TY - JOUR
KW - Adolescent
KW - Adult
KW - Clinical Protocols
KW - Cognitive Therapy/methods
KW - Depressive Disorder/economics/therapy
KW - Female
KW - Follow-Up Studies
KW - Health Maintenance Organizations/manpower/standards
KW - Humans
KW - Male
KW - Mental Health Services/manpower/standards
KW - Middle Aged
KW - Nurse Practitioners/education/standards/utilization
KW - Personnel Selection
KW - Primary Health Care/manpower/standards
KW - Professional-Patient Relations
KW - Quality Assurance, Health Care
KW - Somatoform Disorders/diagnosis
KW - United States
AU - J. S. Lyles
AU - A. Hodges
AU - C. Collins
AU - C. Lein
AU - C. W. Given
AU - B. Given
AU - D. D'Mello
AU - G. G. Osborn
AU - J. Goddeeris
AU - J. C. Gardiner
AU - R. C. Smith
A1 - 
AB - Patients with medically unexplained symptoms (MUS) often are a source of frustration for clinicians, and despite high quality biomedical attention and frequent diagnostic tests, they have poor health outcomes. Following upon progress in depression treatment approaches, we developed a multidimensional treatment protocol for deployment by primary care personnel. This multi-faceted intervention for MUS patients emphasized cognitive-behavioral principles, the provider-patient relationship, pharmacological management, and treating comorbid medical diseases. We deployed it in an HMO using nurse practitioners (NP) to deliver the intervention to 101 patients, while 102 controls continued to receive medical care from their usual primary care physician. Successful deployment of the intervention required training the NPs, continuing support for the NPs in their management of this difficult population, and establishing strong communication links with the HMO. This paper addresses the practical considerations of using primary care personnel to implement a complex intervention in primary care, and it includes a discussion of special challenges encountered as well as solutions developed to overcome them.
BT - General hospital psychiatry
C5 - Education & Workforce; Financing & Sustainability; Medically Unexplained Symptoms
CP - 2
CY - United States
IS - 2
JF - General hospital psychiatry
N2 - Patients with medically unexplained symptoms (MUS) often are a source of frustration for clinicians, and despite high quality biomedical attention and frequent diagnostic tests, they have poor health outcomes. Following upon progress in depression treatment approaches, we developed a multidimensional treatment protocol for deployment by primary care personnel. This multi-faceted intervention for MUS patients emphasized cognitive-behavioral principles, the provider-patient relationship, pharmacological management, and treating comorbid medical diseases. We deployed it in an HMO using nurse practitioners (NP) to deliver the intervention to 101 patients, while 102 controls continued to receive medical care from their usual primary care physician. Successful deployment of the intervention required training the NPs, continuing support for the NPs in their management of this difficult population, and establishing strong communication links with the HMO. This paper addresses the practical considerations of using primary care personnel to implement a complex intervention in primary care, and it includes a discussion of special challenges encountered as well as solutions developed to overcome them.
PP - United States
PY - 2003
SN - 0163-8343; 0163-8343
SP - 63
EP - 73
EP - 
T1 - Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms
T2 - General hospital psychiatry
TI - Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms
U1 - Education & Workforce; Financing & Sustainability; Medically Unexplained Symptoms
U2 - 12676418
VL - 25
VO - 0163-8343; 0163-8343
Y1 - 2003
ER -