A primary care Symptoms Clinic for patients with medically unexplained symptoms: pilot randomised trial

Christopher Burton*, David Weller, Wendy Marsden, Allison Worth, Michael Sharpe

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives: To conduct a pilot trial of a primary care Symptoms Clinic for patients with medically unexplained symptoms and evaluate recruitment and retention, and acceptability of the intervention and to estimate potential treatment effects for a full trial.

Trial design: Randomised parallel group pilot trial.

Setting: Primary care in one locality.

Participants: Primary care database and postal questionnaire were used to identify patients with multiple specialist referrals and multiple physical symptoms unlikely to be explained by disease.

Interventions: General practitioner (GP) with special interest 'Symptoms Clinic' + usual care versus usual care alone. The Symptoms Clinic comprised one long (1 h) and three short (20 min) appointments.

Outcomes: Number of patients identified and recruited; acceptability of the intervention (items from Client Satisfaction Questionnaire and interview); Medical Outcomes Survey Short Form 12 (SF-12) physical component summary.

Randomisation: Automated blocked randomisation accessed by telephone.

Blinding: None.

Numbers randomized: 16 to intervention and 16 to usual care alone.

Recruitment: 72 patients, from seven GP practices, had repeated specialist referrals and a Patient Health Questionnaire (PHQ)-15 score of >= 10 indicating a high probability of medically unexplained symptoms. 15 were ineligible and 25 declined to participate.

Numbers analysed: 26 patients; two patients randomised to the intervention group were incorrectly included, three patients in the intervention group and one control did not complete outcome measures.

Outcome: Most patients randomised to the Symptoms Clinic found the intervention acceptable: eight out of 11 reported the intervention helped them to deal with their problems. The mean difference between groups in SF-12 physical component summary, adjusted for baseline, was 3.8 points (SD 6).

Harms: No observed harms.

Conclusions: Patients with multiple medically unexplained symptoms can be systematically identified in primary care; a randomised trial comparing the Symptoms Clinic with usual care is feasible and has the potential to show clinically meaningful benefit.

Original languageEnglish
Article numberARTN e000513
Number of pages7
JournalBMJ Open
Volume2
Issue number1
DOIs
Publication statusPublished - 2012

Keywords

  • SECONDARY CARE
  • THERAPY
  • ANXIETY
  • DISORDER
  • SOMATIZATION

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