Treating patients with medically unexplained symptoms in primary care.
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.


METHODS
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.


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.


CONCLUSIONS
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.
Smith
Robert C
RC
Department of General Internal Medicine, Michigan State University, East Lansing, Michigan 48824, USA. Robert.smith@nt.msu.edu
Lein
Catherine
C
Collins
Clare
C
Lyles
Judith S
JS
Given
Barbara
B
Dwamena
Francesca C
FC
Coffey
John
J
Hodges
AnneMarie
A
Gardiner
Joseph C
JC
Goddeeris
John
J
Given
C William
CW
D001007:Anxiety / Q000150:complications; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003299:Cooperative Behavior; D003863:Depression / Q000150:complications; D006801:Humans; D008824:Michigan; D005791:Patient Care; D010347:Patient Care Planning; D018802:Patient-Centered Care / Q000379:methods; D017410:Practice Guidelines as Topic / Q000592:standards; D011320:Primary Health Care; D011369:Professional-Patient Relations; D011584:Psychology; D013001:Somatoform Disorders / Q000523:psychology* / Q000628:therapy*