McGorm, Kelly Jane

2018-03-29T12:18:45Z

2018-03-29T12:18:45Z

2006

BACKGROUND One third of frequent attenders to UK outpatient clinics have symptoms that are inadequately explained by disease according to specialist opinion (medically 'unexplained'). Some of these patients are frequently referred for similar symptoms to multiple specialties. The characteristics and treatment needs ofthese frequently referred patients are poorly understood.

AIM The aim was to identify and describe patients frequently referred from primary care to hospital clinics for medically 'unexplained' symptoms (FRMUS) and compare them with patients frequently referred with medically explained symptoms (FRMES) and patients infrequently referred for symptoms (IRS).

HYPOTHESES Compared to FRMES and IRS patients, a greater proportion of FRMUS patients would have anxiety or depression and this would be inadequately treated. Subsidiary hypotheses relating to: consulting multiple doctors, health care costs, perceived general health, satisfaction with care, and health beliefs, as well as the general practitioners' (GPs) expressed difficulty managing the patient, were also tested.

METHODS The methodology employed for this study involved three phases as follows: (1) Identification of cases and controls from five Edinburgh general practices using a combination ofNational Health Service (NHS) referral data and primary care case notes. (2) A case-control study to describe and compare FRMUS patients with the two control patient groups. This comprised a questionnaire survey of GPs and patients, and a lifetime case note review for a 15% random selection of FRMUS and FRMES participants. (3) An economic analysis of the health care contacts.

RESULTS FRMUS patients made up 1.1% (293/26252; CI 0.01-0.013) of the primary care population aged 18-65 years, and nearly two thirds (218/293, 74.4%) were female. The FRMUS patients had statistically more anxiety (67/193, 34.7%) when compared to 37 ofthe 162 FRMES (22.8%, OR 1.8, CI 1.12-2.88) and 23 of the 152 IRS (15.1%, OR 2.98, CI 1.75-5.09) comparison patient groups. Although there was no statistical difference for diagnoses of depression between the FR groups, the FRMUS patients had a significantly greater mean score for depressive symptoms than the FRMES control patients (mean difference 2.03, CI 0.66-3.41). Of the 67 FRMUS patients with an anxiety disorder 41(61.2%) were receiving adequate treatment, and this was considerably more than the six of 37 FRMES (16.2%, OR 8.147, CI 2.99- 22.21) and the six of 23 IRS (26.1%, OR 4.47, CI 1.56-12.8) comparison patients who had an anxiety disorder. Treatment for those patients with depression was also significantly greater for FRMUS patients (43/64, 67.2%) compared with the FRMES (10/41, 24.4%, OR 6.35, CI 2.62-15.36) and IRS (5/21, 23.8%, OR 6.56, CI 2.11- 20.32) groups. FRMUS patients were also more likely to: be female, reside in a deprived area of Lothian, referred by multiple doctors, have problems considered to be more difficult to help by a GP, have high health care costs, and report poor general physical and mental health.

DISCUSSION A third of FRMUS patients had anxiety and depression, the majority of whom were receiving 'adequate treatment'. Factors other than undetected anxiety and depression may better explain why these patients are repeatedly referred to outpatient clinics for 'unexplained' symptoms.

http://hdl.handle.net/1842/29262

The University of Edinburgh

Annexe Thesis Digitisation Project 2018 Block 17

Already catalogued

Patients frequently referred from primary care to hospital outpatient clinics for medically 'unexplained' symptoms

Thesis or Dissertation

Doctoral

PhD Doctor of Philosophy