResultsGPs (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.ConclusionsRegistration 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. Show less
Brinck, R.M. ten; Dijk, B.T. van; Steenbergen, H.W. van; Cessie, S. le; Numans, M.E.; Hider, S.L.; ... ; Helm-van Mil, A. van der 2018
In this thesis we determined the added value of MR imaging in primary care for patients with knee complaints. We conducted a randomised controlled trial including patients with knee complaints... Show moreIn this thesis we determined the added value of MR imaging in primary care for patients with knee complaints. We conducted a randomised controlled trial including patients with knee complaints after trauma, aged 18-45 year. Patients were randomised between usual care (no MR scan) or an MR scan within 2 weeks. MR imaging was bot non-inferior but also not superior to usual care. On the 1-year follow-up, patients in the MR group more often perceived themselves to be recovered and more often reported to be satisfied during the 1-year follow-up. However, the MR scan requested by the GP neither improved health outcomes, nor saved costs. Furthermore, in the MR group there was no reduction in the orthopaedic referral rate and a non-significantly higher proportion of patients underwent an arthroscopy. We also evaluated the added value of MR imaging for patients suspected to develop knee osteoarthritis. We combined early MR osteoarthritis features into a prediction model, resulting in moderate sensitivity and specificity rates for the development of radiographic knee osteoarthritis. We concluded that for the entire population seeking medical attention of the GP for knee complains, MR imaging does not contribute to an improved clinical outcome nor to cost containment. Show less
