Email UpdatesLiterature Collection
Collection Insights
10K+
References
9K+
Articles
1400+
Grey Literature
4500+
Opioids & SU
The Literature Collection contains over 10,000 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).
261 Results
61
Dementia care initiative in primary practice: study protocol of a cluster randomized trial on dementia management in a general practice setting
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: BACKGROUND: Current guidelines for dementia care recommend the combination of drug therapy with non-pharmaceutical measures like counselling and social support. However, the scientific evidence concerning non-pharmaceutical interventions for dementia patients and their informal caregivers remains inconclusive. Targets of modern comprehensive dementia care are to enable patients to live at home as long and as independent as possible and to reduce the burden of caregivers. The objective of the study is to compare a complex intervention including caregiver support groups and counselling against usual care in terms of time to nursing home placement. In this paper the study protocol is described. METHODS/DESIGN: The IDA (Initiative Demenzversorgung in der Allgemeinmedizin) project is designed as a three armed cluster-randomized trial where dementia patients and their informal caregivers are recruited by general practitioners. Patients in the study region of Middle Franconia, Germany, are included if they have mild or moderate dementia, are at least 65 years old, and are members of the German AOK (Allgemeine Ortskrankenkasse) sickness fund. In the control group patients receive regular treatment, whereas in the two intervention groups general practitioners participate in a training course in evidence based dementia treatment, recommend support groups and offer counseling to the family caregivers either beginning at baseline or after the 1-year follow-up. The study recruitment and follow-up took place from July 2005 to January 2009. 303 general practitioners were randomized of which 129 recruited a total of 390 patients. Time to nursing home admission within the two year intervention and follow-up period is the primary endpoint. Secondary endpoints are cognitive status, activities of daily living, burden of care giving as well as healthcare costs. For an economic analysis from the societal perspective, data are collected from caregivers as well as by the use of routine data from statutory health insurance and long-term care insurance. DISCUSSION: From a public health perspective, the IDA trial is expected to lead to evidence based results on the community effectiveness of non-pharmaceutical support measures for dementia patients and their caregivers in the primary care sector. For health policy makers it is necessary to make their decisions about financing new services based on strong knowledge about the acceptance of measures in the population and their cost-effectiveness. TRIAL REGISTRATION: ISRCTN68329593.
Topic(s):
Medically Unexplained Symptoms
See topic collection
62
Depression and anxiety in multisomatoform disorder: prevalence and clinical predictors in primary care
Type: Journal Article
Year: 2008
Publication Place: South Africa
Abstract: OBJECTIVE: Multisomatoform disorder (MSD) is characterised by > or = 3 medically inexplicable, troublesome physical symptoms, together with a > or = 2-year history of somatisation. The aim of this study was to evaluate the prevalence of depressive and anxiety disorders in a South African sample MSD, and to compare demographic and clinical outcomes in those patients with and without co-morbidity. METHODS: Fifty-one adult outpatients with MSD were recruited from primary care clinics in the Cape Town metropolitan area. Participants were assessed for the presence of co-morbid depressive and anxiety disorders using the Mini Neuropsychiatric Interview-Plus (MINI-Plus). Outcomes included somatic symptom severity, disability, reported sick days and health care visits, pain experience, patient satisfaction with health services, and clinician-experienced difficulty. RESULTS: A current co-morbid depressive disorder was present in 29.4% (N = 15) of patients, and a current co-morbid anxiety disorder in 52.9% (N = 27). MSD patients with a co-morbid depressive disorder (current or lifetime) had significantly higher physical symptom counts, greater functional impairment, higher unemployment rates, more clinician-reported difficulties, and more dissatisfaction with health care services than those without the disorder. A larger number of co-morbid disorders was associated with greater overall disability. CONCLUSION: High rates of co-morbid depressive and anxiety disorders were present in a South African sample of primary care patients with MSD. Not all patients had co-morbidity, which is consistent with the view that MSD should be viewed as an independent disorder. However, co-morbid depressive disorders were associated with increased symptom severity and functional impairment, consistent with previous reports from developing countries, emphasising the importance of comorbidity in MSD.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Depression and anxiety in multisomatoform disorder: prevalence and clinical predictors in primary care
63
Depression in African Americans: Breaking barriers to detection and treatment
Type: Journal Article
Year: 2006
Publication Place: United States
Abstract: OBJECTIVE: Recent studies in primary care settings indicate that African Americans face health disparities in the treatment of major depression. We reviewed the literature to find evidence of specific patient, physician, and practice-setting factors related to such barriers. DATA SOURCES: We searched for and retrieved articles in Medline (1966-2004) and hand-checked bibliographies to find additional articles that were relevant to the evaluation and treatment of African Americans with depression. STUDY SELECTION AND DATA EXTRACTION: Two investigators (AKD, MO) independently examined the abstracts retrieved from the literature search, and excluded articles that did not match a predefined search strategy. Two other investigators (HLC, MMW) identified potential articles through bibliographic review. In the extracted set articles, we examined cited barriers to diagnosis and effective management. RESULTS: We found 24 articles that fulfilled our criteria. These studies indicate that African Americans face a number of barriers in the recognition and treatment of major depression including clinical presentation with somatization, stigma about diagnosis, competing clinical demands of comorbid general medical problems, problems with the physician-patient relationship, and lack of comprehensive primary care services. CONCLUSIONS: Research indicates that African Americans who have depression may be frequently under diagnosed and inadequately managed in primary care as a result of patient, physician, and treatment-setting factors. Our systematic review can assist family physicians in understanding how to overcome such barriers to the diagnosis and treatment of depressive disorders in African American patients.
Topic(s):
Healthcare Disparities
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Depression in African Americans: Breaking barriers to detection and treatment
64
Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment
Type: Journal Article
Year: 2008
Publication Place: United States
Abstract: OBJECTIVE: To determine diagnostic overlap of depression, anxiety and somatization as well as their unique and overlapping contribution to functional impairment. METHOD: Two thousand ninety-one consecutive primary care clinic patients participated in a multicenter cross-sectional survey in 15 primary care clinics in the United States (participation rate, 92%). Depression, anxiety, somatization and functional impairment were assessed using validated scales from the Patient Health Questionnaire (PHQ) (PHQ-8, eight-item depression module; GAD-7, seven-item Generalized Anxiety Disorder Scale; and PHQ-15, 15-item somatic symptom scale) and the Short-Form General Health Survey (SF-20). Multiple linear regression analyses were used to investigate unique and overlapping associations of depression, anxiety and somatization with functional impairment. RESULTS: In over 50% of cases, comorbidities existed between depression, anxiety and somatization. The contribution of the commonalities of depression, anxiety and somatization to functional impairment substantially exceeded the contribution of their independent parts. Nevertheless, depression, anxiety and somatization did have important and individual effects (i.e., separate from their overlap effect) on certain areas of functional impairment. CONCLUSIONS: Given the large syndrome overlap, a potential consideration for future diagnostic classification would be to describe basic diagnostic criteria for a single overarching disorder and to optionally code additional diagnostic features that allow a more detailed classification into specific depressive, anxiety and somatoform subtypes.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment
View DOI Record
View the PubMed citation for Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment65
Depression, anxiety, and somatoform disorders: vague or distinct categories in primary care? Results from a large cross-sectional study
Type: Journal Article
Year: 2009
Publication Place: England
Abstract: OBJECTIVE: Depression, anxiety, and somatization are the most frequently observed mental disorders in primary health care. Our main objective was to draw on the often neglected general practitioners' (GPs) perspective to investigate what characterizes these three common mental diagnoses with regard to creating more suitable categories in the DSM-V and ICD-11. METHODS: We collected independent data from 1751 primary care patients (participation rate=77%) and their 32 treating GPs in Germany. Patients filled out validated patient self-report measures for depression (PHQ-9), somatic symptom severity (PHQ-15), and illness anxiety (Whiteley-7), and questions regarding coping and attribution of illness. GPs' clinical diagnoses and associated features were assessed. RESULTS: Patients diagnosed by their GPs with depression, anxiety, and/or somatoform disorders were significantly older, less educated, and more often female than the reference group not diagnosed with a mental disorder. They had visited the GP more often, had a longer duration of symptoms, and were more often under social or financial stress. Among the mental disorders diagnosed by the GPs, depression (OR=4.4; 95% CI=2.6 to 7.5) and comorbidity of somatoform, depressive, and anxiety disorders (OR=9.5; 95% CI=4.6 to 19.4) were associated with the largest degrees of impairment compared to the reference group. Patients diagnosed as having a somatoform/functional disorder only had mildly elevated impairment on all dimensions (OR=2.0; 95% CI=1.4 to 2.7). Similar results were found for the physicians' attribution of psychosocial factors for cause and maintenance of the disease, difficult patient-doctor relationship, and self-assessed mental disorder. CONCLUSION: In order to make the DSM-V and ICD-11 more suitable for primary care, we propose providing appropriate diagnostic categories for (1) the many mild forms of mental syndromes typically seen in primary care; and (2) the severe forms of comorbidity between somatoform, depressive, and/or anxiety disorder, e.g., with a dimensional approach.
