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The Literature Collection contains over 11,000 references for published and grey literature on the integration of behavioral health and primary care. Learn More
Use the Search feature below to find references for your terms across the entire Literature Collection, or limit your searches by Authors, Keywords, or Titles and by Year, Type, or Topic. View your search results as displayed, or use the options to: Show more references per page; Sort references by Title or Date; and Refine your search criteria. Expand an individual reference to View Details. Full-text access to the literature may be available through a link to PubMed, a DOI, or a URL. References may also be exported for use in bibliographic software (e.g., EndNote, RefWorks, Zotero).
306 Results
41
Building Complex Care Capacity in Primary Care: An Educational Evaluation of Project ECHO Ontario Integrated Mental and Physical Health
Type: Journal Article
Year: 2022
Topic(s):
Education & Workforce
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, Medically Unexplained Symptoms
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, HIT & Telehealth
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43
Case and care complexity in the medically ill
Type: Journal Article
Year: 2006
Publication Place: United States
Abstract: The authors have argued that complexity in general health care is increasingly prevalent because of the increase in patients who have multimorbid conditions, and the increased professional and technical possibilities of medicine. In the increasingly complex care systems, it is necessary-specifically when treating patients in need of integrated care by several providers-that an optimal match between case and care complexity be found in order to prevent poor outcomes in this vulnerable group. The authors discussed several approaches to case complexity that can be identified in the literature. Most of them seem unsuitable for adjusting case and care complexity, and inadequate for designing multidisciplinary care. Theoretic approaches to case complexity may be of interest, but did not result in clinically meaningful information. The INTERMED, which can be considered the first empirically based instrument to link case and care complexity, is an attempt to improve care delivery and outcomes for the complex medically ill.
Topic(s):
Medically Unexplained Symptoms
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48
Childhood anxiety in a diverse primary care population: Parent-child reports, ethnicity and SCARED factor structure
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: OBJECTIVE: To explore in a multiethnic primary care population the impact of child gender and of race/ethnicity on parent and child reports of school-age anxiety and on the factor structure of the Screen for Childhood Anxiety and Related Emotional Disorders (SCARED). METHOD: A consecutive sample of 515 children (8 to <13 years) and their parent presenting for primary care completed self-report (C) and parent-report (P) versions of the SCARED-41. RESULTS: Neither SCARED scores nor parent-child difference varied significantly with race/ethnicity. Predictors of higher SCARED scores were less parental education, younger child age and female gender. Exploratory factor analysis conducted separately for SCARED-C and SCARED-P yielded four factors. There was large variation in factor structure between SCARED-C and SCARED-P and across ethnic and gender subgroups, greatest for somatic/panic/generalized anxiety and Hispanic children. CONCLUSIONS: Primary care triage of anxious children requires data from both the parent and child and must go beyond cross-sectional symptom inventories. Clinicians must elicit from each family their perhaps culturally bound interpretation of the child's somatic and psychological symptoms.
Topic(s):
Healthcare Disparities
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, Medically Unexplained Symptoms
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Reference Links: 
View the DOI record for Childhood anxiety in a diverse primary care population: Parent-child reports, ethnicity and SCARED factor structure
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View the PubMed citation for Childhood anxiety in a diverse primary care population: Parent-child reports, ethnicity and SCARED factor structure50
Classification and diagnosis of patients with medically unexplained symptoms
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Patients with medically unexplained symptoms (MUS) have little or no demonstrable disease explanation for the symptoms, and comorbid psychiatric disorders are frequent. Although common, costly, distressed, and often receiving ill-advised testing and treatments, most MUS patients go unrecognized, which precludes effective treatment. To enhance recognition, we present an emerging perspective that envisions a unitary classification for the entire spectrum of MUS where this diagnosis comprises severity, duration, and comorbidity. We then present a specific approach for making the diagnosis at each level of severity. Although our disease-based diagnosis system dictates excluding organic disease to diagnose MUS, much exclusion can occur clinically without recourse to laboratory or consultative evaluation because the majority of patients are mild. Only the less common, "difficult" patients with moderate and severe MUS require investigation to exclude organic diseases. By explicitly diagnosing and labeling all severity levels of MUS, we propose that this diagnostic approach cannot only facilitate effective treatment but also reduce the cost and morbidity from unnecessary interventions.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Classification and diagnosis of patients with medically unexplained symptoms
