• Antonius Schneider, Ewan Donnachie, Stephan Zipfel, and Paul Enck.
• Institute of General Practice and Health Services Research, TUM School of Medicine, Klinikumrechts der Isar, Technical University MunichDepartment of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen.
• Dtsch Arztebl Int. 2021 Jun 25; 118 (25): 425-431.

BackgroundPatients with functional somatic syndromes (FSS) might be prone to potentially harmful medical investigations in ambulatory care. The primary aim was to investigate whether patients with FSS are more likely to undergo diagnostic examinations such as radiography, computed tomography (CT), magnetic reso - nance imaging (MRI), and outpatient surgical procedures. The secondary aim was to evaluate the extent to which coordination of care by primary care physicians reduces healthcare utilization.MethodsRetrospective cohort study using longitudinal regression analysis of routine data. FSS patients were weighted in the regression model to allow a representative comparison with the Bavarian population. The observation period was from 5 years before until 10 years after the diagnosis of FSS.ResultsThe cohort comprised 43 676 patients with FSS and a control group of 50 003 patients without a diagnosis of FSS. The FSS patients exhibited continuously increased healthcare utilization over the 15-year period. The relative risk (RR) for FSS patients was up to 1.48 (95% confidence interval [1.46; 1.50]) for radiography, 2.01 [1.94; 2.08] for CT, 1.91 [1.87; 1.96] for MRI, and 1.30 [1.27; 1.34] for outpatient surgery. Compared with patients whose treatment was coordinated by their primary care physician, patients with no such coordination showed higher service utilization. The ambulatory care costs were up to 1.37 [1.36; 1.38] times greater.ConclusionPatients with FSS more frequently undergo potentially harmful and costly diagnostic testing and outpatient surgery. Coordination of care by the primary care physician is associated with lower healthcare utilization.

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