Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomised trial

Abstract

Background Patients continue to suffer from medically unexplained symptoms otherwise referred to as persistent physical symptoms (PPS). General practitioners (GPs) play a key role in the management of PPS and require further training. Patients are often frustrated with the care they receive. This study aims to assess the acceptability of an ‘integrated GP care’ approach which consists of offering self-help materials to patients with PPS and offering their GPs training on how to utilise cognitive behavioural skills within their consultations, as well as assessing the feasibility of conducting a future trial in primary care to evaluate its benefit. Methods A feasibility cluster randomised controlled trial was conducted in primary care, South London, UK. GP practices (clusters) were randomly allocated to ‘integrated GP care plus treatment as usual’ or ‘treatment as usual’. Patients with PPS were recruited from participating GP practices before randomisation. Feasibility parameters, process variables and potential outcome measures were collected at pre-randomisation and at 12- and 24-weeks post-randomisation at cluster and individual participant level. Results Two thousand nine hundred seventy-eight patients were identified from 18 GP practices. Out of the 424 patients who responded with interest in the study, 164 fully met the eligibility criteria. One hundred sixty-one patients provided baseline data before cluster randomisation and therefore were able to participate in the study. Most feasibility parameters indicated that the intervention was acceptable and a future trial feasible. 50 GPs from 8 GP practices (randomised to intervention) attended the offer of training and provided positive feedback. Scores in GP knowledge and confidence increased post-training. Follow-up rate of patients at 24 weeks was 87%. However estimated effect sizes on potential clinical outcomes were small. Conclusions It was feasible to identify and recruit patients with PPS. Retention rates of participants up to 24 weeks were high. A wide range of health services were used. The intervention was relatively low cost and low risk. This complex intervention should be further developed to improve patients’/GPs’ utilisation of audio/visual and training resources before proceeding to a full trial evaluation. Trial registration NCT02444520 (ClinicalTrials.gov).

Experiences with a structured conversation tool: a qualitative study on feasibility in general practice in Norway

“…The finding of an increased sense of competence in learning cognitive conversational techniques coincides with other studies [ 15 , 16 ]. We compared our findings with those published by Patel et al.…”

“…The finding of an increased sense of competence in learning cognitive conversational techniques is congruent with several studies [ 15 , 16 ]. In clinical practice, CA recognized a need for a structural conversational tool that could both increase patients’ self-coping ability and the doctor's management and sick leave assessment in patients with MUPS.…”

“…We compared our findings with those published by Patel et al. [ 16 ] where 50 GPs tested the feasibility of a shorter training in 90 min on how to utilize cognitive behavioral skills within their consultation on patients with MUPS. The GPs participating in this study increased their confidence in their management of the patients.…”

Somatic symptom disorders.

“…Stepped care models have developed over the last 20 years as a way to better identify individuals who need different kinds of specialty care (often mental health services) and to provide a structure for that to occur (Henningsen et al, 2018;Kathol et al, 2009). Several programs have emerged in Europe and have been actively enrolling patients in both inpatient and outpatient settings (Grochtdreis et al, 2018;Köbler et al, 2022;Löwe et al, 2017Löwe et al, , 2022Patel et al, 2020). These programs share a common goal of providing integrated care through interdisciplinary programs and providers at all levels of medical and mental health complexity.…”

Psychotherapeutische und ärztliche Inanspruchnahme bei persistierenden somatischen Symptomen: 4-Jahres-Katamnese des Netzwerks für somatoforme und funktionelle Störungen (Sofu-Net)

“…Diese zeigt, dass neben komorbider Depression und Angststörung auch höhere Krankheitsangst und somatosensorische Amplifizierung mit einem geringeren Therapieerfolg assoziiert sind. Ähnlich wurde in der prospektiven Studie von Claassen-van Dessel et al [25] [32]. Auf Ebene der Einzelpatienten sollte eine mögliche Ambivalenz gegenüber der psychotherapeutischen Versorgung berücksichtigt werden.…”