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Treating patients with medically unexplained symptoms in primary care.
Smith, Robert C; Lein, Catherine; Collins, Clare; Lyles, Judith S; Given, Barbara; Dwamena, Francesca C; Coffey, John; Hodges, AnneMarie; Gardiner, Joseph C; Goddeeris, John; Given, C William.
Afiliación
  • Smith RC; Department of General Internal Medicine, Michigan State University, East Lansing, Michigan 48824, USA. Robert.smith@nt.msu.edu
J Gen Intern Med ; 18(6): 478-89, 2003 Jun.
Article en En | MEDLINE | ID: mdl-12823656
BACKGROUND: There are no proven, comprehensive treatments in primary care for patients with medically unexplained symptoms (MUS) even though these patients have high levels of psychosocial distress, medical disability, costs, and utilization. Despite extensive care, these common patients often become worse. OBJECTIVE: We sought to identify an effective, research-based treatment that can be conducted by primary care personnel. DESIGN: We used our own experiences and files, consulted with experts, and conducted an extensive review of the literature to identify two things: 1). effective treatments from randomized controlled trials for MUS patients in primary care and in specialty settings; and 2). any type of treatment study in a related area that might inform primary care treatment, for example, depression, provider-patient relationship. MAIN RESULTS: We developed a multidimensional treatment plan by integrating several areas of the literature: collaborative/stepped care, cognitive-behavioral treatment, and the provider-patient relationship. The treatment is designed for primary care personnel (physicians, physician assistants, nurse practitioners) and deployed intensively at the outset; visit intervals are progressively increased as stability and improvement occur. CONCLUSION: Providing a comprehensive treatment plan for chronic, high-utilizing MUS patients removes one barrier to treating this common problem effectively in primary care by primary care personnel.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Trastornos Somatomorfos / Terapia Cognitivo-Conductual / Atención Dirigida al Paciente / Conducta Cooperativa Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2003 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Trastornos Somatomorfos / Terapia Cognitivo-Conductual / Atención Dirigida al Paciente / Conducta Cooperativa Tipo de estudio: Clinical_trials / Diagnostic_studies / Guideline / Prognostic_studies Límite: Humans País/Región como asunto: America do norte Idioma: En Revista: J Gen Intern Med Asunto de la revista: MEDICINA INTERNA Año: 2003 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos