General Hospital Psychiatry
Volume 25, Issue 2 , Pages 63-73, March 2003

Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically unexplained symptoms☆

  • Judith S Lyles, PhD

      Affiliations

    • Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Annemarie Hodges, MA

      Affiliations

    • Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Clare Collins, RNPhD

      Affiliations

    • College of Nursing, Michigan State University, College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Catherine Lein, RN, MS, FNP

      Affiliations

    • College of Nursing, Michigan State University, College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • C.William Given, PhD

      Affiliations

    • Department of Family Practice, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Barbara Given, RN, PhD

      Affiliations

    • College of Nursing, Michigan State University, College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Dale D’Mello, M.D.

      Affiliations

    • Department of Psychiatry, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Gerald G Osborn, D.O.

      Affiliations

    • Department of Psychiatry, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • John Goddeeris, Ph.D.

      Affiliations

    • Department of Economics, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Joseph C Gardiner, Ph.D.

      Affiliations

    • Department of Epidemiology, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • ,
  • Robert C Smith, M.D., Sc.M.

      Affiliations

    • Department of Medicine, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA
    • Corresponding Author InformationCorresponding author. Tel.:+1-517-355-6516; fax:+1-517-432-1326.

Abstract 

Patients with medically unexplained symptoms (MUS) often are a source of frustration for clinicians, and despite high quality biomedical attention and frequent diagnostic tests, they have poor health outcomes. Following upon progress in depression treatment approaches, we developed a multidimensional treatment protocol for deployment by primary care personnel. This multi-faceted intervention for MUS patients emphasized cognitive-behavioral principles, the provider-patient relationship, pharmacological management, and treating comorbid medical diseases. We deployed it in an HMO using nurse practitioners (NP) to deliver the intervention to 101 patients, while 102 controls continued to receive medical care from their usual primary care physician. Successful deployment of the intervention required training the NPs, continuing support for the NPs in their management of this difficult population, and establishing strong communication links with the HMO. This paper addresses the practical considerations of using primary care personnel to implement a complex intervention in primary care, and it includes a discussion of special challenges encountered as well as solutions developed to overcome them.

Keywords:  Randomized controlled trial, Somatization, High utilizing patients, Medically unexplained symptoms, Nurse practitioners, Mental health, Primary care

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☆ Recent epidemiologic studies have found that most patients with mental illness are seen exclusively in primary care medicine. These patients often present with medically unexplained somatic symptoms and utilize at least twice as many health care visits as controls. There has been an exponential growth in studies in this interface between primary care and psychiatry in the last 10 years. This special section, edited by Wayne J. Katon, M.D., will publish informative research articles that address primary care-psychiatric issues.

PII: S0163-8343(02)00288-8

doi:10.1016/S0163-8343(02)00288-8

General Hospital Psychiatry
Volume 25, Issue 2 , Pages 63-73, March 2003

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