Primary Care Clinicians Treat Patients with Medically Unexplained Symptoms: A Randomized Controlled Trial
Version of Record online: 12 MAY 2006
Journal of General Internal Medicine
Volume 21, Issue 7, pages 671–677, July 2006
How to Cite
Smith, R. C., Lyles, J. S., Gardiner, J. C., Sirbu, C., Hodges, A., Collins, C., Dwamena, F. C., Lein, C., William Given, C., Given, B. and Goddeeris, J. (2006), Primary Care Clinicians Treat Patients with Medically Unexplained Symptoms: A Randomized Controlled Trial. Journal of General Internal Medicine, 21: 671–677. doi: 10.1111/j.1525-1497.2006.00460.x
- Issue online: 12 MAY 2006
- Version of Record online: 12 MAY 2006
- Manuscript received March 22, 2005Initial editorial decision May 20, 2005Final acceptance January 27, 2006
- medically unexplained symptoms;
- mental health in primary care;
- provider-patient relationship;
OBJECTIVE: There is no proven primary care treatment for patients with medically unexplained symptoms (MUS). We hypothesized that a long-term, multidimensional intervention by primary care providers would improve MUS patients' mental health.
DESIGN: Clinical trial.
SETTING: HMO in Lansing, MI.
PARTICIPANTS: Patients from 18 to 65 years old with 2 consecutive years of high utilization were identified as having MUS by a reliable chart rating procedure; 206 subjects were randomized and 200 completed the study.
INTERVENTION: From May 2000 to January 2003, 4 primary care clinicians deployed a 12-month intervention consisting of cognitive–behavioral, pharmacological, and other treatment modalities. A behaviorally defined patient-centered method was used by clinicians to facilitate this treatment and the provider-patient relationship.
MAIN OUTCOME MEASURE: The primary endpoint was an improvement from baseline to 12 months of 4 or more points on the Mental Component Summary of the SF-36.
RESULTS: Two hundred patients averaged 13.6 visits for the year preceding study. The average age was 47.7 years and 79.1% were females. Using intent to treat, 48 treatment and 34 control patients improved (odds ratio [OR]=1.92, 95% confidence interval [CI]: 1.08 to 3.40; P=.02). The relative benefit (relative “risk” for improving) was 1.47 (CI: 1.05 to 2.07), and the number needed to treat was 6.4 (95% CI: 0.89 to 11.89). The following baseline measures predicted improvement: severe mental dysfunction (P<.001), severe body pain (P=.039), nonsevere physical dysfunction (P=.003), and at least 16 years of education (P=.022); c-statistic=0.75.
CONCLUSION: The first multidimensional intervention by primary care clinicians led to clinically significant improvement in MUS patients.