Smith G R, Monson R A, Ray D C
N Engl J Med. 1986 May 29;314(22):1407-13. doi: 10.1056/NEJM198605293142203.
The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.
患有多种躯体症状但无明显躯体疾病（躯体化障碍）患者的人均医疗保健支出高达人均平均水平的九倍。我们进行了一项随机对照试验，以确定精神科会诊是否会降低这些患者的医疗费用，同时又不会对患者的治疗结果产生重大改变。38名患者被随机分配到治疗组或对照组，并进行了为期18个月的前瞻性研究。治疗包括精神科会诊以及向初级医生提供管理建议。九个月后，对照组交叉接受相同干预措施的治疗。精神科会诊后，治疗组的季度医疗保健费用下降了53%（P<0.05）。相比之下，对照组的费用波动较大，但总体没有变化。对照组的季度费用显著高于治疗组（P<0.05）。对照组交叉接受治疗后，其季度费用下降了49%（P<0.05）。两组支出的减少主要归因于住院费用的降低。我们得出结论，对躯体化障碍患者进行精神科会诊可降低后续医疗保健支出，且不会导致健康状况或患者对医疗保健满意度的改变。
