Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs

Morriss, Richard; Gask, Linda; Ronalds, Clare; Downes-Grainger, Elin; Thompson, Hale M.; Leese, Brenda; Goldberg, David

doi:10.1093/fampra/15.2.119

Cited by 95 publications

(100 citation statements)

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“…Studies of reattribution interventions, although not in patients with cancer and chronic pain, have found short-term psychological improvements (Morriss, et al, 1999). Interventions aiming to make HNC patients internalise the BPS framework to manage pain should be evaluated in future research.…”

Section: Discussionmentioning

confidence: 99%

Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy

Schaller

Larsson

Lindblad

et al. 2015

Pain Management Nursing

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Section: Discussionmentioning

confidence: 99%

Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy

Schaller

Larsson

Lindblad

et al. 2015

Pain Management Nursing

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“…It has been widely adopted internationally. [7][8][9][10][11][12][13][14] Features of reattribution are that: psychological context can help explain physical symptoms; attributions for symptoms held by patients are unhelpful; broadening patients' attributions will resolve/improve symptoms or enable GPs to treat any underlying psychological or social problems.…”

Section: Introductionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14] A recent UK primary care trial (MUST) demonstrated that GPs can be taught by non-expert trainers to deliver reattribution within routine consultations. 5 GPs' communication changed significantly; trained physicians elicited more patient concerns/beliefs and provided richer symptom explanations that linked physical symptoms to psychosocial issues.…”

Section: Introductionmentioning

confidence: 99%

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

et al. 2008

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BACKGROUND: Despite both parties often expressing dissatisfaction with consultations, patients with medically unexplained symptoms (MUS) prefer to consult their general practitioners (GPs) rather than any other health professional. Training GPs to explain how symptoms can relate to psychosocial problems (reattribution) improves the quality of doctor-patient communication, though not necessarily patient health. OBJECTIVE:To examine patient experiences of GPs' attempts to reattribute MUS in order to identify potential barriers to primary care management of MUS and improvement in outcome.DESIGN: Qualitative study. PARTICIPANTS:Patients consulting with MUS whose GPs had been trained in reattribution. A secondary sample of patients of control GPs was also interviewed to ascertain if barriers identified were specific to reattribution or common to consultations about MUS in general. APPROACH: Thematic analysis of in-depth interviews.RESULTS: Potential barriers include the complexity of patients' problems and patients' judgements about how to manage their presentation of this complexity. Many did not trust doctors with discussion of emotional aspects of their problems and chose not to present them. The same barriers were seen amongst patients whose GPs were not trained, suggesting the barriers are not particular to reattribution.CONCLUSIONS: Improving GP explanation of unexplained symptoms is insufficient to reduce patients' concerns. GPs need to (1) help patients to make sense of the complex nature of their presenting problems, (2) communicate that attention to psychosocial factors will not preclude vigilance to physical disease and (3) ensure a quality of doctor-patient relationship in which patients can perceive psychosocial enquiry as appropriate.

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“…This programme was taught in brief courses (eight hours in total) and adopted a cognitive-oriented approach. The model has been tested in the UK in before-and-after studies and in the Netherlands in a randomized controlled trial demonstrating that GPs acquired the necessary interviewing skills [25], a reduction in overall health care cost [26], a change in patients' health beliefs [27] and an improvement in patients' health [28,29].…”

Section: Treatment Of Somatizationmentioning

confidence: 99%

Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care

Rosendal

Fink

Bro

et al. 2005

Scandinavian Journal of Primary Health Care

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Several definitions of somatization exist and try to deal with the fundamental problem that a large group of patients present with physical symptoms for which a conventional pathology cannot be identified. However, the concept remains somewhat confusing. The prevalence of somatization is high in general practice. Nevertheless, patients do not receive proper treatment and risk iatrogenic somatic fixation and harm, the doctor Á/patient relationship is often negatively affected and the overall healthcare system suffers from high expenditure on unnecessary physical investigations and treatments. During the last decade research has shown that somatization may be treated effectively in specialist care. Little is known about effective treatment in primary care but the Reattribution Model and the Extended Reattribution and Management Model have shown promising results. The development and evaluation of new treatment strategies is, however, hampered by the confusion of definitions and concepts. In this article an overview is presented of the various concepts relevant to the clinical work and research in primary health care. It is important to realize that somatizing patients in primary health care present a broader spectrum of severity than patients seen in a specialist setting. Hence, primary care cannot apply definitions from specialist care directly but needs a definition that also includes the mild cases. We need classifications and agreed definitions applicable in primary health care in order to develop appropriate management strategies, to predict prognosis, and to enable rigorous research concerning the large group of somatizing patients in primary health care.

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Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs

Abstract: Training GPs with the reattribution training package appears to be extremely cost-effective.

Cited by 95 publications

References 0 publications

Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy

Experiences of Pain: A Longitudinal, Qualitative Study of Patients with Head and Neck Cancer Recently Treated with Radiotherapy

What Do Patients Choose to Tell Their Doctors? Qualitative Analysis of Potential Barriers to Reattributing Medically Unexplained Symptoms

Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care

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