Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Orleansstrasse 47, 81667 München, Germany.
BMC Fam Pract. 2011 Jun 18;12:51. doi: 10.1186/1471-2296-12-51.
The effect of psychosomatic co-morbidity on resource use for systems with unlimited access remains unclear. The aim of this study was to evaluate the impact on practice visits, referrals and periods of disability in German general practices and to identify predictors of health care utilisation.
Cross sectional observational study in 13 practices in Upper Bavaria. Patients were included consecutively and filled in the Patients Health Questionnaire (PHQ). Numbers of practice visits, referrals and periods of disability within the last twelve months and permanent mental and somatic diagnoses were extracted manually by review of the computerised charts. Physicians in Germany are obliged to document repetitive reasons of encounter as permanent diagnoses in terms of ICD-10-codes. These ICD-10-codes are used for legitimisation of reimbursement in German general practices.
1005 patients were included (58.6% female). On average, patients had 15.3 (sd 16.3) practice contacts, 3.8 (sd 4.2) referrals and 7.5 (sd 23.1) days of disability per year. The mean number of coded permanent diagnoses was 0.4 (sd 0.7) for mental and 4.0 (sd 4.0) for somatic diagnoses. Patients with mental diagnoses scored higher in depression, anxiety, panic and somatoform disorder scales of PHQ. Frequent practice visits were associated stronger with coded permanent mental diagnoses (OR 20.0; 95%CI 7.5-53.9) than with coded permanent somatic diagnoses (OR 14.4; 95%CI 5.9-35.4). Frequent referrals were associated stronger with somatic diagnoses (OR 4.9; 95%CI 2.0-11.9) than with mental diagnoses (OR 3.6; 95%CI 1.4-9.8). Periods of disability were predicted by mental diagnoses (OR 5.0; 95%CI 1.6-15.8) but not by somatic diagnoses (OR 2.5; 95%CI 0.7-8.1).
Psychosomatic co-morbidity has a stronger impact on health care utilisation in German general practices with respect to practice visits and periods of disability whereas somatic disorders play a stronger role for referrals. Time constraints in the practices might lead to frequent contacts as too little time is left for patients with mental problems. Therefore, structural changes in the health care reimbursement systems might be necessary. Mental diagnoses might be helpful to identify patients at risk for high health care utilisation. However, the use of routinely coded diagnoses for reimbursement might lead to distorted estimation of resource use.
对于拥有无限访问权限的系统，身心共病对资源利用的影响尚不清楚。本研究旨在评估德国普通诊所中对就诊次数、转介和残疾期的影响，并确定医疗保健利用的预测因素。
在上巴伐利亚的 13 家诊所进行横断面观察性研究。连续纳入患者并填写患者健康问卷（PHQ）。在过去 12 个月内，通过回顾计算机图表，手动提取就诊次数、转介次数和残疾期以及永久性精神和躯体诊断。德国的医生有义务根据 ICD-10 代码将重复就诊的原因记录为永久性诊断。这些 ICD-10 代码用于德国普通诊所报销的合法化。
共纳入 1005 例患者（58.6%为女性）。平均而言，患者每年有 15.3（标准差 16.3）次就诊、3.8（标准差 4.2）次转介和 7.5（标准差 23.1）天的残疾期。精神诊断的平均编码永久性诊断数为 0.4（标准差 0.7），躯体诊断为 4.0（标准差 4.0）。患有精神诊断的患者在 PHQ 的抑郁、焦虑、惊恐和躯体形式障碍量表中得分更高。频繁就诊与编码的永久性精神诊断（OR 20.0；95%CI 7.5-53.9）的相关性强于与编码的永久性躯体诊断（OR 14.4；95%CI 5.9-35.4）。频繁转介与躯体诊断（OR 4.9；95%CI 2.0-11.9）的相关性强于精神诊断（OR 3.6；95%CI 1.4-9.8）。残疾期由精神诊断（OR 5.0；95%CI 1.6-15.8）预测，但不由躯体诊断（OR 2.5；95%CI 0.7-8.1）预测。
在德国普通诊所中，身心共病对就诊次数和残疾期的医疗保健利用有更强的影响，而躯体疾病对转介的影响更大。实践中的时间限制可能导致频繁的接触，因为留给有精神问题的患者的时间太少。因此，医疗保健报销系统的结构性变革可能是必要的。精神诊断可能有助于识别高医疗保健利用率的高危患者。然而，为报销而使用常规编码诊断可能会导致对资源利用的扭曲估计。
