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A Randomized Trial of Treatments for High-Utilizing Somatizing Patients

Journal of General Internal Medicine volume 28, pages 1396–1404 (2013)Cite this article

ABSTRACT

BACKGROUND

Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients.

OBJECTIVE

To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting.

DESIGN

Patients were randomly assigned to a two-step cognitive behavioral treatment program accompanied by a training seminar for their primary care physicians, or to relaxation training. Providers routinely working in these patients’ primary care practices delivered the cognitive behavior therapy and relaxation training. A follow-up assessment was completed immediately prior to treatment and 6 and 12 months later.

SUBJECTS

Eighty-nine medical outpatients with elevated levels of somatization, hypochondriacal health anxiety, and medical care utilization.

MEASUREMENTS

Somatization and hypochondriasis, overall psychiatric distress, and role impairment were assessed with well-validated, self-report questionnaires. Outpatient visits and medical care costs before and after the intervention were obtained from the encounter claims database.

RESULTS

At 6 month and 12 month follow-up, both intervention groups showed significant improvements in somatization (p < 0.01), hypochondriacal symptoms (p < 0.01), overall psychiatric distress (p < 0.01), and role impairment (p < 0.01). Outcomes did not differ significantly between the two groups. When both groups were combined, ambulatory visits declined from 10.3 to 8.8 (p = 0.036), and mean ambulatory costs decreased from $3,574 to $2,991 (p = 0.028) in the year preceding versus the year following the interventions. Psychiatric visits and costs were unchanged.

CONCLUSIONS

Two similar cognitive behavioral interventions, delivered with the resources available in routine primary care, improved somatization, hypochondriacal symptoms, overall psychiatric distress, and role function. They also reduced the ambulatory visits and costs of these high utilizing outpatients.

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Acknowledgements

The authors wish to acknowledge the critical assistance of Jessica Ferriero, Zvi Shapiro, Jennifer Sy, and Alexis Lawrence at the Brigham and Women’s Hospital, and Robert Schneider and Noelle Lawler at the Harvard Vanguard Medical Associates.

This work was supported by research grant RO1 MH 071688 from the National Institute of Mental Health.

This work has not been presented previously.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Arthur J. Barsky MD & David K. Ahern PhD

  2. Department of Medicine, Harvard Vanguard Medical Associates, West Roxbury, MA, USA

    Mark R. Bauer MD

  3. Department of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Nyryan Nolido MA & E. John Orav PhD

  4. Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA

    E. John Orav PhD

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  1. Arthur J. Barsky MD
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  2. David K. Ahern PhD
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Corresponding author

Correspondence to Arthur J. Barsky MD.

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ClinicalTrials.gov identifier: NCT00368212

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Barsky, A.J., Ahern, D.K., Bauer, M.R. et al. A Randomized Trial of Treatments for High-Utilizing Somatizing Patients. J GEN INTERN MED 28, 1396–1404 (2013). https://doi.org/10.1007/s11606-013-2392-6

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  • DOI: https://doi.org/10.1007/s11606-013-2392-6

KEY WORDS

  • cognitive behavior therapy
  • somatization
  • hypochondriasis
  • medical utilization
  • medical care costs