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View the PubMed citation for Classification and diagnosis of patients with medically unexplained symptoms52
Classification of somatization and functional somatic symptoms in primary care
Type: Journal Article
Year: 2005
Publication Place: Australia
Abstract: OBJECTIVE: A substantial proportion of patients found in primary care complain of physical symptoms not attributable to any known conventionally defined disorder, that is, medically unexplained or functional somatic symptoms. The objective of this paper is to outline the problems with the current classification and propose a classification more suitable for primary health care. METHOD: We refer to and discuss relevant literature including papers on our own research on the topic in the light of our experiences from major projects on somatizing patients in primary health care. RESULTS: Functional somatic symptoms may impose severe suffering on the patient and are costly for society because of high health-care utilization, lost working years and social expenses. At present, studies on functional somatic symptoms and disorders and their treatment are hampered by lack of a valid and reliable diagnostic classification. The diagnostic categories of somatoform disorders are overlapping. Thus, the present situation is that patients with identical symptoms and clinical pictures may receive different diagnostic labels depending on the focus of interests of the assessing physician. A particular problem in primary care is that the somatoform diagnostic categories only include persistent cases and do not offer the opportunity for classification of the patients with short-symptom duration found in this setting. We present a framework for a new descriptive classification of functional somatic symptoms and unfounded illness worrying, and outline a new classification that covers the whole spectrum of severity seen in clinical practice. CONCLUSION: A precondition for an appropriate management of patients with functional somatic symptoms is a valid taxonomy common for all medical specialties facilitating cooperative care. Classification systems as outlined in this paper may be a candidate for such a system, but it should be subject to further evaluation in research.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Classification of somatization and functional somatic symptoms in primary care
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View the PubMed citation for Classification of somatization and functional somatic symptoms in primary care53
Cognitive-behaviour therapy for patients with Abridged Somatization Disorder (SSI 4,6) in primary care: a randomized, controlled study
Type: Journal Article
Year: 2008
Publication Place: England
Abstract: BACKGROUND: Somatoform disorders are characterized by the presence of multiple somatic symptoms without an organic cause that completely explains their symptoms. These patients generate a high cost in health services. We aim to evaluate the effectiveness and feasibility of a cognitive-behaviour therapy (CBT) programme, administered in group and individual formats in primary care for patients who are diagnosed with abridged somatization disorder. METHOD/DESIGN: Design: Multicentre, randomized, controlled trial involving 3 groups, one of which is the control group consisting of standardized recommended treatment for somatization disorder in primary care (Smith's norms) and the 2 others, the intervention groups, consisting of cognitive-behavioural therapy (10 sessions) administered in individual format (intervention group 1) or in group format (intervention group 2).Setting: 29 primary care health centres in the province of Zaragoza and 3 primary care health centres in the province of Mallorca, Spain.Sample: N = 204 patients, (68 in each of the three groups), aged 18-65 years, able to understand and read Spanish, who fulfil Escobar's criteria of Abridgged Somatization Disorder (SSI 4,6), stable with pharmacotherapy over the previous month, and who will remain stable for the next 3 months in the doctor's opinion, having signed informed consent.Intervention: Control group: Standardized recommended treatment for somatization disorder in primary care (Smith's norms). Intervention group: 10 weekly sessions of CBT, following a protocol designed by Prof. Escobar's group at UMDNJ, USA. There are 2 different treatment conditions: individual and group format.Measurements: Survey on the use of health services, number and severity of somatic symptoms, anxiety, depression, quality of life and clinical global impression. The interviewers will not know which group the patient belongs to (blind). The assessments will be carried out at baseline, post-treatment, 6 months and 12 post-treatment. Main variables: Utilization of health services, number and severity of somatic symptoms.Analysis: The analysis will be per intent to treat. We will use the general linear models of the SPSS v.15 statistical package, to analyse the effect of treatment on the result variable (utilization of health services, number and severity of somatic symptoms). DISCUSSION: It is necessary to develop more effective psychological treatments for somatoform disorders. This randomised clinical trial will determine whether cognitive behaviour therapy, both in group or in individual format, is effective for the treatment of these patients. TRIAL REGISTRATION: Current controlled trials ISRCTN69944771.
