PURPOSE Because recognition and management of patients with somatoform disorders are diffi cult, we wanted to determine the specifi city, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. METHODSWe studied the performance of the PHQ-15 in comparison with the Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis I disorders (SCID-I) as a reference standard. From January through September 2006, we approached patients for participation. This study was conducted in primary care settings in the Netherlands. Patients aged between 18 and 70 years were eligible if they belonged to 1 or more of the following groups: (1) patients with unexplained somatic complaints, (2) frequent attenders, and (3) patients with mental health problems. For the SCID-I interview we invited all patients with a PHQ-15 score of 6 or greater and a random sample of 30% of patients with a PHQ-15 score of less than 6. The primary study outcomes were the sensitivity and specifi city for the validity and the κ coeffi cient for the test-retest reliability.RESULTS Of 2,147 eligible patients, 906 (42%) participated (mean age 48 years, 62% female). At a cutoff level of 3 or more severe somatic symptoms during the past 4 weeks, sensitivity was 78% and specifi city 71%. The test-retest reliability was 0.60. CONCLUSIONSThe PHQ-15 is a valid and moderately reliable questionnaire for the detection of patients in a primary care setting at risk for somatoform disorders. INTRODUCTIONI n primary care 20% to 50% of all patients complaining of physical symptoms can be categorized as having medically unexplained symptoms.1,2 Earlier research shows that the criteria for somatoform disorders are met in 10% to 16% of all primary care patients. [3][4][5] Usually, the medically unexplained symptoms spontaneously resolve or improve by effective management. Sometimes the complaints persist, leading to functional impairment. 6 Somatoform disorders are a burden for both patients and family physicians. Patients with these disorders are at risk of overtesting and unnecessary treatment, 7,8 and the doctor-patient relationship is often diffi cult and strained.9 It is a challenge for physicians to improve their competence in recognizing and managing patients with somatoform disorders, and a screening questionnaire for somatoform disorders might be helpful.We wanted to test a screening questionnaire in a subgroup of patients for whom family physicians will most likely use the instrument. Because screening for early detection in a high-risk population is a key concept in family medicine, 10 we opted to screen the following population in the context of regular primary care: frequent attenders and patients who were identifi ed by their family physicians as having either mental health problems or unexplained somatic complaints. Hiske van 233 DE T EC T ING S O M ATOF OR M DIS OR DER SWe used the Dutch version of the Patient...

BackgroundUsing the Internet may prove useful in providing nutrition counselling and social support for patients with chronic diseases.ObjectiveWe evaluated the impact of Web-based nutrition counselling and social support on social support measures, anthropometry, blood pressure, and serum cholesterol in patients at increased cardiovascular risk.MethodsWe conducted a randomized controlled trial among patients with increased cardiovascular risk in Canadian family practices. During 8 months, patients in the intervention group and control groups received usual care. Patients in the intervention group also had access to a Web-based nutrition counselling and social support tool (Heartweb). Site use during the study was monitored. We measured social support, body mass index, waist/hip ratio, blood pressure, and cholesterol levels at baseline and at 4 and 8 months to assess the effectiveness of the intervention.ResultsWe randomized 146 patients into the Web-based intervention (n=73) or the control group (n=73). Within the Web-based intervention group, Heartweb was used by only 33% (24/73) of patients, with users being significantly younger than nonusers (P=.03). There were no statistically significant differences between the intervention group and the control group in changes in social support, anthropometry, blood pressure, and serum cholesterol levels.ConclusionsUptake of the Web-based intervention was low. This study showed no favourable effects of a Web-based nutrition counselling and social support intervention on social support, anthropometry, blood pressure, and serum cholesterol. Improvements in reach and frequency of site use are needed to increase the effectiveness of Web-based interventions.

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Familiarity with a GP improves patients' assessment of general practice care. Also in the future, personal continuity should be promoted.

The quality of the practice infrastructure and the team scored better in group practices, but patients appreciated the single-handed practice better. The advantages of single-handed practices could be a challenge for group practices to give better personal, continuous care and to put the patient perspective before organizational considerations. This is underlined by the better score on patient information of single-handed practices. Single-handed practices can reduce their vulnerability and openness to high demand by opening up to the requirements of organised primary care.