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Annals of Family Medicine 1:228-235 (2003)
© 2003 Annals of Family Medicine, Inc.
doi: 10.1370/afm.5
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Article

A Randomized Clinical Trial of a Care Recommendation Letter Intervention for Somatization in Primary Care

W. Perry Dickinson, MD1, L. Miriam Dickinson, PhD1, Frank V. deGruy, MD, MSFM1, Deborah S. Main, PhD1, Lucy M. Candib, MD2 and Kathryn Rost, PhD1

1 Department of Family Medicine, University of Colorado Health Sciences Center, Denver, Colo
2 Family Health Center of Worcester and Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, Mass

CORRESPONDING AUTHOR Perry Dickinson, MD, University of Colorado Health Sciences Center, Department of Family Medicine, PO Box 6508, 12474 E 19th Ave, Building 402, Aurora, CO 80045-0508, perry.dickinson{at}uchsc.edu

PURPOSE This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention.

METHODS One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient’s somatization status and provided recommendations for the patient’s care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months.

RESULTS Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01).

CONCLUSIONS The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.

Key Words: Somatoform disorders • mental disorders • primary care




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TRACK Comments:

Read all TRACK Comments

Somatization
Ronald M. Epstein
Annals of Family Medicine, 27 Nov 2003 [Full text]
Addressing the process of change
Lawrence Fisher, et al.
Annals of Family Medicine, 27 Nov 2003 [Full text]
Alternate Explanations For Findings
David A Katerndahl
Annals of Family Medicine, 27 Nov 2003 [Full text]
Somatisation or somatic fixation?
Aya Biderman
Annals of Family Medicine, 27 Nov 2003 [Full text]
What about the doctor?
Glenn H Griffin
Annals of Family Medicine, 2 Dec 2003 [Full text]

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