title: The resource utilisation of medically unexplained physical symptoms.
abstract: OBJECTIVE
  As patients with medically unexplained physical symptoms may present frequently to hospital settings and receive potentially unnecessary investigations and treatments, we aimed to assess the frequency and type of medically unexplained physical symptoms presentations to clinical services and estimate the associated direct healthcare costs.
  
  
  METHODS
  This study was undertaken at the largest district health board in New Zealand. All patients with a diagnosed presentation of medically unexplained physical symptoms in 2013 were identified using the district health board's clinical coding system. The clinical records (medical and psychiatric) of 49 patients were examined in detail to extricate all medically unexplained physical symptoms-related secondary care activity within 6 months before or after their medically unexplained physical symptoms presentation. Standardised national costing methodology was used to calculate the associated healthcare costs.
  
  
  RESULTS
  In all, 49% of patients attended hospital settings at least twice during 2013. The majority of presentations were for neurological or respiratory concerns. The total cost for the sample was GBP89,636 (median: GBP1,221). Costs were most significant in the areas of inpatient admissions and emergency care.
  
  
  CONCLUSIONS
  Medically unexplained physical symptoms result in frequent presentations to hospital settings. The costs incurred are substantial and comparable to the costs of chronic medical conditions with identifiable pathology. Improving recognition and management of medically unexplained physical symptoms has potential to offer more appropriate and cost-effective healthcare outcomes.
authors.affiliation: University of Otago, Dunedin, New Zealand.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Malcolm H
authors.initials: MH
authors.lastname: Johnson
authors.affiliation: Decision Support, Waitemata District Health Board, Auckland, New Zealand.
authors.forename: Julie
authors.initials: J
authors.lastname: Harris
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Frederick
authors.initials: F
authors.lastname: Sundram
keywords: Medically unexplained physical symptoms; critical care/emergency medicine; epidemiology/public health; healthcare costs; healthcare utilisation; mental health/psychiatry; somatoform