Abstract
BackgroundExisting care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes.AimTo explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation.Design & settingProspective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service.MethodThe care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed.ResultsIn total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs.ConclusionThe primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package.
Highlights
IntroductionPatients with MUS ( labelled bodily distress syndrome in newer classification systems), report experiencing physical symptoms that cannot be explained adequately or sufficiently by organic pathology, but which cause distress and functional impairment
Patients with MUS,1,2 report experiencing physical symptoms that cannot be explained adequately or sufficiently by organic pathology, but which cause distress and functional impairment
The results suggest that no single component of the care package seems to account for the changes observed
Summary
Patients with MUS ( labelled bodily distress syndrome in newer classification systems), report experiencing physical symptoms that cannot be explained adequately or sufficiently by organic pathology, but which cause distress and functional impairment. Compared with enhanced or structured care, psychological therapies generally were not more effective for most of the outcomes.’. Compared with enhanced or structured care, psychological therapies generally were not more effective for most of the outcomes.’12 It has frequently been reported in trials that engaging significant numbers of patients in psychological care has been difficult.. The cohort study presented here evaluated the feasibility and the potential clinical–cost implications of a novel care package that provides seamless primary care offering identification, assessment, engagement, and body-oriented interventions to patients with MUS. It aimed to address the following specific research questions:. What is the potential impact of the care package on service utilisation and associated healthcare costs?
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