Primary care physicians treat somatization

  • Smith R
  • Gardiner J
  • Luo Z
 et al. 
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Abstract

BACKGROUND: We hypothesized that somatizing patients managed by primary care physicians (PCP) would improve with a relationship-based intervention. METHODS: We randomized 30 adults with medically unexplained symptoms to treatment or usual care. Four PCPs were trained to intervene with cognitive- behavioral, pharmacological, and patient-centered management and deployed the intervention with seven scheduled visits over 12 months. Outcomes obtained at baseline and 12 months were: Mental component summary (MCS), the primary endpoint, and measures of physical and psychological symptoms and of satis- faction with the PCP. RESULTS: Patients averaged 52.5 years; 83.3% were female; 79.6% were black. Using a difference of differ- ences approach, we found that the intervention pro- duced a large effect size (ES) (0.82; CI: 0.08 to 1.57) for the MCS in the predicted direction, similar to the ES for physical (−0.80; CI: −1.55 to −0.04) and psychological (−1.06; CI: −1.83 to −0.28) improvement and for increased satisfaction with the PCP (0.94; CI: 0.15 to 1.74). Using ANCOVA in a sensitivity analysis, we found that the ES fell slightly (0.59), while other measures were unchanged. CONCLUSIONS: Moderate-large effect sizes support the hypothesis that PCPs can effectively treat somatization. This points to the importance of performing a full RCT

Author-supplied keywords

  • Medically unexplained symptoms
  • Patient-centered
  • Primary care mental health
  • Provider-patient relationship
  • Somatization

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Authors

  • Robert C. Smith

  • Joseph C. Gardiner

  • Zhehui Luo

  • Susan Schooley

  • Lois Lamerato

  • Kathryn Rost

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