Social problems in primary health care - prevalence, responses, course of action, and the need for support from a general practitioners' point of view

Background: Very often patients utilize primary care services for health conditions related to social problems. These problems, which are not primarily medical, can severely influence the course of an illness and its treatment. Little is known about the extent to which problems like unemployment or loneliness occur in a general practice setting. Objectives: What are the most frequent health-related social problems perceived by general practitioners (GPs)? How are these problems associated with GP-or practice characteristics? How do general practitioners deal with the social problems they perceive and what kind of support do they need? Materials and methods: Cross-sectional, postal questionnaire survey with questions derived from Chapter Z social problems'' of the International Classification of Primary Care - 2nd edition. The questionnaire was mailed to available GP addresses in the federal states of Hamburg (n = 1,602) and Schleswig-Holstein (n = 1,242). Results: N = 489 questionnaires (17.2 %) were analyzed. At least three times a week, GPs were consulted by patients with poverty/financial problems (53.4 %), work/unemployment problems (43.7 %), patients with loneliness (38.7 %) as well as partnership issues (25.5 %). Only rarely did GPs report having perceived assault/harmful event problems (0.8 %). The highest frequency of problems was encountered by practices with a high proportion of a migrant population. Conclusions: Social problems are a common issue in routine primary care. GPs in Northwestern Germany usually try to find internal solutions for social problems but also indicated further interest in institutionalized support. A possible approach to solving these issues are community-based, locally organized networks.