Röhricht Frank, Zammit Ivan, Papadopoulos Nina
Psychiatrist and Associate Medical Director, General Adult Psychiatry, East London NHS Foundation Trust, London, UK.
Honorary Professor, Centre for Psychoanalytic Studies, University of Essex, Colchester, UK.
BJGP Open. 2017 Oct 4;1(4):bjgpopen17X101121. doi: 10.3399/bjgpopen17X101121. eCollection 2018 Jan.
Existing care models for patients with persistent medically unexplained symptoms (MUS) do not adequately address the needs of these patients. New and innovative intervention strategies are necessary to achieve better health and corresponding economic outcomes.
To explore the feasibility of implementing a pragmatic care package that provides primary care treatment for patients with persistent MUS and to evaluate recruitment, retention, and acceptability as well as the potential impact on clinical outcomes and service utilisation.
DESIGN & SETTING: Prospective cohort intervention study involving a cluster of seven GP surgeries in Newham, East London, providing a 'One-Stop-Shop' primary care treatment service.
The care package included: identification, assessment, engagement, psychoeducation, and a choice of group interventions (mindfulness-based stress reduction [MBSR] and body-oriented psychological therapy [BOPT]). Baseline and follow-up data on somatic symptom levels (PHQ-15), health-related quality of life (SF-36, EQ-5D) and service utilisation was analysed.
In total, 145 patients were referred and assessed for eligibility, and 93 were included in the study. Participants engaged well with different components of the care package and gained significant improvements in somatic symptom levels with corresponding increases of quality-of-life ratings and a reduction in healthcare utilisation (GP contacts and referrals to specialist services) as well as associated healthcare costs.
The primary care treatment package can be successfully implemented in primary care at a relatively low cost and easily adopted into routine care. The body-oriented approach is well accepted by clinicians and patients. Controlled trials should be conducted to test the efficacy of the treatment package.
现有的针对持续性医学无法解释症状（MUS）患者的护理模式无法充分满足这些患者的需求。需要新的创新干预策略来实现更好的健康状况及相应的经济成果。
探讨实施一个为持续性MUS患者提供初级保健治疗的实用护理套餐的可行性，并评估招募、留存率、可接受性以及对临床结果和服务利用的潜在影响。
前瞻性队列干预研究，涉及东伦敦纽汉姆的七家全科医生诊所，提供“一站式”初级保健治疗服务。
护理套餐包括：识别、评估、参与、心理教育以及多种团体干预措施供选择（基于正念的减压疗法[MBSR]和身体导向心理疗法[BOPT]）。分析了关于躯体症状水平（PHQ - 15）、健康相关生活质量（SF - 36、EQ - 5D）和服务利用的基线及随访数据。
共有145名患者被转诊并评估是否符合条件，93名患者被纳入研究。参与者积极参与护理套餐的不同组成部分，躯体症状水平有显著改善，生活质量评分相应提高，医疗保健利用率（全科医生就诊次数和专科服务转诊次数）以及相关医疗费用降低。
初级保健治疗套餐可以在初级保健中以相对较低的成本成功实施，并易于纳入常规护理。身体导向方法受到临床医生和患者的广泛接受。应进行对照试验以测试该治疗套餐的疗效。
