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Cited by 91Psychosomatic Disorders and Their TreatmentsChronic Disease Management StrategiesPrimary Care and Health Outcomes

A Randomized Clinical Trial of a Care Recommendation Letter Intervention for Somatization in Primary Care

Open access
Dickinson, W. P.·2003·The Annals of Family Medicine
DOI 10.1370/afm.5PMC PMC1466611
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Abstract

PURPOSE: This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention. METHODS: One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient's somatization status and provided recommendations for the patient's care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months. RESULTS: Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01). CONCLUSIONS: The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.

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  • Close medication management, GP training, care coordination and psychological interventions such as CBT have been effective in either improving mental health or reducing service use.

    “Close medication management, GP training, care coordination and psychological interventions such as cognitive behaviour therapy (CBT) have been effective in either improving mental health or reducing service use, 9,10”

    From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [9]

    The background section says antidepressant treatment and CBT have been beneficial for some patients. But it does not establish that close medication management, GP training, or care coordination improved mental health or reduced service use. The Discussion reports improved physical functioning from the care-recommendation letter, no apparent mental-health benefit, and no evaluation of its effect on expenditures. (LLM, conf=0.86)

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2 of the 61 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Escobar JI. Pharmacological treatment of somatization/hypochondria- sis. Psychopharmacol Bull. 1996;32:589-596.
  2. Robins LN, Helzer JE, Croughan J, Ratcliff KS. National Institute of Mental Health Diagnostic Interview Schedule. Arch Gen Psychiatry. 1981;38:381-389.
  3. Diggle P, Kenward M. Informative dropout in longitudinal data analysis. Appl Stat. 1994;43:49-93.

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Authors
Dickinson, W. P.
Affiliations
University of Colorado Health (US)
Corresponding author
Dickinson, W. P.
ORCID
Dickinson, W. P.
Venue
The Annals of Family Medicine
Publisher
Annals of Family Medicine
Published
2003-11-01
Volume
1
Issue
4
Pages
228-235
ISSN
  • 1544-1709 (ISSN-L)
  • 1544-1717
DOI
10.1370/afm.5
PMC
PMC1466611
OpenAlex
W2169456198
Cited by
90
References
61
Citations by year
2021: 2 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 2 · 2014: 2 · 2013: 7 · 2012: 9
FWCI
2.25
Type
journal article
Language
en
Open access
Locations
  • The Annals of Family Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
  • National Institutes of Health (1r29mh045441-01a1)
  • National Institute of Mental Health (MH 63651, MH45441, K02MH063651)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
somatization, primary care, physician-patient communication, physical function, unexplained physical symptoms, SF-36
MeSH terms
Alabama, Chronic Disease, Family Practice, Female, Humans, Longitudinal Studies, Male, Middle Aged, Patient Care Planning, Postal Service, Somatoform Disorders, Comorbidity, Likelihood Functions, Treatment Outcome, Cross-Over Studies

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