scholarly journals Encounters between medical specialists and patients with medically unexplained physical symptoms; influences of communication on patient outcomes and use of health care: a literature overview

2012 ◽  
Vol 1 (4) ◽  
pp. 192-206 ◽  
Author(s):  
Anne Weiland ◽  
Rianne E. Van de Kraats ◽  
Annette H. Blankenstein ◽  
Jan L. C. M. Van Saase ◽  
Henk T. Van der Molen ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Outcomes ◽  
Physical Symptoms ◽  
Medically Unexplained Physical Symptoms ◽  
Medical Specialists ◽  
Literature Overview ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms ◽  
Use Of Health Care

Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial

2016 ◽  
Vol 6 (1) ◽  
pp. 50-60
Author(s):  
Anne Weiland ◽  
Annette H Blankenstein ◽  
Jan L Van Saase ◽  
Henk T Van der Molen ◽  
David Kosak ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Controlled Trial ◽  
Physical Symptoms ◽  
Communication Training ◽  
Medically Unexplained Physical Symptoms ◽  
Medical Specialists ◽  
Randomized Controlled ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms

Objectives: Medically unexplained physical symptoms (MUPS) burden patients in their well-being and functioning and have a prevalence of approximately 25-50% in primary and specialist care. Medical specialists often find patients with unexplained symptoms difficult to deal with, whereas patients are not always understood. We report effects on patient outcomes of an evidence-based MUPS-focused communication training for medical specialists.Methods: In a multi-center randomized controlled trial medical specialists and residents allocated to the intervention received a 14-hour MUPS-focused communication training. They practiced a patient-centered approach, including multi-factorial symptom exploration and explanation of MUPS with perpetuating factors. To study intervention effects, each doctor had to include three MUPS patients before and three after the intervention and to ask them to complete questionnaires at baseline and at 3 and 6 months follow-up. The questionnaires included illness worries (Whitely Index), symptom severity (Visual Analogue Scale), distress, depression, anxiety and somatization (4DSQ) and daily functioning (SF-36).Results: A sufficient number of 123 medical specialists and residents participated in the study. They included 478 MUPS patients. Out  of them, 297 patients filled out questionnaires at baseline, 165 patients at 3-months follow-up and 71 patients at 6-months follow-up. Recruitment of patients was lower than expected and patients’ non-response to baseline and follow-up questionnaires was higher than estimated. No significant effects were found on patient outcomes.Conclusions: It remains unclear whether medical specialist training results in better patient outcomes in MUPS as the trial was underpowered. New research with special attention to patient recruitment and retention is needed to answer this question.

scholarly journals Predicting Costs of Veterans Affairs Health Care in Gulf War Veterans with Medically Unexplained Physical Symptoms

2005 ◽  
Vol 170 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Jan Tackett ◽  
Matthew L. Maciejewski ◽  
Ralph D. Richardson ◽  
Stephen C. Hunt ◽  
Lisa Roberts ◽  
...  
Keyword(s):  
Health Care ◽  
Physical Symptoms ◽  
Veterans Affairs ◽  
Gulf War ◽  
War Veterans ◽  
Medically Unexplained Physical Symptoms ◽  
Gulf War Veterans ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms

A Primary Care Perspective on Prevailing Assumptions about Persistent Medically Unexplained Physical Symptoms

2002 ◽  
Vol 32 (2) ◽  
pp. 125-140 ◽  
Author(s):  
Ian M. Stanley ◽  
Sarah Peters ◽  
Peter Salmon
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Mental State ◽  
Physical Symptoms ◽  
Health Care Use ◽  
Medically Unexplained Physical Symptoms ◽  
Wide Range ◽  
Medically Unexplained ◽  
Primary Care Patients ◽  
Unexplained Physical Symptoms

Objective: To re-examine the widespread assumption that medically unexplained physical symptoms represent discrete syndromes resulting from somatization of mental illness. Method: Primary care patients ( N = 223) with medically unexplained symptoms of at least one year's duration were recruited to a study of exercise therapy. Data gathered from patients, from their general practitioners, and from medical records were used to examine relationships between self-defined disability, symptoms, mental state, and use of health care. Results: Levels of disability and health care use were both raised, but were only weakly correlated. While most patients were depressed and/or anxious, a minority (14 percent) were neither. Although mental state correlated with disability, health care use was unrelated to either. Among a wide range of recorded symptoms, few correlations were found to support the existence of discrete syndromes. Analysis of agreement between patients and their doctors in assigning symptoms to broadly defined “syndromes” appears to reflect collaboration that is largely expedient. Conclusions: In this sample of primary care patients with persistent unexplained physical symptoms, we found little evidence of discrete somatic syndromes. The level of health care use is no indication of mental state or level of disability, and the findings are equally consistent with depression or anxiety being secondary to disability and its consequences as with them being primary. The observed collaboration between patients and their doctors carries the risk of shaping, reinforcing, and legitimizing dubious syndromes.

scholarly journals Effectiveness of a Blended Multidisciplinary Intervention for Patients with Moderate Medically Unexplained Physical Symptoms (PARASOL): Protocol for a Cluster Randomized Clinical Trial (Preprint)

2017 ◽  
Author(s):  
Paula Elisabeth van Westrienen ◽  
Martijn F Pisters ◽  
Suze A.J. Toonders ◽  
Marloes Gerrits ◽  
Cindy Veenhof ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Clinical Trial ◽  
Cost Effectiveness ◽  
Physical Symptoms ◽  
Self Management ◽  
Medically Unexplained Physical Symptoms ◽  
Medically Unexplained ◽  
Unexplained Physical Symptoms ◽  
Health Care Centers

BACKGROUND Medically unexplained physical symptoms are an important health problem in primary care, with a spectrum from mild to chronic. The burden of chronic medically unexplained physical symptoms is substantial for patients, health care professionals, and society. Therefore, early identification of patients with moderate medically unexplained physical symptoms is needed in order to prevent chronicity. The preventive screening of medically unexplained physical symptoms (PRESUME) screening method was developed using data from the electronic medical record of the patients' general practitioner and demonstrated its prognostic accuracy to identify patients with moderate medically unexplained physical symptoms. In the next step, we developed a proactive blended and integrated mental health and physical therapy intervention program (PARASOL) to reduce complaints of moderate medically unexplained physical symptoms, stimulate self-management, and prevent chronicity. OBJECTIVE The primary objective of this study is to investigate the effectiveness of the blended PARASOL intervention on the impact of symptoms and quality of life in patients with moderate medically unexplained physical symptoms compared with usual care. Secondary objectives are to study the effect on severity of physical and psychosocial symptoms, general health, physical behavior, illness perception, and self-efficacy in patients with moderate medically unexplained physical symptoms as well as to determine the cost-effectiveness of the program. METHODS This paper presents the study protocol of a multicenter cluster randomized clinical trial. Adult patients with moderate medically unexplained physical symptoms will be identified from electronic medical record data using the PRESUME screening method and proactively recruited for participation in the study. Cluster randomization will be performed at the level of the participating health care centers. In total 248 patients with moderate medically unexplained physical symptoms (124 patients per arm) are needed. The PARASOL intervention is a 12-week blended primary care program consisting of 4 face-to-face consultations with the mental health nurse and 5 physical therapy sessions, supplemented with a Web-based program. The Web-based program contains (1) information modules and videos on self-management and educative themes, (2) videos and instructions on prescribed home exercises, and (3) assignments to gradually increase the physical activity. The program is directed at patients’ perception of symptoms as well as modifiable prognostic risk factors for chronicity using therapeutic neuroscience education. It encourages self-management, as well as an active lifestyle using a cognitive behavioral approach and graded activity. Primary outcomes are impact of symptoms and quality of life. Secondary outcomes are severity of physical and psychosocial symptoms, general health, physical behavior, illness perceptions, self-efficacy, and cost-effectiveness. All measurements will be performed at baseline, 3 and 12 months after baseline. Retrospective cost questionnaires will also be sent at 6 and 9 months after baseline and these will be used for the cost-effectiveness analysis. RESULTS The intervention has been developed, and the physical therapists and mental health nurses in the participating experimental health care centers have received two days of training on the content of the blended PARASOL intervention. The recruitment of health care centers started in June 2016 and inclusion of patients began in March 2017. Follow-up assessments of patients are expected to be completed in March 2019. CONCLUSIONS This study is the first randomized clinical trial to determine the effectiveness (including cost-effectiveness) of a proactive, blended, and integrated mental health and physical therapy care program for patients with moderate medically unexplained physical symptoms. The findings will help to improve the treatment for patients with moderate medically unexplained physical symptoms and prevent chronicity. CLINICALTRIAL Netherlands Trial Register NTR6755; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6755 (Archived by WebCite at http://www.webcitation.org/6ywporY7u).

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