Costly patients with unexplained medical symptoms: a high-risk population.
OBJECTIVE
To identify a group of costly patients with unexplained medical symptoms (UMS), and address their needs.


METHODS
Prospective controlled trial; 42 patients with annual costs of care of $6500 or more were randomized into an intervention and a usual care group. A primary care team with expertise in the biopsychosocial (BPS) approach implemented the intervention.


RESULTS
In the intervention group, the annual number of visits to consultants declined from 31.8 to 12.6 (p<.0001) and 14.6 (p=.72) after 1 and 2 years, respectively; visits to hospital emergency wards declined from 33.5 to 4.1 (p<.0001) and 3.5 (p=.18); and in-hospital days declined from 112.7 to 19 (p<.0001) and 6.5 (p=.25). Those parameters remained unchanged in the control group. Five years follow-up demonstrated a reduction in mortality rates between the two groups: 6/21 versus 17/21 (p<0.001).


CONCLUSIONS
When compared to usual care, a BPS intervention was followed by a decline in patients' visits to medical settings and health-care expenditures, along with significant decline in mortality rate.


CONCLUSIONS
Costly UMS patients should be identified every year and treated using a BPS approach.
Margalit
Alon P A
AP
Moshe Prywes Center for Medical Education, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. alon@talk2doc.net
El-Ad
Aviva
A
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D019090:Case Management / Q000458:organization & administration; D015897:Comorbidity; D017281:Cost of Illness; D005190:Family / Q000523:psychology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006694:Holistic Health; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies; D012307:Risk Factors; D013001:Somatoform Disorders / Q000150:complications / Q000191:economics* / Q000401:mortality / Q000517:prevention & control*; D018709:Statistics, Nonparametric