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Management of patients with persistent medically unexplained symptoms: a descriptive study
Kate Sitnikova1, Rinske Pret-Oskam2, Sandra M A Dijkstra-Kersten2
1Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands. e.sitnikova@vumc.nl.
BMC Family Practice
|June 20, 2018
Summary
Dutch GPs partially follow the national guideline for medically unexplained symptoms (MUS). While medication use may exceed recommendations, comprehensive symptom exploration and mental health referrals are underutilized in managing persistent MUS.
Area of Science:
- General Practice
- Health Services Research
- Psychiatry
Background:
- The Dutch national guideline for medically unexplained symptoms (MUS) was established in 2013.
- Persistent MUS poses a challenge in primary care, necessitating evaluation of current management practices.
- Assessing adherence to guidelines and temporal trends in care is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the medical care provided to adult primary care patients with persistent MUS.
- To determine the extent to which current general practitioner (GP) management aligns with the Dutch national guideline.
- To identify any changes in management strategies over time.
Main Methods:
- An observational study utilizing electronic medical records from 30 general practices in the Netherlands.
- Data from 1035 MUS consultations involving 77 adult patients were analyzed over a 5-year period.
- GP management strategies were categorized based on the Dutch guideline, and changes over time were assessed.
Main Results:
- Physical examination (24.5%) and GP-led investigations (11.1%) were common diagnostic strategies.
- Prescribing medication (24.6%) and providing explanations (11.2%) were frequent therapeutic approaches.
- Management evolved with persistent symptoms, showing increased medication adjustment, progress discussion, and follow-up scheduling, yet limited exploration of all complaint dimensions (3.5%) and mental health referrals (0.6% combined).
Conclusions:
- General practitioner management of MUS in the Netherlands is partially consistent with the national guideline.
- There is a potential overuse of medication and underutilization of comprehensive symptom dimension exploration and mental health referrals.
- Further efforts are needed to fully integrate guideline recommendations into primary care for patients with persistent MUS.
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