Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms
Richard Morriss1, Christopher Dowrick, Peter Salmon
1Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7 2UH, UK. richard.morriss@nottingham.ac.uk
Background:
Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.
Aims:
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.
Method:
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.
Results:
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.
Conclusions:
Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.
