Training General Practitioners in the Treatment of Functional Somatic Symptoms: Effects on Patient Health in a Cluster-Randomised Controlled Trial (the Functional Illness in Primary Care Study)

Abstract

Background: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. Methods: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). Results: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. Conclusions: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.

Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial

“…The speciAL sample shows the typical sociodemographic characteristics of MUS patients in primary care as reported by previous, comparable studies, except for a slightly higher mean age [6,7,60,62,63], as patients up to the age of 70 years were included. Primary care patients with multiple, heterogeneous bodily complaints [63] were treated.…”

“…psychiatric consultation followed by a consultation letter [72] and GP training without [7,73,74] or with structured, scheduled individual intervention [63]. These other studies reported effects only in the subscales of the SF-36 [7,63,72], no effects [73] or even negative effects [74].…”

“…MUS are present in approximately 20% of primary care patients [5,6] and cause substantial patient impairment. MUS patients usually suffer from high somatic symptom severity that is often associated with relevant health anxiety and significant disability [6,7]. Due to excessive health care use, these patients are costly for society [8,9].…”

Economics of Medically Unexplained Symptoms: A Systematic Review of the Literature

“…This affects physicians’ knowledge and skills in diagnosis and management of patients with medically unexplained symptoms [29]. Physicians should be skilled in the basic communication techniques to handle functional patients.…”

An introduction for the treatment and educational strategy of medically unexplained symptoms in Denmark

“…And it continues to Step C, D, E. In this way, TERM summarizes the important communication techniques and leads to the better understanding for the patients. According to the outcome survey, TERM doesn't improve the symptoms of MUS patients, but it improves the GPs’ attitude and reduce the anxiety to see these patients 24, 25…”