Primary care clinicians treat patients with medically unexplained symptoms

Smith, Robert C.; Lyles, Judith S.; Gardiner, Joseph C.; Sirbu, Corina; Hodges, Annemarie; Collins, Clare E.; Dwamena, Francesca C.; Lein, Catherine; Given, Charles W.; Given, Barbara; Goddeeris, John H.

doi:10.1111/j.1525-1497.2006.00460.x

Cited by 170 publications

(159 citation statements)

References 25 publications

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“…One other study examined the effect of training primary care clinicians to identify and treat somatization using a biopsychosocial model (Smith et al, 2006). This study involved the most intensive such training programs studied, one entailing 84 hours over 10 weeks.…”

Section: Integrating Cbt Into Primary Carementioning

confidence: 99%

“…Patients who received treatment from these trained nurses reported modest improvements on self-report scales of mental health such as mood and energy and physical functioning. A post hoc analysis was interpreted by the study's investigators as suggesting improvements were attributable to more frequent and appropriate use of antidepressant medication among patients of nurses who received the training (Smith et al, 2006).…”

Section: Integrating Cbt Into Primary Carementioning

confidence: 99%

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Cognitive Behavioral Therapy for Somatoform Disorders

Allen¹,

Woolfolk

2010

Psychiatric Clinics of North America

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Section: Integrating Cbt Into Primary Carementioning

confidence: 99%

Section: Integrating Cbt Into Primary Carementioning

confidence: 99%

Cognitive Behavioral Therapy for Somatoform Disorders

Allen¹,

Woolfolk

2010

Psychiatric Clinics of North America

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“…Only one study showed a positive outcome 184 and four reported no effect of training on patient outcomes. 99,145,162,173 Trials of collaborative care models reported benefits, 150,188 as did trials of different types of psychological therapy [cognitive-behavioural therapy (CBT, reflecting interviews)].…”

Section: Medically Unexplained Symptomsmentioning

confidence: 99%

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

Dowrick

Chew‐Graham

Lovell

et al. 2013

Programme Grants for Applied Research

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BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…[16][17][18][19][20][21][22][23] Providing physicians with management guidelines [24][25][26][27] and educational programs has also been found to be modestly effective. 28,29 However, much room remains for improving the care of somatizing and hypochondriacal patients for several reasons. 30 First, these tend to be chronic and treatment resistant problems that are maintained by psychological and psychosocial homeostasis.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

et al. 2013

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BACKGROUND: Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. OBJECTIVE: To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting. DESIGN: Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients' primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later. SUBJECTS: Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization. MEASUREMENTS: Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database. RESULTS: At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (p< 0.01), hypochondriacal symptoms (p<0.01), overall psychiatric distress (p< 0.01), and role impairment (p<0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (p=0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (p=0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged. CONCLUSIONS: Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.K E Y W O R D S : co g n it i v e b e ha v i or t h e ra p y ; so m a t i z a t i o n; hypochondriasis; medical utilization; medical care costs.

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Primary care clinicians treat patients with medically unexplained symptoms

Cited by 170 publications

References 25 publications

Cognitive Behavioral Therapy for Somatoform Disorders

Cognitive Behavioral Therapy for Somatoform Disorders

Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

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