A randomized clinical trial of a care recommendation letter intervention for somatization in primary care.
OBJECTIVE
This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention.


METHODS
One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient's somatization status and provided recommendations for the patient's care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months.


RESULTS
Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01).


CONCLUSIONS
The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.
Dickinson
W Perry
WP
Department of Family Medicine, University of Colorado Health Sciences Center, Denver, CO, USA. perry.dickinson@uchsc.edu
Dickinson
L Miriam
LM
deGruy
Frank V
FV
Main
Deborah S
DS
Candib
Lucy M
LM
Rost
Kathryn
K
D000407:Alabama / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D015897:Comorbidity; D018592:Cross-Over Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D011177:Postal Service; D013001:Somatoform Disorders / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome