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).

scholarly journals Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0259341
Author(s):  
Naomi S. Kane ◽  
Nicole Anastasides ◽  
David R. Litke ◽  
Drew A. Helmer ◽  
Stephen C. Hunt ◽  
...  
Keyword(s):  
Mental Health ◽  
Physical Symptoms ◽  
Gulf War ◽  
Health Conditions ◽  
Disability Benefits ◽  
Gulf War Illness ◽  
War Veterans ◽  
Gulf War Veterans ◽  
Medically Unexplained ◽  
Us Veterans

Objective Conditions defined by persistent “medically unexplained” physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990–1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. Methods A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran’s medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. Results Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). Conclusion Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.

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