417 Enhanced care may help people with functional somatic symptoms

May 04, 2014

PEARLS 417, January 2014, written by Brian R McAvoy

Clinical question
How effective are enhanced care interventions for adults with functional symptoms in primary care?

Bottom line
Trials aimed to teach general practitioners (GPs) a variety of interventions, ranging from an opportunistic approach to individual consultations to more structured management (eg, with patient diaries and planned follow up). While statistical heterogeneity in some comparisons precluded meta-analysis, it was feasible for others. Effect sizes for both physical and mental health were small and without clinical significance at both short-term and long-term follow up. Patient satisfaction with care appeared to be greater in the intervention group in all 3 studies evaluating this aspect, though the results were not statistically significant. Effects on healthcare use were inconclusive with regard to GP visits; effects on overall healthcare costs could not be estimated. Attrition was slightly higher in the intervention group.

Caveat
The trials were only of moderate quality and most were of small size. The studies included in the review were effectiveness studies carried out in "real world" settings. As such, they suffered from problems with blinding of GPs, recruitment bias with baseline imbalance and relatively high levels of patient attrition. Attention should be paid to difficulties, including limited consultation time, lack of skills, the need for a degree of diagnostic openness and patient resistance towards psychosomatic attributions.

Context
GPs see many people with physical symptoms or syndromes for which there is no apparent disease. GPs find it difficult to help patients with these "functional" somatic symptoms, but specialist services can help those most severely affected. If GPs were able to offer similar treatments (enhanced care) within their surgeries, they might help patients more quickly and save resources.

Cochrane Systematic Review
Rosendal M et al. Enhanced care by generalists for functional somatic symptoms and disorders in primary care. Cochrane Reviews, 2013, Issue 10. Art. No.: CD008142.DOI: 10.1002/14651858. CD008142.pub2. This review includes 7 studies involving 233 GPs and 1787 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.