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Frequent attenders with medically unexplained symptoms: service use and costs in secondary care

  • Steven Reid (a1), Simon Wessely (a1), Tim Crayford (a2) and Matthew Hotopf (a1)
Abstract
Background

Frequent attenders in medical settings account for a disproportionate amount of health-care resources. Little is known about service use and costs of secondary care in those frequent attenders presenting with medically unexplained symptoms.

Aims

To compare health-care use and costs of patients with medically unexplained symptoms with other frequent attenders in secondary care.

Method

In a sample of 400 frequent attenders of secondary care services, those presenting with medically unexplained symptoms were identified by a review of medical records. Their use of health-care resources was compared with that of other frequent attenders.

Results

Of the frequent attenders 17% had at least two medically unexplained consultation episodes. These patients had a greater number of referrals to secondary care and were more likely to undergo particular investigations.

Conclusions

Frequent attenders with medically unexplained symptoms account for levels of service use and expenditure that are comparable with other frequent attenders, but the use and cost of medical investigations in this group are significantly greater.

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Copyright
Corresponding author
Dr S. Reid, Paterson Centre for Mental Health, St Mary's Hospital, 20South Wharf Road, London W2IPD, UK. Tel: 020 7886 1968; Fax: 020 7886 6667
Footnotes
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Declaration of interest

Funded by the National Health Service Executive National Research and Development Programme.

Footnotes
References
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Bass, C., Hyde, G., Bond, A., et al (2001) A survey of frequent attenders at a gastroenterology clinic. Journal of Psychosomatic Research, 50, 107109.
Bridges, K. W. & Goldberg, D. P. (1985) Somatic presentation of DSM–III psychiatric disorders in primary care. Journal of Psychosomatic Research, 29, 563569.
Escobar, J. I., Golding, J. M., Hough, R. L., et al (1987) Somatisation in the community: relationship to disability and use of services. American Journal of Public Health, 77, 837840.
Fink, P. (1992) The use of hospitalizations by persistent somatizing patients. Psychological Medicine, 22, 173180.
Garfinkel, S. A., Riley, G. F. & lannacchinoe, V. G. (1988) High-cost users of medical care. Health Care Financing Review, 9, 4152.
Gill, D. & Sharpe, M. (1999) Frequent consulters in general practice: a systematic review of studies of prevalence, associations and outcome. Journal of Psychosomatic Research, 47, 115130.
Hamilton, J., Campos, R. & Creed, F. (1996) Anxiety, depression and management of medically unexplained symptoms in medical clinics. Journal of the Royal College of Physicians of London, 30, 1820.
Hansen, J. M., Bytzer, P., Bondesen, S., et al (1991) Efficacy and outcome of an open access endoscopy service. Danish Medical Bulletin, 38, 288290.
Howard, L. M. & Wessely, S. (1996) Reappraising reassurance – the role of investigations. Journal of Psychosomatic Research, 41, 307311.
Karlsson, H., Lehtinen, V. & Joukamaa, M. (1995) Psychiatric morbidity among frequent attender patients in primary care. General Hospital Psychiatry, 17, 1925.
Karlsson, H., Joukamaa, M., Lahti, I., et al (1997) Frequent attender profiles: different clinical subgroups among frequent attender patients in primary care. Journal of Psychosomatic Research, 42, 157166.
Katon, W., von Korff, M., Lin, E., et al (1990) Distressed high utilisers of medical care: DSM–III–R diagnoses and treatment needs. General Hospital Psychiatry, 12, 355362.
Kouyanou, K., Pither, C. & Wessely, S. (1997) Iatrogenic factors and chronic pain. Psychosomatic Medicine, 59, 597604.
Kouyanou, K., Pither, C. E., Rabe-Hesketh, S., et al (1998) A comparative study of iatrogenesis, medication abuse, and psychiatric morbidity in chronic pain patients with and without medically unexplained symptoms. Pain, 76, 417426.
Kroenke, K. & Mangelsdorff, A. D. (1989) Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, 262266.
Lin, E. H. B., Katon, W., von Korff, M., et al (1991) Frustrating patients: physician and patient perspectives among distressed high users of medical services. Journal of General Internal Medicine, 6, 241246.
Mayou, R. & Sharpe, M. (1997) Treating medically unexplained physical symptoms. BMJ, 315, 561562.
McFarland, B. H., Freeborn, D. K., Mullooly, J. P., et al (1985) Utilization patterns among long-term enrol lees in a prepaid group practice health maintenance organization. Medical Care, 23, 12211223.
Nimnuan, C., Hotopf, M. & Wessely, S. (2001) Medicallly unexplained symptoms: an epidemiological study in seven specialities. Journal of Psychosomatic Research, 51, 361367.
Portegijs, P. J. M., van der Horst, F. G., Proot, I. M., et al (1996) Somatization in frequent attenders of general practice. Social Psychiatry and Psychiatric Epidemiology, 31, 2937.
Potts, S. G. & Bass, C. M. (1993) Psychosocial outcome and use of medical resources in patients with chest pain and normal or near normal coronary arteries: a long-term follow-up study. Quarterly Journal of Medicine, 86, 583593.
Reid, S., Crayford, T., Richards, S., et al (1999) Recognition of medicallly unexplained symptoms – do doctors agree? Journal of Psychosomatic Research, 47, 483485.
Reid, S., Wessely, S., Crayford, T., et al (2001) Medically unexplained symptoms in frequent attenders of secondary health care. BMJ, 322, 767769.
Rost, K., Kashner, T. M. & Smith, G. R. Jr (1994) Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. General Hospital Psychiatry, 16, 381387.
Shaw, J. & Creed, F. (1991) The cost of somatization. Journal of Psychosomatic Research, 35, 307312.
Smith, G. R. Jr (1994) The course of somatization and its effects on utilization of health care resources. Psychosomatics, 35, 263267.
Smith, G. R., Monson, R. A. & Ray, D. C. (1986) Psychiatric consultation in somatization disorder: a randomised controlled trial. New England Journal of Medicine, 314, 14071413.
Smith, G. R., Rost, K. & Kashner, T. M. (1995) Atrial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry, 52, 238243.
Sox, H. C. Jr, Margulies, I. & Sox, C. H. (1981) Psychologically mediated effects of diagnostic tests. Annals of Internal Medicine, 95, 680685.
Stata Corp (1997) Stata Statistical Software: Release 5.0. College Station, TX: Stata Corporation.
van Dulmen, A. M., Fennis, J. F. M., Mokkink, H. G. A., et al (1995) Doctor-dependent changes in complaint-related cognitions and anxiety during medical consultations in functional abdominal complaints. Psychological Medicine, 25, 10111018.
Ward, A. M., Underwood, P., Fatovich, B., et al (1994) Stability of attendance in general practice. Family Practice, 11, 431437.
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  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Frequent attenders with medically unexplained symptoms: service use and costs in secondary care

  • Steven Reid (a1), Simon Wessely (a1), Tim Crayford (a2) and Matthew Hotopf (a1)
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