Topic(s):
Medically Unexplained Symptoms
See topic collection
66
Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition
Type: Journal Article
Year: 2007
Publication Place: United States
Abstract: Recent studies emphasize the negative impact of comorbidity on the course of depression. If undiagnosed, depression and comorbidity contribute to high medical utilization. We aimed to assess (1) prevalences of depression alone and with comorbidity (anxiety/somatoform disorders) in primary care, (2) coexistence of anxiety/somatoform disorders in depressive patients, and (3) diagnostic validity of two screeners regarding depression with versus without comorbidity. We examined 394 primary care outpatients using the Composite International Diagnostic Interview (CIDI), the General Health Questionnaire (GHQ-12), and the Well-Being Index (WHO-5). We conducted configurational frequency analyses to identify nonrandom configurations of the disorders and receiver operating characteristic (ROC)-analyses to assess diagnostic validity of the screeners. Point prevalence of any depressive disorder was 22.8%; with at least one comorbid disorder, 15%; and with two comorbid conditions, 6.1%, which significantly exceeded expected percentage (0.9%, P< or =.0001). Depression without comorbidity occurred significantly less often than expected by chance (P< or =.0007). Comorbidity of depressive and anxiety or somatoform disorders was associated with a high odds ratio (6.25). The screeners were comparable regarding their diagnostic validity for depression with [GHQ-12: area under the curve (AUC)=0.86; WHO-5: AUC=0.88] and without comorbidity (GHQ-12: AUC=0.84; WHO-5: AUC=0.86). It can be concluded that comorbidity between depression and anxiety/somatoform disorders in primary care may occur much more frequently than expected. These results confirm assumptions that the current division between depression and anxiety might be debatable. Validity of screeners tested in our study was not affected by comorbid conditions (e.g., anxiety or somatoform disorders).
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition
View DOI Record
View the PubMed citation for Depressive, anxiety, and somatoform disorders in primary care: prevalence and recognition67
Detecting somatoform disorders in primary care with the PHQ-15
Type: Journal Article
Year: 2009
Publication Place: United States
Abstract: PURPOSE: Because recognition and management of patients with somatoform disorders are difficult, we wanted to determine the specificity, sensitivity, and the test-retest reliability of the 15-symptom Patient Health Questionnaire (PHQ-15) for detection of somatoform disorders in a high-risk primary care population. METHODS: We studied the performance of the PHQ-15 in comparison with the Structured Clinical Interview for the Diagnostic and Statistical Manual-IV Axis I disorders (SCID-I) as a reference standard. From January through September 2006, we approached patients for participation. This study was conducted in primary care settings in the Netherlands. Patients aged between 18 and 70 years were eligible if they belonged to 1 or more of the following groups: (1) patients with unexplained somatic complaints, (2) frequent attenders, and (3) patients with mental health problems. For the SCID-I interview we invited all patients with a PHQ-15 score of 6 or greater and a random sample of 30% of patients with a PHQ-15 score of less than 6. The primary study outcomes were the sensitivity and specificity for the validity and the kappa coefficient for the test-retest reliability. RESULTS: Of 2,147 eligible patients, 906 (42%) participated (mean age 48 years, 62% female). At a cutoff level of 3 or more severe somatic symptoms during the past 4 weeks, sensitivity was 78% and specificity 71%. The test-retest reliability was 0.60. CONCLUSIONS: The PHQ-15 is a valid and moderately reliable questionnaire for the detection of patients in a primary care setting at risk for somatoform disorders.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for Detecting somatoform disorders in primary care with the PHQ-15
View DOI Record
View the PubMed citation for Detecting somatoform disorders in primary care with the PHQ-1569
Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial
Type: Journal Article
Year: 2003
Publication Place: England
Abstract: BACKGROUND: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services. AIM: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs). DESIGN OF STUDY: Cluster randomised controlled trial, with practices as the randomisation unit. SETTING: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark. METHOD: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire. RESULTS: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups. CONCLUSION: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial
71
Differentiation of somatizing patients in primary care: why the effects of treatment are always moderate
Type: Journal Article
Year: 2005
Publication Place: United States
Abstract: The heterogeneity of somatizing patients influences outcomes, especially in unselected samples in primary care. A cluster analysis was performed as secondary analysis on an existing data set of 127 somatizing patients included in a randomized controlled clinical trial. Anxiety and depression (HADS), number and intensity of physical symptoms (SOMS), physical and emotional functioning (short form of the SF-36 Health Survey), health beliefs (KKU-G), and psychological distress (General Health Questionnaire) were used for clustering. Outcome, treatment satisfaction, and diagnosis were calculated and compared for the clusters. We differentiated three groups from this analysis: one with elevated emotional and physical stress, one in which emotional stress dominated, and one with low emotional and physical stress. The three groups did not differ in diagnoses of somatoform disorders. The high-stress groups improved over time, whereas the depression and emotional-functioning scores in the low-stress group deteriorated. All patients were satisfied with the treatment provided. Deterioration in the scores of the low-stress group may be a result of a clinically valuable change process, in that patients who were initially in denial were able to open up and admit their problems. The increased satisfaction with treatment supports this interpretation. This so-called response shift must be taken into account in the planning of studies.
Topic(s):
Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Differentiation of somatizing patients in primary care: why the effects of treatment are always moderate
72
Distinctive patterns of medical care utilization in patients who somatize
Type: Journal Article
Year: 2006
Publication Place: URL
Abstract: BACKGROUND: Somatizing patients have maladaptive and increased rates of medical care utilization. If there were a way of routinely identifying such patients, one that did not require intensive, case-by-case review, they could be targeted for specific interventions to improve their use of medical care. OBJECTIVE: We sought to identify patterns of medical care utilization that would distinguish somatizing and nonsomatizing medical outpatients with acceptable sensitivity and specificity. DESIGN: Subjects completed questionnaires assessing somatization and sociodemographic characteristics. Their medical care utilization was obtained for the 12 months preceding the index visit. We then used multivariable logistic regression and recursive partitioning to identify patients with a provisional diagnosis of somatoform disorder. These exploratory models used various patterns of medical care utilization and sociodemographic characteristics as the independent variables. SUBJECTS: We studied consecutive adults attending 2 primary care practices on randomly chosen days. MEASURES: The provisional diagnosis of a somatoform disorder was assessed with a 15-item self-report questionnaire. The number of primary care visits, specialty visits, mental health visits, emergency visits, and inpatient and outpatient costs were obtained for the 12 months preceding the index visit from our hospital's automated medical records, which also provided a rating of aggregate medical morbidity. Self-reported utilization outside our hospital system was obtained from a subsample of patients. RESULTS: Complete data were obtained on 1440 patients. Somatizing patients had more specialty care than primary care visits, higher outpatient than inpatient costs, and more emergency visits than nonsomatizing patients. A regression model containing 7 measures of utilization and 4 sociodemographic characteristics distinguished somatizing and nonsomatizing patients with a c-statistic = 0.73. Recursive partitioning identified 10 terminal nodes with a very high specificity (99%) but a very low sensitivity (15%). CONCLUSIONS: We identified 7 discrete patterns of medical care utilization that distinguished somatizing and nonsomatizing patients. However, they did so with only modest specificity and sensitivity. This algorithm might be used effectively as the first step in a 2-step screening procedure whose second step would entail more intensive screening or individual, case-by-case review to identify somatizing patients in primary care practice.
Topic(s):
Financing & Sustainability
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Distinctive patterns of medical care utilization in patients who somatize
75
Economic costs of neuroticism: A population-based study
Type: Journal Article
Year: 2010
Publication Place: United States
Abstract: CONTEXT: The importance of neuroticism for mental health care use and public health is well established. However, most research has focused on the association between neuroticism and a single specific disorder or health outcome, and the overall effect of neuroticism on use of somatic and mental health care and on society is not clear. OBJECTIVE: To examine the economic costs of neuroticism to get an impression of the overall effect of neuroticism on mental health care and on society in general. DESIGN: Cross-sectional population-based study. SETTING: General population. PARTICIPANTS: A large representative sample (N = 5504) of the Dutch general population. MAIN OUTCOME MEASURES: The costs (health service uptake in primary and secondary mental health care, out-of-pocket costs, and production losses) associated with neuroticism. RESULTS: The total per capita excess costs were $12 362 per year for the reference year 2007 in the 5% highest scorers of neuroticism, $8243 in the 10% highest scorers, and $5572 in the 25% highest scorers. The per capita excess costs of neuroticism are considerably higher than those of mental disorders. The total excess costs of neuroticism per 1 million inhabitants resulting from the 25% highest scorers ($1.393 billion) were approximately 2.5 times as high as the excess costs of common mental disorders ($585 million). CONCLUSIONS: The economic costs of neuroticism are enormous and exceed those of common mental disorders. We should start thinking about interventions that focus not on each of the specific negative outcomes of neuroticism but rather on the starting point itself.
Topic(s):
Financing & Sustainability
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links: View the PubMed citation for Economic costs of neuroticism: A population-based study
76
eDiagnostics: a promising step towards primary mental health care
Type: Journal Article
Year: 2013
Publication Place: England
Abstract: INTRODUCTION: There is a growing interest in eHealth applications in daily health care. Considering that a psychological examination, to a large extent, consists of filling out questionnaires, the use of the Internet seems logical. We evaluated an eDiagnostic system for mental health disorders that has recently been introduced in primary care in the Netherlands. METHODS: We monitored the diagnoses produced by the system. Evaluation questionnaires from both GPs/practice nurses (PNs) and patients were collected. In addition, we compared the advice produced by the GPs/PNs and the advice produced by the system. RESULTS: The most prevalent disorders were mood, anxiety and somatoform disorders (n = 353). Patients (n = 242; 74% response rate) were moderately enthusiastic about the eHealth approach, and GPs/PNs (n = 49, 72% response rate per practice) were very enthusiastic. Patients showed no clear preference for a face-to-face consultation with a psychologist over an eDiagnostic system. GPs/PNs felt strengthened in their control function. In most cases, the system gave a different echelon advice (i.e. referral to primary or secondary mental health care) than the GPs/PNs (kappa = 0.13, P = 0.003). Nevertheless, GPs/PNs accept the results of the examination and the advice given. CONCLUSIONS: Using the Internet to diagnose mental health problems in primary care seems very promising. This system of using eDiagnostics before referral to a mental health institution may change the management of mental health care. Further research should investigate whether this tool is valid, reliable and (cost) effective.
Topic(s):
HIT & Telehealth
See topic collection
, Medically Unexplained Symptoms
See topic collection
Reference Links:
View the DOI record for eDiagnostics: a promising step towards primary mental health care
View DOI Record
View the PubMed citation for eDiagnostics: a promising step towards primary mental health care77
Effect of psychiatric consultation models in primary care. A systematic review and meta-analysis of randomized clinical trials
Type: Journal Article
Year: 2010
Publication Place: England
Topic(s):
Medically Unexplained Symptoms
See topic collection
79
Effectiveness of a primary care based complex intervention to promote self-management in patients presenting psychiatric symptoms: study protocol of a cluster-randomized controlled trial
Type: Journal Article
Year: 2014
Publication Place: England
Abstract: BACKGROUND: Anxiety, Depression and Somatoform (ADSom) disorders are highly prevalent in primary care. Managing these disorders is time-consuming and requires strong commitment on behalf of the General Practitioners (GPs). Furthermore, the management of these patients is restricted by the high patient turnover rates in primary care practices, especially in the German health care system.In order to address this problem, we implement a complex, low-threshold intervention by an Advanced Practice Nurse (APN) using a mixture of case management and counseling techniques to promote self-management in these patients. Here we present the protocol of the "Self-Management Support for Anxiety, Depression and Somatoform Disorders in Primary Care" (SMADS)-Study. METHODS/DESIGN: The study is designed as a cluster-randomized controlled trial, comparing an intervention and a control group of 10 primary care practices in each case. We will compare the effectiveness of the intervention applied by an APN with usual GP-care. A total of 340 participants will be enrolled in the study, 170 in either arm. We use the Patient Health Questionnaire-German version (PHQ-D) as a screening tool for psychiatric symptoms, including patients with a score above 5 on any of the three symptom scales. The primary outcome is self-efficacy, measured by the General Self-Efficacy Scale (GSE), here used as a proxy for self-management. As secondary outcomes we include the PHQ-D symptom load and questionnaires regarding coping with illness and health related quality of life. Outcome assessments will be applied 8 weeks and 12 months after the baseline assessment. DISCUSSION: The SMADS-study evaluates a complex, low threshold intervention for ambulatory patients presenting ADSom-symptoms, empowering them to better manage their condition, as well as improving their motivation to engage in self-help and health-seeking behaviour. The benefit of the intervention will be substantiated, when patients can enhance their expected self-efficacy, reduce their symptom load and engage in more self-help activities to deal with their everyday lives. After successfully evaluating this psychosocial intervention, a new health care model for the management of symptoms of anxiety, depression and somatoform disorders for ambulatory patients could emerge, supplementing the work of the GP. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01726387.
Topic(s):
Medically Unexplained Symptoms
See topic collection
80
Effectiveness of a stepped, collaborative, and coordinated health care network for somatoform disorders (Sofu-Net): A controlled cluster cohort study
Type: Journal Article
Year: 2017
Publication Place: United States
Abstract: OBJECTIVE: Stepped, collaborative, and coordinated approaches have been proposed as the optimal treatment strategy for somatic symptom and related disorders (SSRD), but evidence supporting this strategy is lacking. The aim of this study was to assess the effectiveness of a guideline-based health care network for patients who are at high risk of somatoform disorder (Sofu-Net). METHODS: In a controlled, prospective, observer-blinded cluster cohort study, patients who were at high risk of somatoform disorder were recruited at 18 primary care practices in the Sofu-Net and at 15 primary care practices that provided care as usual (CAU). The primary outcome at 6-months follow-up was the rate at which the patients received mental health treatment since the establishment of Sofu-Net. The secondary outcomes included the patients' clinical symptom severity. RESULTS: A total of 119 patients in the Sofu-Net intervention group and 100 patients in the CAU control group who were at high risk of somatoform disorder were followed for 6 months. A significantly greater proportion of Sofu-Net patients than CAU patients received mental health treatment (47.9% vs. 31.0%; OR = 1.96; 95%CI 1.07 to 3.58). However, the Sofu-Net group did not show greater reductions clinical symptom burden compared to the CAU group. CONCLUSIONS: The treatment of somatoform disorders within a guideline-based health care network resulted in increased rates of mental health treatment, but failed to improve patient clinical outcomes. Future investigations are needed to investigate the combined value of health care networks with specialized psychotherapy interventions in patients at high risk of SSRD. TRIAL REGISTRATION: ISRCTN55870770.
Topic(s):
Medically Unexplained Symptoms
See topic collection