title: Costly patients with unexplained medical symptoms: a high-risk population.
abstract: 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.
authors.affiliation: Moshe Prywes Center for Medical Education, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. alon@talk2doc.net
authors.forename: Alon P A
authors.initials: AP
authors.lastname: Margalit
authors.forename: Aviva
authors.initials: A
authors.lastname: El-Ad
mesh_terms: 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