Michigan State University, East Lansing, MI, USA.
J Gen Intern Med. 2009 Jul;24(7):829-32. doi: 10.1007/s11606-009-0992-y. Epub 2009 Apr 30.
We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention.
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.
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.
Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT.
我们假设初级保健医生（PCP）管理的躯体化患者通过基于关系的干预会有所改善。
我们将 30 名有医学无法解释症状的成年人随机分为治疗组或常规护理组。4 名 PCP 接受了认知行为、药物和以患者为中心的管理干预培训，并在 12 个月内通过 7 次预约实施了干预。在基线和 12 个月时获得的结果是：心理成分综合评分（MCS），主要终点，以及身体和心理症状以及对 PCP 的满意度的测量。
患者平均年龄为 52.5 岁；83.3%为女性；79.6%为黑人。使用差异的差异方法，我们发现干预在预测方向上对 MCS 产生了较大的效应量（ES）（0.82；CI：0.08 至 1.57），与身体（-0.80；CI：-1.55 至 -0.04）和心理（-1.06；CI：-1.83 至 -0.28）改善以及对 PCP 的满意度增加（0.94；CI：0.15 至 1.74）的 ES 相似。在敏感性分析中使用 ANCOVA，我们发现 ES 略有下降（0.59），而其他指标保持不变。
中等至较大的效应量支持 PCP 可以有效治疗躯体化的假设。这表明进行全面 RCT 的重要性。
