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Title: Patients frequently referred from primary care to hospital outpatient clinics for medically 'unexplained' symptoms
Author: McGorm, K. J.
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2007
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Abstract:
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). HYPOTHESIS: 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: doctor ‘shopping’, health care costs, disability, satisfaction with care, and health beliefs, as well as the general practitioners’ (GPs) expressed difficulty managing the patient, were also tested. METHODS: (1) Case and control identification from five Edinburgh general practices using a combination of National Health Service (NHS) referral data and primary care case notes.  (2) A case-control study including a questionnaire survey of GPs and patients. (3) A prospective follow-up study of FRMUS patients’ new referrals over a one year period. RESULTS: FRMUS patients made up 1.1% of the primary care population aged 18-64 years, and nearly two thirds were female. Compared to controls, FRMUS patients were more likely to be anxious or depressed, but 64% were receiving ‘adequate’ treatment. FRMUS patients were also more likely to: be considered difficult to help by a GP, consult many different GPs, have high health care costs, and report high levels of disability. FRMUS patients were more likely to live in a socially deprived area and nearly half were unemployed. FRMUS patients continued to be referred for MUS during follow-up. DISCUSSION: Although a substantial proportion of FRMUS patients had anxiety and depression, considerably more had received apparently adequate treatment when compared to the two comparison groups. Lack of coordinated patient care, rather than undetected psychiatric morbidity, may be the key factor leading to repeat referrals.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.666215  DOI: Not available
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