Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms

Br J Psychiatry. 2007 Dec:191:536-42. doi: 10.1192/bjp.bp.107.040683.

Abstract

Background: Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.

Aims: To determine if practice-based training of GPs in reattribution changes doctor-patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.

Method: Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.

Results: With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference -0.9, 95% CI -1.6 to -0.1; P=0.027) with no other effects on patient outcome or health contacts.

Conclusions: Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cluster Analysis
  • Communication
  • Education, Medical, Continuing / methods*
  • Education, Medical, Continuing / standards
  • Female
  • Humans
  • Male
  • Mental Health Services / standards*
  • Middle Aged
  • Physician-Patient Relations
  • Problem-Based Learning / methods
  • Program Evaluation
  • Reproducibility of Results
  • Somatoform Disorders / therapy*
  • Workforce