Enhanced care may help people with functional somatic symptoms

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: 
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.
Review CD#: 
CD008142
PEARLS No: 
417
Date: 
January, 2014
Authored by: 
Brian R McAvoy