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.

References 

  1. Lipowski ZJ. Somatization (the concept, and its clinical application). Am J Psychiatry. 1988;145:1358–1368
  2. Ford CV. The somatizing disorders (illness as a way of life). New York: Elsevier Biomedical; 1983;
  3. Culpan R, Davies B. Psychiatric illness at a medical, and a surgical outpatient clinic. Compr Psychiatry. 1960;1:228–235
  4. Barsky AJ. Hidden reasons why some patients visit doctors. Ann Intern Med. 1981;94:492–498
  5. Katon W, Ries RK, Kleinman A. The prevalence of somatization in primary care. Compr Psychiatry. 1984;25:208–215
  6. Stoeckle JD, Zola LK, Davidson GE. The quantity, and significance of psychological distress in medical patients. J Chron Dis. 1964;14:959–965
  7. Roberts BH, Norton NM. The prevalence of psychiatric illness in a medical outpatient clinic. N Engl J Med. 1952;246:82–86
  8. Katon W, Russo J. Somatic symptoms, and depression. J Fam Pract. 1989;29:65–69
  9. Kroenke K, Mangelsdorff AD. Common symptoms in ambulatory care (incidence, evaluation, therapy, and outcome). Am J Med. 1989;86:262–266
  10. Smith GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder. N Engl J Med. 1986;314:1407–1413
  11. Cherkin D, Deyo RA. Nonsurgical hospitalization for low back pain (is it necessary?). Spine. 1993;18:1728–1735
  12. Hoffman RM, Wheeler KJ, Deyo RA. Surgery for herniated lumbar discs (a literature synthesis). J Gen Intern Med. 1993;8:487–496
  13. Deyo RA, Ciol MA, Cherkin DC, Loeser JD, Bigos SJ. Lumbar spinal fusion (a cohort study of complications, reoperations, and resource use in the Medicare population). Spine. 1993;1:1463–1470
  14. Fink P. Surgery, and medial treatment in persistent somatizing patients. J Psychosom Res. 1992;36:439–447
  15. Bass C, Benjamin S. The management of chronic somatization. Brit J Psychiatry. 1993;162:472–480
  16. Lightfoot JRW, Luft BJ, Rahn DW, et al.  Empiric parenteral antibiotic treatment of patients with fibromyalgia, and fatigue, and a positive serologic result for Lyme disease. Ann Intern Med. 1993;119:503–509
  17. Escobar JI, Waitzkin H, Silver RC, et al.  Abridged somatization (a study in primary care). Psychosom Med. 1998;60:466–472
  18. Bass C, Murphy M. Somatisation disorder in a British teaching hospital. British Journal of Clinical Practice. 1991;45:237–244
  19. deGruy F, Columbia L, Dickinson P. Somatization disorder in a family practice. J Fam Pract. 1987;25:45–51
  20. deGruy F, Crider J, Hashimi DK, Dickinson P, Mullins HC, Troncale J. Somatization disorder in a university hospital. J Fam Pract. 1987;25:579–584
  21. Lipsitt DR. Challenges of somatization (diagnostic, therapeutic, and economic). Psychiatric Medicine. 1992;10:1–12
  22. Sharpe M, Bass C, Mayou R. An overview of the treatment of functional somatic symptoms. In:  Mayou R,  Bass C,  Sharpe M editor. Treatment of Functional Somatic Symptoms. Oxford: Oxford University Press; 1995;p. 66–86
  23. Sharpe M, Hawton K, Simkin S, et al.  Cognitive behaviour therapy for the chronic fatigue syndrome (a randomised controlled trial. Used comparison of % improved vs. not improved > ES or MCID). Brit Med J. 1996;312:22–26
  24. Warwick HMC, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive-behavioural treatment of hypchondriasis. Brit J Psychiatry. 1996;169:189–195
  25. van Dulmen AM, Fennis JFM, Bleijenberg G. Cognitive-behavioral group therapy for irritable bowel syndrome (effects, and long-term follow-up). Psychosom Med. 1996;58:508–514
  26. Speckens AEM, van Hemert AM, Spinhoven P, et al.  Cognitive behavioural therapy for medically unexplained physical symptoms (a randomised controlled trial). Brit Med J. 1995;311:1328–1332
  27. Smith RC. Patient-Centered Interviewing (An Evidence-Based Method). 2nd ed. Philadelphia: Lippincott Williams, and Wilkins; 2002;
  28. Smith RC. Videotape of Evidence-Based Interviewing: 1) Patient-centered interviewing, and 2) Doctor-centered interviewing. Produced by Michigan State University Broadcasting Services, Eric Schultz, Producer—Available from Marketing Division, Instructional Media Center, Michigan State University: 1) PO Box 710, East Lansing,MI48824; 2)517-353-9229(tel); 3)517-432-2650(fax); 4)http://www.msuvmall.msu.edu/imc
  29. Smith RC, Lyles JS, Mettler J, et al.  The effectiveness of intensive training for residents in interviewing. A randomized, controlled study. Ann Intern Med. 1998;128:118–126
  30. Smith RC, Marshall-Dorsey AA, Osborn GG, et al.  Evidence-based guidelines for teaching patient-centered interviewing. Patient Education and Counseling. 2000;39:27–36
  31. Smith RC, Dorsey AM, Lyles JS, Frankel RM. Teaching self-awareness enhances learning about patient-centered interviewing. Acad Med. 1999;74:1242–1248
  32. Ethridge P, Lamb GS. Professional nursing case management improves quality, access, and costs. Nursing Management. 1989;20:30–35
  33. Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. Brit Med J. 2002;324:819–823
  34. Mundinger MO. Twenty-first-century primary care (new partnerships between nurses, and doctors). Acad Med. 2002;77:776–780
  35. Ziruras SJ, Stuart GW, Jackson AC. Assessing the evidence on case management. Brit J Psychiatry. 2002;181:17–21
