A TRIAL OF THE EFFECT OF A STANDARDIZED PSYCHIATRIC-CONSULTATION ON HEALTH OUTCOMES AND COSTS IN SOMATIZING PATIENTS

Background: Patients who somatize but who do not meet criteria for som atization disorder are common in the community. Virtually no research has been conducted to determine how to treat these patients. Methods: We conducted a randomized controlled clinical trial of a psychiatric c onsultation intervention we had previously shown to improve the manage ment of somatization disorder. The study population included 51 physic ians treating 56 somatizing patients who had a history of seeking help for six to 12 lifetime unexplained physical symptoms. At the onset of the experiment, physicians randomized to the treatment condition rece ived a consultation letter recommending a specific management approach ; physicians randomized to the control/crossover condition received th e consultation letter after 12 months. Data on health outcomes and cha rges were collected every 4 months for 2 years after randomization for 96% of subjects who entered the study. Results: Patients of physician s who received the intervention reported significantly increased physi cal functioning, an improvement that remained stable during the year a fter the intervention. The intervention reduced annual medical care ch arges by $289 (95% confidence interval, $40 to $464) in 1990 constant dollars, which equates to a 32.9% reduction in the annual median cost of their medical care. Conclusions: Somatizing patients with a lifetim e history of six to 12 unexplained physical symptoms reported better p hysical functioning after their primary care physician was provided ap propriate treatment recommendations via a psychiatric consultation. Su ch a consultation is cost-effective because it reduces subsequent char ges for medical care, while improving health outcomes in a chronically impaired population.