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

• Published in: British journal of psychiatry Vol. 191; no. 6; pp. 536 - 542
• Main Authors: Morriss, Richard, Dowrick, Christopher, Salmon, Peter, Peters, Sarah, Dunn, Graham, Rogers, Anne, Lewis, Barry, Charles-Jones, Huw, Hogg, Judith, Clifford, Rebecca, Rigby, Christine, Gask, Linda
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.12.2007; RCP
• Subjects: Cluster Analysis; Cluster randomized controlled trials; Communication; Doctor-Patient communication; Education, Medical, Continuing - methods; Education, Medical, Continuing - standards; Family physicians; Female; General practice; Humans; Idiopathic; Intervention; Male; Medical personnel; Mental disorders; Mental health; Mental Health Services - manpower; Mental Health Services - standards; Middle Aged; Patient communication; Patient satisfaction; Physician-Patient Relations; Physicians; Primary care; Problem-Based Learning - methods; Professionals; Program Evaluation; Psychiatry; Quality of care; Quality of life; Reproducibility of Results; Somatoform Disorders - therapy; Surgery; Symptoms; Training; Unexplained
• ISSN: 0007-1250; 1472-1465
• DOI: 10.1192/bjp.bp.107.040683

Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms. 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. 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. 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. Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.