Treating patients with medically unexplained symptoms in primary care

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

doi:10.1046/j.1525-1497.2003.20815.x

Cited by 110 publications

(106 citation statements)

References 133 publications

(223 reference statements)

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“…Smith et al 80 reviewed the literature on management of patients with unexplained symptoms and psychosocial distress, concluding that 80% of these patients accept management by primary care physicians but only 10% will attend a psychosocial referral. When a referral is made, the primary care physician plays an important role in outcome success.…”

Section: Supporting Literaturementioning

confidence: 99%

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Rosenthal¹

2008

The Journal of the American Board of Family Medicine

448

341

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Introduction:A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient's health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans.Methods: Standard literature databases, including PubMed, and Internet sites of numerous professional associations, government agencies, business groups, and private health organizations identified over 200 references, reports, and books evaluating the medical home and patient-centered primary care.Findings: Evaluations of several patient-centered medical home models corroborate earlier findings of improved outcomes and satisfaction. The peer-reviewed literature documents improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home. Patient autonomy and choice also contributes to satisfaction. Although industry has funded case management models demonstrating value superior to traditional fee-for-service reimbursement adoption of the medical home as a basis for medical care in the United States, delivery will require effort on the part of providers and incentives to support activities outside of the traditional face-to-face office visit.Conclusions: Evidence from multiple settings and several countries supports the ability of medical homes to advance societal health. A combination of fee-for-service, case management fees, and quality outcome incentives effectively drive higher standards in patient experience and outcomes. Community/ provider boards may be required to safeguard the public interest.

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Section: Supporting Literaturementioning

confidence: 99%

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Rosenthal¹

2008

The Journal of the American Board of Family Medicine

448

341

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“…The term medically unexplained symptoms (MUS) does not have a perspicuous definition, but is generally accepted to include those symptoms that evade the search for a medical cause (1,2). The condition is very commonly encountered in general clinical practice, and may lead to a battery of investigations exploring the genesis of symptoms (3).…”

Section: Introductionmentioning

confidence: 99%

Pathways to Care for Medically Unexplained Symptoms at a Specialty Psychosomatic Clinic in South India in 2014

Menon

Vivek

Sarkar

2016

Iran J Psychiatry Behav Sci

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Background: A growing body of evidence suggests that patients with medically unexplained symptoms (MUS) tend to delay help seeking behaviours. Objectives: The aim of this study was to explore the pathway to care for patients with MUS at a specialty psychosomatic clinic. Materials and Methods:The clinic caters to patients with MUS referred from other departments or directly seeking treatment. After detailed assessment, diagnosis was made as per ICD 10 clinical descriptions, diagnostic guidelines, and management plan. The pathway of care for patients registered in this clinic was assessed, using a structured questionnaire. Results: Pathway-of-care information was available for 49 out of the 53 patients (92.5% of the sample) registered in the first 8 months of the clinic. The median age of the participants was 36 years, of them, 25 (51.0%) were female, 40 (81.6%) married, and 32 (65.3%) belonged to nuclear family. Thirty-three patients (67.3%) visited general practitioners, 13 (26.5%) had visited traditional practitioners and faith healers, 48 (98.0%) had made visits to specialists/ tertiary care centers, and nine (18.4%) had consulted psychiatrists before being referred to our center. The first point of contact was the general practitioner in the majority of the cases (55.1%). Patients had waited for a mean of 21.73 (± 36.55) months and taken 5.53 (± 3.86) consultations before referring to our clinic. Conclusions: Patients with medically unexplained somatic symptoms may undertake considerable number of consultations before being referred to psychiatric treatment services. This signifies the need to train more doctors, particularly general practitioners, to empower them to recognize and manage unexplained medical symptoms.

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“…Patients with somatization are common and have physical symptoms with little documented basis in disease 1 . The prevalence of primary care patients with one or more somatizing symptoms ranges from 33% upwards in outpatient settings, and their care has occasioned safety and cost problems 1 .…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence of primary care patients with one or more somatizing symptoms ranges from 33% upwards in outpatient settings, and their care has occasioned safety and cost problems 1 .…”

Section: Introductionmentioning

confidence: 99%

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Primary Care Physicians Treat Somatization

et al. 2009

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BACKGROUND:We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention. METHODS:We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitivebehavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP. RESULTS:Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (−0.80; CI: −1.55 to −0.04) and psychological (−1.06; CI: −1.83 to −0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged. CONCLUSIONS:Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.KEY WORDS: somatization; medically unexplained symptoms; primary care mental health; patient-centered; provider-patient relationship.

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Treating patients with medically unexplained symptoms in primary care

Cited by 110 publications

References 133 publications

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Pathways to Care for Medically Unexplained Symptoms at a Specialty Psychosomatic Clinic in South India in 2014

Primary Care Physicians Treat Somatization

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