A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics and their use of medical resources.
BACKGROUND
Frequent attenders in primary care are a professional challenge for family physicians, and the medical costs of their care can be very high. Some of them suffer from somatization and are concerned solely with their physical complaints, although somatic complaints are the most common presentation of anxiety and depression. To assess and treat these patients comprehensively, a multidisciplinary clinic was created in the community.


METHODS
This study describes the first 40 patients referred to the clinic. All patients completed a mental health screening questionnaire and a functional assessment of health. The utilization of medical resources was assessed by chart review for the year before and the year after the first encounter in the clinic. The intervention consisted of a comprehensive bio-psychosocial consultation where life history and medical symptoms were woven together into a new narrative. The intervention also included pharmacological treatment and short-term psychological interventions.


RESULTS
The majority of referred patients were women and their average age was 52 years. Headache was the leading symptom, followed by fatigue. The mean number of reported symptoms for each individual patient was 10. Mental health problems were mainly somatization, depression and anxiety. The average yearly costs per person of US$4035 were reduced to US$1161 the year following referral.


CONCLUSIONS
The integrated approach of the clinic satisfied at least three needs: of the patient, of the referring physician and of the health maintenance organization. The results of this uncontrolled pilot study suggest that this intervention helped to modify illness behaviour, decreasing the costs of medical investigations.
Matalon
Andre
A
Department of Family Medicine, Tel-Aviv University and General Health Services, Dan-Petach Tikva District, Israel.
Nahmani
Tzvia
T
Rabin
Stanley
S
Maoz
Benjamin
B
Hart
Jacob
J
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy*; D001291:Attitude of Health Personnel; D003863:Depression / Q000628:therapy*; D005221:Fatigue / Q000628:therapy; D005260:Female; D006261:Headache / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D013001:Somatoform Disorders / Q000628:therapy*; D014481:United States