Chronic pain in German general practice.

INTRODUCTION: This study evaluates the prevalence of chronic pain, intensity of pain, activity limitation, and pain-related diagnoses in German general practices. METHODS: In 40 general practices, up to 50 consecutive patients presenting to general practitioners (GP) for routine medical consultation were questioned, and those reporting pain that lasted for more than 3 months received a questionnaire referring to intensity of pain and activity limitations. GPs received a questionnaire asking about the duration of treatment and diagnoses. RESULTS: Three hundred forty-six out of 1,860 questioned patients suffered from pain that lasted for more than 3 months (a point prevalence of 18.4% [95% confidence interval 16.7-20.3]). The average degree of pain equaled 5 out of 10 points on a numerical grading scale (NRS); the average degree of activity limitation was 4.8 out of 10. In most cases, the pain was related to musculoskeletal degenerative diseases. CONCLUSION: Chronic pain patients constitute a considerable share of workload in general practice.

Cardiovascular risk factors and motivation for a healthy life-style in a German community--results of the GP-based Oestringen study.

This paper explores the motivation of patients towards a healthy life-style in a small community with a special general practice and community-based health education program in order to identify reasons for different motivations and barriers and to improve preventive measures and outcome. The last of six standardised health surveys carried out over 9 years in the five general practices was therefore combined with a questionnaire to explore the attitudes of a sample of patients from these practices (N = 1044) and all attendees of 11 health education courses (N = 153). In addition to the cardiovascular risk factors, data were collected on sociodemographic factors and motivations for health promotion. The results show that, over time, the risk factors of hypertension (P < 0.001) and smoking (P < 0.005) had decreased. Health-promoting activities were not associated with cardiovascular risk factors; the motivations "duty" and "staying young" correlated with gender (P < 0.05). Patients with good health and white collar professions were more active. About 20% specified specific barriers to health-related activities. As expected, the participants of an educational program were more highly motivated by "fun", "fitness" and "meaningfulness". This group was mainly female. Future preventive measures should take into account that motivation for health promotion depends more on psychosocial factors than on risk factors; frequent obstacles should be noticed in the community.

Patient willingness to pay for preventive measures in primary care: a study of five GPs in a German community.

OBJECTIVE: To explore the willingness of patients in a usual primary care setting to pay out-of-pocket fees for their own health promotion, in correlation with risk factors and net income, and compared to patients of an educational programme. METHODS: A standardised health survey carried out in five general practices (GPs) of a small community with a special GP-based health education programme was combined with a questionnaire to explore the special attitudes of patients from a practice sample (n = 973) and from educational courses (n = 202): covering, in addition to cardiovascular risk factors, the sociodemographic factors, net income, and out-of-pocket fees that could be spent for own health promotion. RESULTS: After attending an educational programme, the patient's willingness to spend 15-40 euros/month for their own health promotion was high but there was no correlation with the income (p < 0.56), in contradiction to the patients of the practice sample who would pay more money the more they earn (p < 0.001). High levels of cardiovascular risk were associated with low education (p < 0.001), but net income and willingness to pay for preventive measures did not significantly correlate with cardiovascular risk factors. CONCLUSION: Participants of educational courses are willing to pay a rational out-of-pocket fee for preventive measures without correlation with their incomes, thus reducing the social gradient; future preventive measures should take into account that reasonable cost sharing is well accepted by well-informed patients.

Quality of life and objective disease criteria in patients with intermittent claudication in general practice.

BACKGROUND: The quality of life (QoL) of patients with chronic diseases is an important decision criterion for medical treatment, especially in primary care settings. It is known that subjective sickness feelings often cannot be correlated with objective disease criteria. OBJECTIVE: The aim of the study was to determine the QoL of patients with intermittent claudication with the arterial morphology, haemodynamic parameters and functional disability of peripheral arterial occlusive disease (PAOD). METHODS: In 150 patients with stable intermittent claudication, the health-related QoL was compared with the angiogram score, the resting Doppler pressure values, and the initial claudication distance (ICD) and absolute claudication distance (ACD) with treadmill exercise. RESULTS: The QoL did not correlate significantly with either the angiogram score or the ankle systolic blood pressure and ankle brachial index. ICD and ACD correlated significantly with the QoL activity subscales of pain, complaints and functional status (P < 0.001). In a multiple regression analysis, ACD and body mass index were the most predictive variables for the QoL. CONCLUSION: The QoL of PAOD patients is independent of the peripheral Doppler pressure and the angiographic severity of the disease. The most important criterion for the QoL is the patient's functional disability.