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《国际疾病分类第十版》中不明原因身体症状及躯体形式障碍的编码——一项针对德国全科医生的调查

ICD-10-Coding of Medically Unexplained Physical Symptoms and Somatoform Disorders-A Survey With German GPs.

作者信息

Pohontsch Nadine J, Zimmermann Thomas, Lehmann Marco, Rustige Lisa, Kurz Katinka, Löwe Bernd, Scherer Martin

机构信息

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Front Med (Lausanne). 2021 Mar 30;8:598810. doi: 10.3389/fmed.2021.598810. eCollection 2021.

Abstract

General practitioners (GPs) are reluctant to use codes that correspond to somatization syndromes. To quantify GPs' views on coding of medically unexplained physical symptoms (MUPS), somatoform disorders, and associated factors. Survey with German GPs. We developed six survey items [response options "does not apply at all (1)"-"does fully apply (6)"], invited a random sample of 12.004 GPs to participate in the self-administered cross-sectional survey and analysed data using descriptive statistics and logistic regression analyses. Response rate was 15.2% with = 1,731 valid responses (54.3% female). Participants considered themselves familiar with ICD-10 criteria for somatoform disorders ( = 4.52; =.036) and considered adequate coding as essential prerequisite for treatment ( = 5.02; = 1.21). All other item means were close to the scale mean: preference for symptom or functional codes ( = 3.40; = 1.21), consideration of the possibility of stigmatisation ( = 3.30; = 1.35) and other disadvantages ( = 3.28; = 1.30) and coding only if psychotherapy is intended ( = 3.39; = 1.46). Exposure, guideline knowledge, and experience were most strongly associated with GPs' self-reported coding behaviour. Subjective exposure, guideline knowledge, and experience as a GP, but no sociodemographic variable being associated with GPs' subjective coding behaviour could indicate that GPs offer a relatively homogeneous approach to coding and handling of MUPS and somatoform disorders. Strengthening guideline knowledge and implementation, and practise with simulated patients could increase the subjective competence to cope with the challenge that patients with MUPS and somatoform disorders present.

摘要

全科医生(GPs)不愿使用与躯体化综合征相对应的编码。为了量化全科医生对医学上无法解释的身体症状(MUPS)、躯体形式障碍及相关因素编码的看法。对德国全科医生进行调查。我们设计了六个调查项目[回答选项“完全不适用(1)”-“完全适用(6)”],邀请了12004名全科医生的随机样本参与自填式横断面调查,并使用描述性统计和逻辑回归分析来分析数据。回复率为15.2%,有1731份有效回复(女性占54.3%)。参与者认为自己熟悉躯体形式障碍的国际疾病分类第十版(ICD - 10)标准(均值 = 4.52;标准差 = 0.036),并认为适当编码是治疗的基本前提(均值 = 5.02;标准差 = 1.21)。所有其他项目的均值都接近量表均值:对症状或功能编码的偏好(均值 = 3.40;标准差 = 1.21)、对污名化可能性的考虑(均值 = 3.30;标准差 = 1.35)以及其他不利因素(均值 = 3.28;标准差 = 1.30),以及仅在打算进行心理治疗时才编码(均值 = 3.39;标准差 = 1.46)。接触、指南知识和经验与全科医生自我报告的编码行为关联最为紧密。作为全科医生的主观接触、指南知识和经验,但没有社会人口统计学变量与全科医生的主观编码行为相关,这可能表明全科医生在对MUPS和躯体形式障碍的编码及处理上提供了相对一致的方法。加强指南知识和实施,以及与模拟患者进行实践操作,可能会提高应对MUPS和躯体形式障碍患者所带来挑战的主观能力。

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