This is the second revision of a competing continuation proposal to conduct a randomized, controlled, intervention trial of a three-part treatment program to improve the treatment of hypochondriacal patients, and to integrate their care into the delivery of primary care services. The program consists of: 1) psychoeducational counseling conducted by primary care nurses, followed by a specific, cognitive/ behavioral therapy for patients who do not respond to counseling; 2) a skills-based training program to improve the primary care physicians' medical management of these patients; and 3) a restructuring of the delivery of services to include an expanded, collaborative role for nurses in co-managing hypochondriacal patients. This intervention will be compared with relaxation training, a credible, non-specific, attention control treatment. The program's effectiveness will be assessed in three domains: 1) patient hypochondriacal symptoms, functional status, and satisfaction with care; 2) physician and nurse satisfaction and frustration in caring for hypochondriacal patients; and 3) medical care utilization, costs, and cost-effectiveness. The study will be carried out in a large, community practice setting. Twenty primary care physician- nurse pairs will be randomized to the treatment or control condition. Hypochondriacal patients will be identified through screening with a self-report questionnaire, characteristic patterns of medical care utilization ascertained from automated encounter data, and voluntary responses to announcements of the program. Four hundred fifty patients meeting eligibility criteria will then enter the experimental treatment program or receive relaxation training. Research follow-up interviews will be conducted immediately after the completion of treatment, and 8 and 14 months after inception (approximately 6 and 12 months after the completion of treatment). An intent-to-treat analytic design will be used to compare the two groups on the outcomes of interest at 6- and 12-month follow-up, after controlling for any group differences at baseline.
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