Healthy patients who perceive poor health and their use of primary care services

Connelly, Julia E.; Smith, Gary; Philbrick, John T.; Kaiser, Donald L.

doi:10.1007/bf02599392

Cited by 37 publications

(25 citation statements)

References 9 publications

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“…This may have skewed the results towards excessive weight being given to morbidity as an explanatory factor for PCC. 37 Only two self-reported chronic illnesses were included in the final regression. This does not imply that no other chronic illnesses were associated with PCC.…”

Section: Discussionmentioning

confidence: 99%

Patient psychosocial factors and primary care consultation: a cohort study

2007

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Background. The combined influence of psychological distress, family dysfunction and social support on primary care consultation (PCC) remains unclear.Objective. To build an explanatory model of PCC concerning users' psychosocial factors.Methods. We undertook a multicentre, prospective cohort study of a random sample of 1141 persons assigned to 113 GPs, belonging to 11 urban health centres in four Spanish cities (Seville, Malaga, Jaen and Granada), of whom 955 (84%) were interviewed in their homes. They were followed up for 1 year and then contacted again. After the second interview, 70 (7.3%) patients were excluded; accordingly, we measured the number of PCC of 885 valid patients using their medical charts.Results. A multilevel analysis was developed. The null model with three levels showed that 93.29% of the variability was explained by the patients, 1.56% by the GPs and 5.15% by the health centres. We selected a two-level model (patients and health centres) with random effects. The variables used in the multilevel analysis explained 48% of PCC, 36% at the patient level and 12% at the health centre level. Poor mental health (GHQ-28, partial correlation coefficient = 0.28) and family dysfunction (Family APGAR index, partial correlation coefficient = 0.26) were the most predictive variables, whereas social support (Duke-UNC-11, partial correlation coefficient = -0.14) lost significance in the multivariate analysis. Chronic illness seemed less relevant in our study, and only two predisposing factors were included in the equation: age and satisfaction with their doctor.Conclusions. Mental health and family function were the most important psychosocial factors predicting PCC. More comprehensive identification of psychosocial factors may enhance our understanding of PCC.

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Section: Discussionmentioning

confidence: 99%

Patient psychosocial factors and primary care consultation: a cohort study

2007

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“…Solche Patienten werden häufig von ihren Ärz-ten als frustrierend empfunden, die zu behandeln nicht lohnt [Lin et al, 1991]. Sie stellen sich selber als weniger gesund dar, als objektive Messungen ergeben würden [Connelly et al, 1991]. Da solche Patienten sowohl schwierig klinisch zu behandeln sind als auch eine unangemessene Anzahl von Gesundheitsversorgungsressourcen verbrauchen, wäre es hilfreich, ein umfassenderes Verständnis einiger kognitiver Prozesse zu erzielen, was sie dahin leitet, sich selbst als krank darzustellen und medizinische Hilfe zu benötigen.…”

Section: Verhaltenstherapieunclassified

Attribution von Körperempfindungen bei Patienten in der medizinischen Erstversorgung: Zusammenhänge mit der Häufigkeit von Arztbesuchen und mit Hypochondrie

Sensky¹,

Haynes²,

Rigby³

et al. 1998

Verhaltenstherapie

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“…Despite high utilization and much medical attention, MUS patients do poorly with their predominantly personal, psychologic problems (2)(3)(4)6). Moreover, there are no evidence-based treatment guidelines for the primary care clinicians who care for most MUS patients (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms

Smith

Gardiner

Lyles

et al. 2005

Psychosomatic Medicine

105

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Objectives-Investigators and clinicians almost always rely on Diagnostic and Statistical Manual of Mental Disorder, 4th edition's (DSM-IV) somatoform disorders (and its derivative diagnoses) to characterize and identify patients with medically unexplained symptoms (MUS). Our objective was to evaluate this use by determining the prevalence of DSM-IV somatoform and nonsomatoform disorders in patients with MUS proven by a gold standard chart review.Methods-In a community-based staff model HMO, we identified subjects for a clinical trial using a systematic and reliable chart rating procedure among high-utilizing MUS patients. Only baseline data are reported here. The World Health Organization Composite International Diagnostic Interview provided full and abridged DSM-IV diagnoses. Patients with full or abridged DSM-IV somatoform diagnoses were labeled "DSM somatoform-positive," whereas those without them were labeled "DSM somatoform-negative."Results-Two hundred six MUS patients averaged 13.6 visits in the year preceding study, 79.1% were females, and the average age was 47.7 years. We found that 124 patients (60.2%) had a nonsomatoform ("psychiatric") DSM-IV diagnosis of any type; 36 (17.5%) had 2 full nonsomatoform diagnoses, and 41 (19.9%) had >2; 92 (44.7%) had some full anxiety diagnosis and 94 (45.6%) had either full depression or minor depression diagnoses. However, only 9 of 206 (4.4%) had any full DSM-IV somatoform diagnosis, and only 39 (18.9%) had abridged somatization disorder. Thus, 48 (23.3%) were "DSM somatoform-positive" and 158 (76.7%) were "DSM somatoform-negative." The latter exhibited less anxiety, depression, mental dysfunction, and psychosomatic symptoms (all p< .001) and less physical dysfunction (p = .011). Correlates of this DSM somatoform-negative status were female gender (p = .007), less severe mental (p = .007), and physical dysfunction (p = .004), a decreased proportion of MUS (p< .10), and less psychiatric comorbidity (p < .10); c-statistic = 0.77.Conclusion-We concluded that depression and anxiety characterized MUS patients better than the somatoform disorders. Our data suggested radically revising the somatoform disorders for DSM-V by incorporating a new, very large group of now-overlooked DSM somatoform-negative patients who were typically women with less severe dysfunction.

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Healthy patients who perceive poor health and their use of primary care services

Cited by 37 publications

References 9 publications

Patient psychosocial factors and primary care consultation: a cohort study

Patient psychosocial factors and primary care consultation: a cohort study

Attribution von Körperempfindungen bei Patienten in der medizinischen Erstversorgung: Zusammenhänge mit der Häufigkeit von Arztbesuchen und mit Hypochondrie

Exploration of DSM-IV Criteria in Primary Care Patients With Medically Unexplained Symptoms

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