Long-term objective. Improved care at the same or reduced costs for chronic somatizing patients, those patients without disease explanations for their prominent physical symptoms.
Specific aims. It is predicted that a comprehensive, multidimensional management intervention will lead to the following changes: 1) improvement in mental health, physical health, satisfaction with care, and economic productivity; 2) decrease in pain, nonpain physical symptoms, anxiety, depression, and health care utilization. 3) We expect no change in costs for health services used. Significance. Chronic somatizing patients present a paradox: excessive utilization that results in poor care. This is due in part to poor recognition of the problem, disinterest among physicians, and the absence of research-based guidelines -- in light of a 5-10 percent prevalence. Design and Method. In a managed care setting we will generate a list of likely somatizers from computerized data systems, based on number of visits and types of symptoms. By chart review, a medical student will then identify which patients are somatizers. Of these somatizers, two groups of 100 each will be randomly assigned to a usual care control group and an intervention group. Intervention patients will be referred to a nurse practitioner (backed-up by a usual care physician) for confirmation of somatization and intitiation of treatment. The nurse practitioner will be trained for managing somatizing patients and their psychiatric comorbidities and will manage the intervention group. Measures of health related quality of life and economic cost will be used to assess the effectiveness of the 12 month treatment intervention. Outcome. If the prediction is supported, an important step towards developing research-based management guidelines for one of the most common and difficult problems in primary care will have been taken.
