Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

Waal, Margot W. M. de; Arnold, Ingrid; Eekhof, Just; Assendelft, W.J.J.; Hemert, Albert M. van

doi:10.1186/1471-2296-9-5

Cited by 32 publications

(20 citation statements)

References 28 publications

(27 reference statements)

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“…health care system [2][3][4][5]. Not only do these disorders have a high prevalence [6,7], but patients suffering from them make up a disproportionately large portion of GPs' workloads and are often considered difficult and draining to treat [8].…”

mentioning

confidence: 99%

Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Hanel

Henningsen

Herzog

et al. 2009

Journal of Psychosomatic Research

213

117

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mentioning

confidence: 99%

Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Hanel

Henningsen

Herzog

et al. 2009

Journal of Psychosomatic Research

213

117

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“…18,19 High attendance rates are also found for patients with medically unexplained somatic symptoms, health anxiety, and perceived poor health. [20][21][22] The few longitudinal studies show attendance rates regress to the mean over time, with only 20-30% of frequent attenders continuing to attend frequently in the following year. [4][5][6][7] However, these studies of persistent frequent attendance use different definitions of frequent attenders and lack the power to detect factors associated with transient frequent attendance becoming persistent.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Predictability of persistent frequent attendance: a historic 3-year cohort study

Smits¹,

Brouwer²,

Weert³

et al. 2009

Br J Gen Pract

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Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders. AimTo develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records. Design of studyA historic 3-year cohort study. MethodData of 28 860 adult patients from 2003 to 2005 were examined. Frequent attenders were patients whose attendance rate ranked in the (age-and sex-adjusted) top 10% during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). Bootstrapped multivariable logistic regression analysis was used to determine which predictors contained information on persistent frequent attendance. ResultsOf 3045 1-year frequent attenders, 470 (15.4%) became persistent frequent attenders. The prediction rule could update this prior probability to 3.3% (lowest value) or 43.3% (highest value). However, the 10th and 90th centiles of the posterior probability distribution were 7.4% and 26.3% respectively, indicating that the model performs modestly. The area under the receiver operating characteristic curve was 0.67 (95% confidence limits 0.64 and 0.69). ConclusionAmong 1-year frequent attenders, six out of seven are transient frequent attenders. With the present indicators, the rule developed performs modestly in selecting those more likely to become persistent frequent attenders.

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“…This somewhat conflicts with the common belief that high-utilizing somatizers are predominantly women. In the U.S., women are more likely to be high utilizers of primary care 36,44 .…”

Section: Resultsmentioning

confidence: 99%

Health Care Utilization and Poor Reassurance: Potential Predictors of Somatoform Disorders

Puri

Dimsdale

2011

Psychiatric Clinics of North America

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Objective Somatoform disorders are common conditions, but the current diagnostic criteria are considered to be unreliable, based largely on medically unexplained symptoms. DSM-5 is considering other possible characteristics of somatizers including high utilization, dissatisfaction with care, and poor response to reassurance. This paper reviews the available literature for evidence to support these criteria, and evaluates if distinctive aspects of these characteristics exist in somatizers. Methods The Pubmed database was searched combining terms such as “somatoform disorder” with “reassurance,” “satisfaction,” and “utilization.” Articles were individually inspected. Results Many studies report a deficit in long-term response to reassurance in somatizers; there was some evidence that patients respond initially to reassurance, followed by return of anxiety, leading to further reassurance seeking. There was insufficient evidence to support poor satisfaction with care as a characteristic of somatizers. While there is no standard criterion for high utilization, regardless of definition, evidence was found to support over-utilization, particularly in outpatient visits. However, no unique pattern of utilization was found that could identify somatizers within a broader group of high utilizers. Conclusions This review revealed evidence of over-utilization in many areas of healthcare, as well as poor long term response to reassurance in somatizers. Dissatisfaction with care, though, was not a consistent finding. It is difficult to study alternative diagnostic criteria for somatoform patients when the current criteria rest on so many problematic assumptions. Future research should attempt to validate criteria empirically in patient groups, with selection not based on medically unexplained symptoms.

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Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

Cited by 32 publications

References 28 publications

Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Depression, anxiety, and somatoform disorders: Vague or distinct categories in primary care? Results from a large cross-sectional study

Predictability of persistent frequent attendance: a historic 3-year cohort study

Health Care Utilization and Poor Reassurance: Potential Predictors of Somatoform Disorders

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