title: Patients with persistent medically unexplained symptoms in general practice: characteristics and quality of care.
abstract: BACKGROUND
  Medically unexplained physical symptoms (MUPS) are common in general practice (GP), and are even more problematic as they become persistent. The present study examines the relationship between persistent MUPS in general practice on the one hand and quality of life, social conditions, and coping on the other hand. Additionally, it is examined how patients with persistent MUPS evaluate the quality of GP-care.
  
  
  METHODS
  Data were used from a representative survey of morbidity in Dutch general practice, in which data from the electronic medical records were extracted. A random sample of patients participated in an extensive health interview and completed self-reported measures on social isolation, coping and the quality of GP-care. Patients with persistent MUPS (N = 192) were compared with general practice patients not meeting the criteria for persistent MUPS (N = 7.314), and with a group of patients that visited the GP in comparable rates for medical diagnoses (N = 2.265). Multiple logistic regression analyses were used to control for relevant socio-demographic variables and chronic diseases.
  
  
  RESULTS
  After adjustment for demographics and chronic diseases, patients with persistent MUPS reported more psychological distress, more functional impairment, more social isolation, and they evaluated the quality of GP-care less positive than the other two patient groups. Although the majority of MUPS patients were positive about the quality of GP-care, they more often felt that they were not taken seriously or not involved in treatment decisions, and more often reported that the GP did not take sufficient time. The three groups did not differ with respect to the statement that the GP unnecessarily explains physical problems as psychological ones.
  
  
  CONCLUSIONS
  Strengthening MUPS patients' social network and encouraging social activities may be a meaningful intervention in which the GP may play a stimulating role. To further improve MUPS patients' satisfaction with GP-care, GPs may pay extra attention to taking sufficient time when treating MUPS patients, taking the problems seriously, and involving them in treatment decisions.
authors.affiliation: Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands. a.dirkzwager@nivel.nl
authors.forename: Anja J E
authors.initials: AJ
authors.lastname: Dirkzwager
authors.forename: Peter F M
authors.initials: PF
authors.lastname: Verhaak
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D005194:Family Practice / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D009426:Netherlands; D010358:Patient Participation; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards*; D011785:Quality Assurance, Health Care; D012650:Self Disclosure; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors