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.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH057099-03
Application #
6392240
Study Section
Services Research Review Committee (SER)
Program Officer
Pearson, Jane L
Project Start
1999-06-01
Project End
2003-05-31
Budget Start
2001-06-01
Budget End
2003-05-31
Support Year
3
Fiscal Year
2001
Total Cost
$626,023
Indirect Cost
Name
Michigan State University
Department
Internal Medicine/Medicine
Type
Schools of Osteopathy
DUNS #
193247145
City
East Lansing
State
MI
Country
United States
Zip Code
48824
Dwamena, Francesca C; Lyles, Judith S; Frankel, Richard M et al. (2009) In their own words: qualitative study of high-utilising primary care patients with medically unexplained symptoms. BMC Fam Pract 10:67
Smith, Robert C; Gardiner, Joseph C; Luo, Zhehui et al. (2009) Diagnostic accuracy of predicting somatization from patients' ICD-9 diagnoses. Psychosom Med 71:366-71
Smith, Robert C; Dwamena, Francesca C (2007) Classification and diagnosis of patients with medically unexplained symptoms. J Gen Intern Med 22:685-91
Luo, Zhehui; Goddeeris, John; Gardiner, Joseph C et al. (2007) Costs of an intervention for primary care patients with medically unexplained symptoms: a randomized controlled trial. Psychiatr Serv 58:1079-86
Smith, Robert C; Lyles, Judith S; Gardiner, Joseph C et al. (2006) Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial. J Gen Intern Med 21:671-7
Smith, Robert C; Gardiner, Joseph C; Lyles, Judith S et al. (2005) Exploration of DSM-IV criteria in primary care patients with medically unexplained symptoms. Psychosom Med 67:123-9
Smith, Robert C; Korban, Elie; Kanj, Mohammed et al. (2004) A method for rating charts to identify and classify patients with medically unexplained symptoms. Psychother Psychosom 73:36-42
Lein, Catherine; Collins, Clare; Lyles, Judith S et al. (2003) Building Research Relationships With Managed Care Organizations: Issues and Strategies. Fam Syst Health 21:205-214
Lyles, Judith S; Hodges, Annemarie; Collins, Clare et al. (2003) Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms. Gen Hosp Psychiatry 25:63-73
Smith, Robert C; Lein, Catherine; Collins, Clare et al. (2003) Treating patients with medically unexplained symptoms in primary care. J Gen Intern Med 18:478-89