Identification of barriers and difficulties involved in the process of diagnosing somatic symptom disorders in primary care

对于大多数患有功能性躯体综合征的患者来说，全科医生是与医疗保健系统接触的第一点。尽管初级保健在躯体症状障碍的管理中发挥着核心作用，但在这种情况下，检测躯体形式障碍患者仍存在大量问题。这导致了对躯体症状紊乱的诊断不足和治疗不足。根据跨学科的德国S3指南“非特异性，功能性和躯体形式的身体不适”（AWMF），在初级保健中，关于功能性躯体综合征的诊断过程的高质量研究明显缺乏证据。很少有人知道的障碍和困难，阻碍全科医生实施循证建议，并正确诊断躯体症状障碍。这种混合方法研究的定性部分的目的是分析和简要描述导致原发性汽车躯体症状障碍诊断或非诊断的诊断过程。此外，我们的目标是确定相关的障碍和困难，阻碍实施的证据为基础的建议，在诊断过程中。定量部分的目的是量化在德国全科医生的书面调查中发现的障碍。最后，基于定性和定量的结果，解决方案的方法，以改善实施循证建议在诊断过程中的躯体症状障碍。

For most patients who suffer from functional somatic syndromes, general practitioners are the first point of contact with the health care system. Despite primary care's central role in the management of somatic symptom disorders, there are substantial problems in detecting patients with somatoform disorders in this setting. This has led to the under-diagnosis and under-treatment of somatic symptom disorders. According to the interdisciplinary German S3-guideline 'Non-specific, functional, and somatoform bodily complaints' (AWMF), there is a distinct lack of evidence from high-quality studies regarding the diagnostic process of functional somatic syndromes in primary care. Little is known about the barriers and difficulties that hinder general practitioners to implement evidence based recommendations and to correctly diagnose somatic symptom disorders. The aim of the qualitative part of this mixed-methods study is to analyse and concisely describe the diagnostic process that results in the diagnosis or non-diagnosis of a somatic symptom disorder in primary car. In addition, we aim to identify relevant barriers and difficulties which hinder the implementation of evidence based recommendations in the diagnostic process. The aim of the quantitative part is to quantify the identified barriers in a written survey given to general practitioners throughout Germany. Finally, based on the qualitative and quantitative results, solution approaches to improve the implementation of evidence based recommendations in the diagnostic process of somatic symptom disorders will be developed.