title: Collaborative stepped care for somatoform disorders: A pre-post-intervention study in primary care.
abstract: OBJECTIVE
  The successful management of somatoform disorders in primary care is often limited due to low diagnostic accuracy, delayed referral to psychotherapy, and unstructured overuse of health care. This study aimed to investigate the feasibility of establishing a collaborative stepped health care network for somatoform disorders, and its impact on the diagnostic process and treatment recommendations in primary care.
  
  
  METHODS
  The Network for Somatoform and Functional Disorders (Sofu-Net) was established to connect 41 primary care physicians (PCP), 35 psychotherapists, and 8 mental health clinics. To evaluate Sofu-Net, primary care patients at high risk of having a somatoform disorder were identified using the Patient Health Questionnaire, and were assessed in detail at the patient and PCP level. Discussion of psychosocial distress in the consultations, diagnostic detection rates and treatment recommendations were compared before and 12 months after establishing the network.
  
  
  RESULTS
  Out of the pre- (n=1645) and 12-months-post Sofu-Net patient samples (n=1756), 267 (16.2%) and 269 (15.3%) high-risk patients were identified. From these, 156 and 123 patients were interviewed and information was assessed from their PCP. Twelve months after Sofu-Net establishment, high-risk patients more frequently discussed psychosocial distress with their PCP (63.3% vs. 79.2%, p<.001). PCPs prescribed more antidepressants (3.8% vs. 25.2%, p<.001) and less benzodiazepines (21.8% vs. 6.5%, p<.001). Sofu-Net did not affect PCP's diagnostic detection rates or recommendation to initiate psychotherapy.
  
  
  CONCLUSIONS
  The study results indicate feasibility of an interdisciplinary network for somatoform disorders. Collaborative care networks for somatoform disorders have the potential to improve doctor-patient-communication and prescription behavior.
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: m.shedden-mora@uke.de.
authors.forename: M C
authors.initials: MC
authors.lastname: Shedden-Mora
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Gross
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany; Department of Medical Psychology, University of Greifswald, Walther-Rathenau-Straße 48, 17475 Greifswald, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Lau
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Gumz
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Clinic Hamburg-Eilbek, Martinistr. 52, 20246 Hamburg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Löwe
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D019058:Community Networks; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D011320:Primary Health Care; D011613:Psychotherapy; D013001:Somatoform Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D001569:Benzodiazepines
keywords: Collaborative stepped care; Functional disorders; Health care network; Medically unexplained symptoms; Primary care; Somatoform disorders