Behavioural Medicine Group Intervention for High-Utilising Somatising Patients: Evaluation Across 7 Unrelated Healthcare Organisations
Steven E. Locke
Pauline P. Chan
Debra S. Morley
Caroline C. McLeod
Matthew A. Budd
Objective: To determine the clinical effectiveness of a standardised behavioural medicine group intervention when implemented by different group leaders in 7 geographically diverse healthcare organisations (HCOs). Design: This study used longitudinal data collected for quality assurance purposes. Patients were asked to complete questionnaires measuring presenting problems (Initial Health Status questionnaire), health and functional status [Short Form-36 Health Survey (SF-36)], and physical [Medical Symptom Check List (MSCL)] and psychological distress [Brief Symptom Inventory (BSI)]. Intervention: The Personal Health Improvement Program(TM) (PHIP) designed to treat somatising high utilisers of general medical services. Participants: Patients enrolled in PHIP courses at 7 different HCOs. Complete data were collected from 1194 patients before the course, 787 immediately after the course and 467 at a 6-month follow-up. 39% of patients who finished the course completed questionnaires at all 3 time-points (times 1, 2 and 3, respectively). Of the 467 patients who provided data at all points, complete information was obtained for 356 patients (the study sample). Main outcome measures and results: Patients' symptoms of anxiety, depression, hostility and somatisation, as well as overall psychological distress improved (p <= 0.001) after the course and at follow-up as determined by repeated measures by group analysis of variance (ANOVA). Results were similar for health status (SF-36), with significant improvements in all of the functional health measures between time 1 and time 3. The majority of participants completing the PHIP reported long term reductions in patterns of distress commonly associated with high levels of medical utilisation. Participants also reported improvements in functional status. In addition, the value of the programme was highly rated by participants. Conclusions: Despite the lack of a control group, the consistency of these findings across the sites are likely to be due to the clinical effectiveness of the course content. The PHIP is an effective and standardised programme, which can be taught to leaders in a short period of time and implemented across very different sites to different populations.
Cognitive behavioural therapy, Disease management programmes, Patient education, Pharmacoeconomics, Quality of care, Quality of life, Quality of life rating scales, Somatoform disorders
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