ArticleBMC family practice2011
Unlimited access to health care--impact of psychosomatic co-morbidity on utilisation in German general practices.
Article in BMC family practice, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Measurement Properties of the Patient Health Questionnaire-15 and Somatic Symptom Scale-8: A Systematic Review and Meta-Analysis.JAMA network open · 2024Pooled it
- Pooled it
- Psychiatric Diagnoses in Prehospital Emergency Care and Sociodemographic Characteristics of the Incident Location at the District Level.Prehospital and disaster medicine · 2025Article
- Interest in a short psychological intervention in patients with psoriasis: a cross-sectional observational study at a German clinic.Frontiers in medicine · 2023Article
- Health economic evaluation of a web-based intervention for depression: the EVIDENT-trial, a randomized controlled study.Health economics review · 2019Article
- Do general practice patients with and without appointment differ? Cross-sectional study.BMC family practice · 2018Article
- Reasons for encounters and psychiatric comorbidity in an urban Bavarian primary care out-of-hour service - results of a cross sectional study.BMC health services research · 2017Article
- Overutilization of ambulatory medical care in the elderly German population?--An empirical study based on national insurance claims data and a review of foreign studies.BMC health services research · 2016Article
- [Validation of the Spanish version of the Screening for Somatoform Symptoms-2 scale for use in Primary Care].Atencion primaria · 2015Article
- Predicting Health Care Utilization After Behavioral Health Referral Using Natural Language Processing and Machine Learning.AMIA ... Annual Symposium proceedings. AMIA Symposium · 2015Article
- Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders - evidence from Germany.Risk management and healthcare policy · 2014Article
- The effect of mental comorbidity on service delivery planning in primary care: an analysis with particular reference to patients who request referral without prior assessment.Deutsches Arzteblatt international · 2013Article
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsCross 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.
results1005 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).
conclusionsPsychosomatic 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.
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