Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study)

Tomas Toft, Marianne Rosendal, Eva Ørnbøl, Frede Olesen, Lisbeth Frostholm, Per Fink

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

BACKGROUND: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. METHODS: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). RESULTS: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. CONCLUSIONS: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.
OriginalsprogEngelsk
TidsskriftPsychotherapy and Psychosomatics
Vol/bind79
Udgave nummer4
Sider (fra-til)227-37
Antal sider11
ISSN0033-3190
DOI
StatusUdgivet - 1. jun. 2010

Fingeraftryk

General Practitioners
Primary Health Care
Randomized Controlled Trials
Health
Control Groups
Medically Unexplained Symptoms
Neuropsychiatry
International Classification of Diseases
Outcome Assessment (Health Care)
Interviews
Education

Citer dette

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Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study). / Toft, Tomas; Rosendal, Marianne; Ørnbøl, Eva; Olesen, Frede; Frostholm, Lisbeth; Fink, Per.

I: Psychotherapy and Psychosomatics, Bind 79, Nr. 4, 01.06.2010, s. 227-37.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (the Functional Illness in Primary Care study)

AU - Toft, Tomas

AU - Rosendal, Marianne

AU - Ørnbøl, Eva

AU - Olesen, Frede

AU - Frostholm, Lisbeth

AU - Fink, Per

N1 - Copyright 2010 S. Karger AG, Basel.

PY - 2010/6/1

Y1 - 2010/6/1

N2 - BACKGROUND: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. METHODS: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). RESULTS: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. CONCLUSIONS: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.

AB - BACKGROUND: Patients with medically unexplained or functional somatic symptoms (FSS) are prevalent in primary care. In this pragmatic cluster-randomised controlled trial we aimed to test the effect of a training programme (The Extended Reattribution and Management model) for general practitioners (GPs) in the treatment of FSS. METHODS: 38 participating GPs were randomised to the control group or the training group. The GPs included consecutive 18- to 65-year-old patients presenting during a 3-week period for new health complaints. We assessed a stratified subsample with the psychiatric interview Schedules of Clinical Assessment in Neuropsychiatry. Of 701 patients interviewed, 350 fulfilled the diagnostic criteria for any ICD-10 somatoform disorder (SD) and 111 presented FSS without fulfilling these criteria (sub-threshold SD). Patients completed questionnaires at baseline and after 3, 12 and 24 months. The questionnaires included assessment of health status (36-item Medical Outcomes Study Short Form; SF-36), health anxiety (Whiteley-7) and physical symptoms (Symptom Check List-90, somatization subscale). RESULTS: Patients with SD consulting trained GPs improved more on our primary outcome of physical functioning than patients consulting control GPs at the 3-month follow-up (p = 0.004), but the improvement was not statistically significant at later follow-up. We found no significant differences in improvement between patients with SD and those with sub-threshold SD. Results for other SF-36 subscales, physical symptoms and health anxiety only showed statistically significant differences between the intervention and control groups for patients with SD; patients consulting trained GPs had less improvement in vitality, health anxiety and physical symptoms at 24 months compared with the control group. CONCLUSIONS: GP training may accelerate improvement in physical functioning for patients with SD. However, the effect is small and may not be clinically significant.

KW - Adult

KW - Cluster Analysis

KW - Denmark

KW - Education, Medical, Continuing

KW - Family Practice

KW - Female

KW - Follow-Up Studies

KW - Health Status

KW - Humans

KW - Male

KW - Middle Aged

KW - Outcome and Process Assessment (Health Care)

KW - Physicians, Family

KW - Primary Health Care

KW - Questionnaires

KW - Somatoform Disorders

U2 - 10.1159/000313691

DO - 10.1159/000313691

M3 - Journal article

C2 - 20424500

VL - 79

SP - 227

EP - 237

JO - Psychotherapy and Psychosomatics

JF - Psychotherapy and Psychosomatics

SN - 0033-3190

IS - 4

ER -