Bodily distress syndrome: A new diagnosis for functional disorders in primary care?
Many primary care patients seek consultations for symptoms that cannot be attributed to any conventionally defined medical disease or mental disorder. Numerous names have been given to these symptoms and disorders, such as medically unexplained symptoms (MUS), functional symptoms, functional somatic syndromes, central sensitivity syndromes and somatoform disorders. From a primary care perspective, there is a serious need for a unifying diagnostic category for functional disorders that is both evidence based and applicable in the primary care setting.
This debate article discusses the classification of functional disorders in primary care and focuses on a new diagnostic concept and category of moderate-to-severe functional disorders: bodily distress syndrome (BDS). The authors argue that this diagnosis is based on an increasing amount of evidence and has the potential to include many functional conditions and syndromes that are currently sources of ongoing debate and controversy in this field.
Inequalities in access to healthcare services are widely recognized as being associated with socioeconomic deprivation. One of the most popular schemes many governments use to tackle the inequalities in primary care delivery is the pay-for-performance scheme. In this arrangement, clinicians receive financial incentives for better healthcare outcomes. It is based on the premise that financial incentives attached to quality indicators can improve practice and reduce inequalities in healthcare provision.
Thus far, evidence on the effectiveness of pay-for-performance in primary care is mixed at best. In this paper, the authors undertook a longitudinal survey over four years to examine whether local pay-for-performance scheme can reduce gaps in achievement of targets between the general practices serving the least and most socioeconomically deprived populations. Their findings indicate that any gaps in achievement between practices were modest but mostly sustained or widened over the duration of the scheme.
Analysis of factors influencing general practitioners’ decision to refer obese patients
Obesity is an epidemic in many developed countries. Its burden on public health is substantial and increasing. Primary care clinicians have been assigned a key role in the prevention and treatment of excess weight and obesity. Recently, many countries have implemented evidence-based guidelines recommending that primary care physicians refer behavioral, or in more severe cases, surgical interventions to patients who have been identified as overweight or obese. Despite the proactive guidelines, studies have found that few obese patients actually receive health professional advice from their general practitioners.
There is a lack of research into general practitioners’ decisions and intentions to refer obese patients for lifestyle programs or surgery. This qualitative study aimed to describe the factors influencing general practitioners’ referral intentions for their obese patients. Their data suggests that general practitioners’ attitudes to referral were often formed by their limited case experience rather than by a review of more systematic evidence, especially for surgical interventions. These patterns may be improved by educating and better communicating with general practitioners about the outcomes for their patients when they are referred.
The prevalence of chronic diseases is globally on the rise, with cardiovascular diseases, respiratory disease, diabetes, cancer, and other chronic illnesses being major contributors to disability. Chronic disease is a major driver of health care expenditure in most developed countries. The current health care system is oriented towards episodic and acute care, making it unprepared to address the multi-faceted and complex needs of those with chronic diseases. Given the need for continuity, comprehensiveness and coordination, primary care has been suggested as potentially playing a central role in effective management and integration of care. However, literature on current practice suggests that patients often receive inadequate care, with limited physician involvement in disease management, and little coordination and communication among care providers.
The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. This systematic review synthesized findings of studies that implemented the CCM in primary care, and identified barriers and facilitators of implementation across various primary care settings.
Impact of comorbidity and multimorbidity on primary care practice
Comorbidity and multimorbidity are often defined as the co-existence of two or more long-term medical conditions. Comorbidity and multimorbidity have been shown to be associated with adverse health outcomes, such as poor quality of life, disability, psychological problems and increased mortality. They also associated with increased frequency of health-service use involving emergency hospital admission, adverse drug events, poly-pharmacy, duplicate testing and poor care co-ordination.
Presently, health care workers have limited guidance or experience as to how to approach care decisions for patients with multimorbidity. Medical training and clinical care has been largely informed by evidence and guidelines for single systems or diseases. Current clinical practice is increasingly specialist, with healthcare professionals often basing treatment decisions on relatively narrow aspects of an individual’s health problems. As such, our medical care systems are particularly ill-prepared to deal with patients with comoribidity and multimorbidity. These issues are especially relevant in certain clinical settings, such as general practice and services caring for the aging population.
In this context, BMC Family Practice launches our special issue focused on the impact of comorbidity and multimoribidty on primary care. This ongoing thematic series examines the breadth of research on comorbidity and multimorbidity and their impact on clinical practice in primary care. We invite submissions using different research methods to add to the literature, including clinical trials, epidemiological and qualitative studies. Submissions of article types, Research article, Debate and Technical Advances are encouraged.
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