Abstract
BACKGROUND
We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention.
METHODS
We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive-behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satisfaction with the PCP.
RESULTS
Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differences approach, we found that the intervention produced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (−0.80; CI: −1.55 to −0.04) and psychological (−1.06; CI: −1.83 to −0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged.
CONCLUSIONS
Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.
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Acknowledgements
We gratefully acknowledge the generous financial support of the Department of Family Practice, Henry Ford Health System, Detroit, MI and the Dean’s Office of the College of Human Medicine, Michigan State University, East Lansing, MI. This material was presented at the annual meeting of the Academy of Psychosomatic Medicine, Amelia Island, FL on November 17, 2007.
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Smith, R.C., Gardiner, J.C., Luo, Z. et al. Primary Care Physicians Treat Somatization. J GEN INTERN MED 24, 829–832 (2009). https://doi.org/10.1007/s11606-009-0992-y
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DOI: https://doi.org/10.1007/s11606-009-0992-y