Turning theory into practice: rationale, feasibility and external validity of an exploratory randomized controlled trial of training family practitioners in reattribution to manage patients with medically unexplained symptoms (the MUST).
BACKGROUND
The evidence for the effectiveness of reattribution training are limited, and optimal service delivery is not yet established.


OBJECTIVE
The objectives of this study were to establish the feasibility and to optimize the service delivery and design of a definitive randomized controlled trial (RCT) of reattribution training for patients with medically unexplained symptoms (MUSs) in routine primary care.


METHODS
The study was of a cluster RCT design with the practice as the unit of randomization. Health facilitator (HF)-delivered reattribution training was compared with no reattribution training. The primary outcome measure used is doctor-patient communication in the consultation. Quantitative and qualitative methods identify barriers to effectiveness. The acceptability and feasibility of the intervention were established by attendance rates and postal survey after completion of training.


RESULTS
Sixteen practices and 70 family practitioners (FPs) were recruited with representative practice and FP characteristics. Six hours of HF reattribution training to FPs in the workplace proved feasible and acceptable with all 35 FPs completing the training. Feedback from 27 (77%) FPs who received training indicated that 25 (93%) FPs believed that specific and relevant learning achievements were made, 22 (82%) felt more confident and 21 (77%) thought the training was useful.


CONCLUSIONS
HF-delivered reattribution training to whole practices is feasible and acceptable, and its effectiveness is measurable in routine primary care.
Morriss
Richard
R
Division of Psychiatry, School of Behavioural, Community and Population Science, University of Liverpool, Royal Liverpool University Hospital, L69 3GA Liverpool, UK. Richard.morris@nottingham.ac.uk
Dowrick
Christopher
C
Salmon
Peter
P
Peters
Sarah
S
Rogers
Anne
A
Dunn
Graham
G
Lewis
Barry
B
Charles-Jones
Huw
H
Hogg
Judith
J
Clifforda
Rebecca
R
Iredale
Wendy
W
Towey
Maria
M
Gask
Linda
L
D000328:Adult; D003142:Communication; D004502:Education, Medical, Continuing / Q000379:methods / Q000592:standards*; D005194:Family Practice / Q000193:education* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods / Q000592:standards*; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D010817:Physician-Patient Relations; D015397:Program Evaluation; D015203:Reproducibility of Results; D013001:Somatoform Disorders / Q000175:diagnosis / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology