Enhanced care of patients with medically unexplained symptoms delivered by general practitioners

Martin Seifert

Keywords: medically unexplained symptoms , general practice, psychosomatic therapy, enhanced care, psychosomatic education

Background:
Patients with medically unexplained symptoms (MUS) make up a significant proportion of patients in general practice and can be very burdensome for doctors and the whole health and social care system. There has been no research focusing on patients with MUS or with somatization disorders in primary care in the Czech republic. Czech general practitioners (GPs) can officially achieve second medical specialization in Psychosomatic medicine which is based on many courses, months of internships, around 250 hours of self-experience, an original paper and finally an oral exam. In our study POCMUS we would like to compare the results of care of patients with MUS delivered by GPs with psychosomatic education and by those without. Also, we would like to detect the effective factors of the enhanced psychosomatic care provided by GPs with psychosomatic education.

Research questions:
What is the effect of a 30-minute intervention by a GP who has received specialized psychosomatic training compared to conventional care by a GP without training in psychosomatics on quality of life and health care utilization in their MUS patients?

Method:
Focus groups with GPs without and with GPs with psychosomatic training facilitated by a psychotherapist with experience with MUS patients and thematic analysis of the collected data. Prospective naturalistic intervention cohort study comparing the outcome of patients with MUS in quality of life, degree of disability from somatic symptoms, volume of health care received, work ability of patients with MUS, satisfaction with health care and perception of doctor-patient relationship treated by GPs with and without psychosomatic training. In-depth semi-structured interviews with selected patients from boths groups.

Results:

Conclusions:
We expect to prove better outcome in patients with MUS treated by GPs with special psychosomatic training with additional paid 30 minutes once a month. Effective factors of the enhanced care will be analysed and described.

Points for discussion:
What should be the right cost-effective psychosomatic education for GPs? Ellective or for everybody?

How should the cost-effective psychosomatic intervention in primary care look like?

How to identify the "psychosomatic" patients in general practice and how to select the patients for the study?