Fazekas Christian, Matzer Franziska, Greimel Elfriede R, Moser Gabriele, Stelzig Manfred, Langewitz Wolf, Loewe Bernd, Pieringer Walter, Jandl-Jager Elisabeth
Department of Medical Psychology and Psychotherapy, Medical University Graz, Austria.
Wien Klin Wochenschr. 2009;121(13-14):446-53. doi: 10.1007/s00508-009-1176-9.
General practitioners (GPs) are often confronted with patients presenting somatic symptoms presumed to be decisively modulated by psychosocial factors.
We aimed to explore GPs' reported clinical routine in dealing with these patients according to the GPs' level of training in psychosomatic medicine.
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.
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.
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.
全科医生（GPs）经常面对一些出现躯体症状的患者，这些症状被认为受到心理社会因素的决定性调节。
我们旨在根据全科医生在身心医学方面的培训水平，探讨他们在处理这些患者时所报告的临床常规做法。
对所有具有身心医学标准化培训背景（三个培训级别；时长在1至6年之间）的奥地利全科医生以及一个奥地利全科医生的全国随机样本（无此类培训）进行了结构化的邮寄问卷调查，形成了四个研究亚组。
受访者估计，他们出现躯体症状的患者中有20%至40%需要处理心理社会因素。研究亚组在其报告的诊断和治疗常规行为模式方面存在显著差异。一些诊断方法，如明确外行病因，随着培训水平的提高呈线性增加。据报告，在全科医生自己的诊所接受相应治疗的患者比例也随着培训水平的提高而增加（无培训：35%，一级和二级：46%，三级：54%），尽管所有亚组都估计超过20%的患者没有接受任何相应治疗。
结果表明身心医学的一般培训在初级保健中的临床相关性。它们还表明需要在观察性研究中证实特定的培训效果。
