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Evaluation of General Practitioners' Training: How to Manage Patients With Unexplained Physical Symptoms

Received February 14, 2005; revised June 28, 2005; accepted August 9, 2005. From the Dept. of Clinical Psychology and Psychotherapy, Philipps-Univ. of Marburg, Marburg, Germany. Send correspondence and reprint requests to Dr. W. Rief, Dept. of Clinical Psychology and Psychotherapy, Philipps-Univ. of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany. e-mail: rief{at}staff.uni-marburg.de

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP’s office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.

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