Topic(s):
Medically Unexplained Symptoms
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56
Communication between psychosomatic C-L consultants and general practitioners in a German health care system
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: A randomized and prospective study examined the effects of intensive communication between treatment providers on physician behavior and patient care using a representative sample of patients referred to a German psychosomatic consultation-liaison (C-L) service (1998-1999). Sixty-seven patients were grouped (ICD-10) and randomized into intervention (n=33) and control groups (n=34). In the control group (CG), only the inpatient referring physicians were informed of consultation findings, as is standard practice in Germany. In the IG, the consultant directly reported the consultation findings to the general practitioner (GP). Patients were examined at 6-month (T2) and 3.5-year (T3) follow-up. Physician feedback and requests regarding the nature of communication were also assessed at T2. A significant reduction in symptoms was revealed at both follow-ups for the IG and CG. No significant group differences were found for acceptance of psychotherapy (59.1% IG and 42.3% CG at T3). The utilization of medical services remained stable across time. Patients who began psychotherapy were shown to have greater baseline symptom levels and "openness for new experiences" (NEO Five-Factor Inventory, NEO-FFi). Regular GP integration of psychosocial aspects into primary care differed between IG (44.0%) and CG (25.0%). Ninety-one percent of the GPs requested the option for a telephone conversation with the consultant or a case conference involving the patient at either their practice (37.7%) or the clinic (24.5%). We conclude that GPs are interested in a differentiated and more intensive cooperation concerning the integration of psychosocial aspects in their outpatient treatment. The patient's acceptance to follow a recommendation for psychotherapy, however, is related to the level of symptom severity and openness for new experiences.
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Communication between psychosomatic C-L consultants and general practitioners in a German health care system
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View the PubMed citation for Communication between psychosomatic C-L consultants and general practitioners in a German health care system57
Comorbidity between common mental disorders and chronic somatic diseases in primary care patients
Type: Journal Article
Year: 2010
Publication Place: United States
Topic(s):
Medically Unexplained Symptoms
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Reference Links:
View the DOI record for Comorbidity between common mental disorders and chronic somatic diseases in primary care patients
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View the PubMed citation for Comorbidity between common mental disorders and chronic somatic diseases in primary care patients58
Comparing cognitive and somatic symptoms of depression in myocardial infarction patients and depressed patients in primary and mental health care
Type: Journal Article
Year: 2013
Publication Place: United States
Abstract: Depression in myocardial infarction patients is often a first episode with a late age of onset. Two studies that compared depressed myocardial infarction patients to psychiatric patients found similar levels of somatic symptoms, and one study reported lower levels of cognitive/affective symptoms in myocardial infarction patients. We hypothesized that myocardial infarction patients with first depression onset at a late age would experience fewer cognitive/affective symptoms than depressed patients without cardiovascular disease. Combined data from two large multicenter depression studies resulted in a sample of 734 depressed individuals (194 myocardial infarction, 214 primary care, and 326 mental health care patients). A structured clinical interview provided information about depression diagnosis. Summed cognitive/affective and somatic symptom levels were compared between groups using analysis of covariance, with and without adjusting for the effects of recurrence and age of onset. Depressed myocardial infarction and primary care patients reported significantly lower cognitive/affective symptom levels than mental health care patients (F (2,682) = 6.043, p = 0.003). Additional analyses showed that the difference between myocardial infarction and mental health care patients disappeared after adjusting for age of onset but not recurrence of depression. These group differences were also supported by data-driven latent class analyses. There were no significant group differences in somatic symptom levels. Depression after myocardial infarction appears to have a different phenomenology than depression observed in mental health care. Future studies should investigate the etiological factors predictive of symptom dimensions in myocardial infarction and late-onset depression patients.
Topic(s):
Medically Unexplained Symptoms
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60
Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment
Type: Journal Article
Year: 2017
Publication Place: Ireland
Topic(s):
Measures
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, Medically Unexplained Symptoms
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, Opioids & Substance Use
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Reference Links:
View the DOI record for Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment
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View the PubMed citation for Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment