Plain language summary
Enhancing GP care for people with unexplained physical symptoms: a review of the evidence
Why is this review important?
GPs see many people with physical symptoms or syndromes for which there is no apparent disease. GPs find it difficult to help patients with these ‘functional’ somatic symptoms, but specialist services can help those most severely affected. If GPs were able to offer similar treatments (enhanced care) within their surgeries, they might help patients more quickly and save resources.
Who may be interested in this review?
People affected by a range of unexplained physical symptoms or syndromes, and their carers
GPs and practice nurses
GP commissioning groups
What questions does the review aim to answer?
Does training GPs to enhance care for patients with functional somatic symptoms improve physical or mental health outcomes?
Which research studies were included in this review?
Searching databases revealed six relevant studies, completed between 2000 and 2006 in north-western Europe. To be included, studies needed to:
involve GPs who had received training in ‘enhanced care’ before offering it to their own patients in the surgery;
involve types of enhanced care which enabled patients with somatic symptoms to reconsider their physical problems, broadening their understanding to include psychological issues in order to improve their health and quality of life;
measure both physical and mental health outcomes for patients;
compare a group of patients who received the enhanced care with another group who did not.
Altogether the six studies covered 233 GPs and 1787 patients.
What does the evidence tell us?
The review found that the relevant six studies varied in significant ways:
how severe the patients’ symptoms were;
the form and intensity of the enhanced care offered.
These differences made the studies difficult to compare. Many people left the studies before the outcomes could be measured.
Given these problems with comparing existing research, it is only possible to say:
enhanced care may help people with functional somatic symptoms;
more intensive enhanced care may be more effective than very brief interventions.
What should happen next?
Further research into this topic is needed to test how much and what type of enhanced care could be effective. Future research should take into account barriers that might prevent such treatments benefitting patients. These include:
GPs’ lack of time or skills, and their low expectations that enhanced care might help patients;
patients’ reluctance to accept non-physical understandings of somatic symptoms.