Costly patients with unexplained medical symptoms: A high-risk population

Abstract

Objectives To identify a group of costly patients with unexplained medical symptoms (UMS), and address their needs. Methods Prospective controlled trial; 42 patients with annual costs of care of $6500 or more were randomized into an intervention and a usual care group. A primary care team with expertise in the biopsychosocial (BPS) approach implemented the intervention. Results In the intervention group, the annual number of visits to consultants declined from 31.8 to 12.6 ( p < .0001) and 14.6 ( p = .72) after 1 and 2 years, respectively; visits to hospital emergency wards declined from 33.5 to 4.1 ( p < .0001) and 3.5 ( p = .18); and in-hospital days declined from 112.7 to 19 ( p < .0001) and 6.5 ( p = .25). Those parameters remained unchanged in the control group. Five years follow-up demonstrated a reduction in mortality rates between the two groups: 6/21 versus 17/21 ( p < 0.001). Conclusions When compared to usual care, a BPS intervention was followed by a decline in patients’ visits to medical settings and health-care expenditures, along with significant decline in mortality rate. Practice implication Costly UMS patients should be identified every year and treated using a BPS approach.