title: Primary care clinicians treat patients with medically unexplained symptoms: a randomized controlled trial.
abstract: OBJECTIVE
  There is no proven primary care treatment for patients with medically unexplained symptoms (MUS). We hypothesized that a long-term, multidimensional intervention by primary care providers would improve MUS patients' mental health.
  
  
  METHODS
  Clinical trial.
  
  
  METHODS
  HMO in Lansing, MI.
  
  
  METHODS
  Patients from 18 to 65 years old with 2 consecutive years of high utilization were identified as having MUS by a reliable chart rating procedure; 206 subjects were randomized and 200 completed the study.
  
  
  METHODS
  From May 2000 to January 2003, 4 primary care clinicians deployed a 12-month intervention consisting of cognitive-behavioral, pharmacological, and other treatment modalities. A behaviorally defined patient-centered method was used by clinicians to facilitate this treatment and the provider-patient relationship.
  
  
  METHODS
  The primary endpoint was an improvement from baseline to 12 months of 4 or more points on the Mental Component Summary of the SF-36.
  
  
  RESULTS
  Two hundred patients averaged 13.6 visits for the year preceding study. The average age was 47.7 years and 79.1% were females. Using intent to treat, 48 treatment and 34 control patients improved (odds ratio [OR]=1.92, 95% confidence interval [CI]: 1.08 to 3.40; P=.02). The relative benefit (relative "risk" for improving) was 1.47 (CI: 1.05 to 2.07), and the number needed to treat was 6.4 (95% CI: 0.89 to 11.89). The following baseline measures predicted improvement: severe mental dysfunction (P<.001), severe body pain (P=.039), nonsevere physical dysfunction (P=.003), and at least 16 years of education (P=.022); c-statistic=0.75.
  
  
  CONCLUSIONS
  The first multidimensional intervention by primary care clinicians led to clinically significant improvement in MUS patients.
authors.affiliation: Department of Medicine, Michigan State University, East Lansing, MI, USA. Robert.Smith@HT.MSU.edu
authors.forename: Robert C
authors.initials: RC
authors.lastname: Smith
authors.forename: Judith S
authors.initials: JS
authors.lastname: Lyles
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Gardiner
authors.forename: Corina
authors.initials: C
authors.lastname: Sirbu
authors.forename: Annemarie
authors.initials: A
authors.lastname: Hodges
authors.forename: Clare
authors.initials: C
authors.lastname: Collins
authors.forename: Francesca C
authors.initials: FC
authors.lastname: Dwamena
authors.forename: Catherine
authors.initials: C
authors.lastname: Lein
authors.forename: C
authors.initials: C
authors.lastname: William Given
authors.forename: Barbara
authors.initials: B
authors.lastname: Given
authors.forename: John
authors.initials: J
authors.lastname: Goddeeris
mesh_terms: D000328:Adult; D000368:Aged; D004502:Education, Medical, Continuing; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D008875:Middle Aged; D010146:Pain; D018579:Patient Selection; D010821:Physicians, Family; D016896:Treatment Outcome