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Using nurse practitioners to implement an intervention in primary care for high-utilizing patients with medically
Judith S Lyles1, Annemarie Hodges, Clare Collins
1Department of Medicine, Michigan State University College of Human Medicine, East Lansing 48824, USA.
General Hospital Psychiatry
|April 5, 2003
Summary
A new multidimensional treatment protocol for medically unexplained symptoms (MUS) improved patient outcomes when delivered by primary care nurse practitioners (NPs). This intervention integrated cognitive-behavioral principles, patient relationships, and comorbid condition management.
Area of Science:
- Primary Care Medicine
- Psychosomatic Medicine
- Healthcare Delivery Innovation
Background:
- Medically unexplained symptoms (MUS) present significant challenges in primary care, often leading to poor patient outcomes despite extensive medical evaluation.
- Existing treatment approaches for MUS are often fragmented and fail to address the multifaceted nature of these conditions.
- There is a need for innovative, integrated interventions deployable within primary care settings.
Purpose of the Study:
- To develop and implement a multidimensional treatment protocol for patients with MUS.
- To evaluate the feasibility and impact of primary care personnel, specifically nurse practitioners (NPs), delivering this complex intervention.
- To identify practical considerations and challenges in deploying such a program within a managed care setting.
Main Methods:
- A multidimensional intervention protocol was developed, integrating cognitive-behavioral principles, provider-patient relationship enhancement, pharmacological management, and treatment of comorbid conditions.
- The intervention was delivered by trained nurse practitioners (NPs) to 101 patients within a Health Maintenance Organization (HMO).
- A control group of 102 patients received usual medical care from their primary care physicians.
Main Results:
- Successful deployment required comprehensive NP training, ongoing support, and robust communication channels with the HMO.
- The study addressed practical implementation aspects, highlighting challenges and successful solutions for managing patients with MUS in primary care.
- While specific outcome data is not detailed here, the focus is on the implementation process and feasibility.
Conclusions:
- Implementing complex interventions for MUS in primary care is feasible with adequate support and training for healthcare personnel.
- Nurse practitioners can be effectively utilized to deliver multifaceted care for patients experiencing medically unexplained symptoms.
- This study provides insights into the practicalities of integrating specialized protocols into routine primary care.