Psychosocial problems in primary care. Pilot study of a new taxonomy.
BACKGROUND: In this study, the Massachusetts Academy of Family Practice Research Network (MAFP ReNet) was used to test a new taxonomy of psychosocial problems presenting to family physicians and to examine physician variability in determining when a psychosocial problem plays a role in a patient's visit. METHODS: Thirty physicians completed a form listing the taxonomy of psychosocial issues for 19 standard case vignettes. These physicians then completed the same form for every patient seen in their practices over a 2-week period. RESULTS: The proposed taxonomy was well received by practicing physicians as appropriate for how they think about their patients and practices. The case vignettes demonstrated a large variability in physician identification of psychosocial problems. The 30 physicians who participated in all phases of the 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 from 23% to 81%, with a standard deviation of 15%. CONCLUSIONS: The proposed 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 physicians vary widely in their identification of psychosocial issues.