  36. Mead N, Bower P, Gask L. Emotional problems in primary care (what is the potential for increasing the role of nurses?). J Adv Nurs. 1997;26:879–890
  37. Aubert RE, Herman WH, Waters J, et al.  Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization (a randomized, controlled trial). Ann Int Med. 1998;129:605–612
  38. Sullivan MD. Psychosomatic clinic or pain clinic (which is more viable?). Gen Hosp Psych. 1993;15:375–380
  39. Goldberg D, Gask L, O’Dowd T. The treatment of somatization (teaching techniques of reattribution). J Psychosom Res. 1989;33:689–695
  40. Jones RL, Badger LW, Ficken RP, et al.  Inside the hidden mental health network (examining mental health care delivery of primary care physicians). Gen Hosp Psychiatry. 1987;9:287–293
  41. deGruy FV. Mental healthcare in the primary care setting (a paradigm problem). Families, Systems, Health;. 1997;15:3–26
  42. Lin E, Katon W, Simon G, et al.  Achieving guidelines for the treatment of depression in primary care (is physician education enough?). Med Care. 1997;35:831–842
  43. Smith RC, Gardiner JC, Armatti S, et al.  Screening for high utilizing somatizing patients using a prediction rule derived from the management information system of an HMO (a preliminary study). Med Care. 2001;39:968–978
  44. Katon WJ, VonKorff M, Lin E, Simon G. Rethinking practitioner roles in chronic illness (the specialist, primary care physician, and the practice nurse). Gen Hosp Psychiatry. 2001;23:138–144
  45. Smith RC. A clinical approach to the somatizing patient. J Fam Pract. 1985;21:294–301
  46. Smith RC. Somatization disorder (defining its role in clinical medicine). J Gen Intern Med. 1991;6:168–175
  47. Smith RC, Korban E, Kanj M, et al. A method for rating charts to identify, and classify patients with medically unexplained symptoms (under revision) 2003.
  48. Kleinman A. Explanatory models in health-care relationships (a conceptual frame for research on family-based health-care activities in relation to folk, and professional forms of clinical care). In:  Stoeckle JD editors. Encounters between patients and doctors. Cambridge: The MIT Press; 1987;p. 273–283
  49. Sharpe M. Cognitive behavioural therapies in the treatment of functional somatic symptoms. In:  Mayou R,  Bass C,  Sharpe M editor. treatment of functional somatic symptoms. Oxford: Oxford University Press; 1995;p. 122–143
  50. Fordyce WE. Behavioral methods for chronic pain, and illness. Saint Louis: CV Mosby; 1976;
  51. Heymann-Monnikes I, Arnold R, Florin I, et al.  The combination of medical treatment plus multicomponent behavioral therapy is superior to medical treatment alone in the therapy of irritable bowel syndrome. Am J Gastroenterol. 2000;95:981–994
  52. Spitzer RL, Williams JBW, Kroenke K, et al.  Utility of a new procedure for diagnosing mental disorders in primary care (the PRIME-MD Study). JAMA. 1994;272:1749–1756
  53. Kroenke K, Spitzer RL, deGruy FV, et al.  Multisomatoform disorder (an alternative to undifferentiated somatoform disorder for the somatizing patient in primary care). Arch Gen Psychiatry. 1997;54:352–358
  54. Spitzer RL, Kroenke K, Williams JBW. Validation, and utility of a self-report version of the PRIME-MD. JAMA. 1999;282:1737–1744
  55. Smith RC. Teaching supplement for “The patient’s story—integrated patient-doctor interviewing’. B306 Clinical Center, Michigan State University, East Lansing, MI 48824: Robert C. Smith, 1996
  56. Marshall AA, Smith RC. Physicians’ emotional reactions to patients (recognizing, and managing countertransference). Am J Gastroenterol. 1995;90:4–8
  57. Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects, and the nocebo phenomenon. JAMA. 2002;287:622–627
  58. Sartorius N. Composite International Diagnostic Interview (CIDI)—Core Version 1.1. Copyright World Health Organization
  59. American Psychiatric Association. Diagnostic, and statistical manual of mental disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994
  60. Radloff LS. The CES-D scale (a self-report depression scale for research in the general population). Appl Psychol Measur. 1977;1:385–401
  61. Chibnall J, Tait R. The Psychosomatic Symptom Checklist revisited (reliability, and validity in a chronic pain population). J Behav Med. 1989;12:297–307
  62. Ware J JE, Snow KK, Kosinski M, Gandek B. SF-36 health survey - manual, and interpretation guide. Boston: The Health Institute, New England Medical Center, Box 345, 750 Washington St., 1993
  63. McHorney CA, Ware JJE, Raczek AE. The MOS 36-item short-form health survey (SF-36) (II. Psychometric, and clinical tests of validity in measuring physical, and mental health constructs). Med Care. 1993;31:247–263
  64. Ware JJE, Kosinski M, Bayliss MS, et al.  Comparison of methods for the scoring, and statistical analysis of SF-36 health profile, and summary measures: summary of results from the Medical Outcomes Study. Med Care. 1995;33:AS264–279
  65. Ware JE, Kosinski M, Keller SD. SF-36 physical, and mental health summary scales (a user’s manual). Boston: The Health Institute, New England Medical Center; 1994;
  66. Spielberger CD, Gorsuch RL, Lushene PR, Jacobs GA. State-trait anxiety inventory (Form Y) (“Self-evaluation questionnaire”). Palo Alto, CA 94303: Consulting Psycologists Press, Inc; 1983;

 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