Treatment of somatization in primary care: evaluation of the Personal Health Improvement Program

The objective of this evaluation is to examine the clinical utility of a behavioral medicine intervention for treatment of prevalent, ill-defined physical symptoms in primary care. Commonly known as somatization, these symptoms have no known organic or psychiatric cause, and are poorly treated by biomedicine alone. Designed to treat these mood-related physical symptoms, the Personal Health Improvement Program (PHIP) is a 6-week structured group intervention which includes classroom videos, exercises and home study assignments. Data were collected from 21 PHIP courses offered at both staff and group model delivery sites at Harvard Pilgrim Health Care. One hundred and seventy-one participants filled out questionnaires at the first and last session of the course, and returned follow-up questionnaires by mail 3 months later. In order to obtain clinical data, medical charts were reviewed for the periods 1 year before and 1 year after the course. Questionnaire data included a Medical Symptoms Checklist, the Brief Symptom Inventory, the SF-36, a course satisfaction form, and visits to the health care site. After PHIP, participants reported decreases in emotional and physical distress, increases in functional status, and high levels of satisfaction. Patient improvement was also reflected in decreased use of medical resources after a long-standing pattern of high utilization. These data suggest that by addressing physical complaints that are resistant to biomedical treatment alone, PHIP has practical utility, promoting increased quality of care, increased patient satisfaction, and better allocation of health care resources.