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的第一个接触点。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，在检测躯体形式障碍患者方面仍存在重大问题。这导致了对躯体症状障碍的诊断和治疗不足。根据德国跨学科S3指南《非特异性、功能性和躯体形式躯体症状》(AWMF)，关于初级保健中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。对阻碍全科医生实施循证建议和正确诊断躯体症状障碍的障碍和困难知之甚少。这项混合方法研究的定性部分的目的是分析和简明扼要地描述导致初诊时躯体症状障碍被诊断或未被诊断的诊断过程。此外，我们的目标是找出在诊断过程中阻碍基于证据的建议实施的相关障碍和困难。量化部分的目的是量化德国全科医生书面调查中确定的障碍。最后，基于定性和定量的结果，将制定解决方案，以改进基于证据的建议在躯体症状障碍诊断过程中的实施情况。

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.