PSYCHOSOCIAL PROBLEMS IN PRIMARY-CARE PILOT-STUDY OF A NEW TAXONOMY

Background. In this study, the Massachusetts Academy of Family Practic e Research Network (MAFP ReNet) was used to test a new taxonomy of psy chosocial problems presenting to family physicians and to examine phys ician variability in determining when a psychosocial problem plays a r ole in a patient's visit. Methods. Thirty physicians completed a form listing the taxonomy of psychosocial issues for 19 standard case vigne ttes. These physicians then completed the same form for every patient seen in their practices over a 2-week period. Results. The proposed ta xonomy was well received by practicing physicians as appropriate for h ow they think about their patients and practices. The case vignettes d emonstrated a large variability in physician identification of psychos ocial problems. The 30 physicians who participated in all phases of th e study completed evaluations of 2876 patient visits, identifying 43% of these as involving one or more psychosocial problems. The frequency of psychosocial problem identification among the physicians ranged fr om 23% to 81%, with a standard deviation of 15%. Conclusions. The prop osed new taxonomy may be helpful in both future research and teaching. The high degree of variation in physician responses both to the same clinical vignettes and to patients in their practices suggests that ph ysicians vary widely in their identification of psychosocial issues.