Patients repeatedly referred to secondary care with symptoms unexplained by organic disease: prevalence, characteristics and referral pattern

Kelly McGorm, Christopher Burton, David Weller, Gordon Murray, Michael Sharpe

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background. Patients with medically unexplained symptoms (MUS) are commonly referred to specialist clinics. Repeated referrals suggest unmet patient need and inefficient use of resources.
Objectives. How often does this happen, who are the patients and how are they referred?
Methods. The design of the study is a case-control survey. The setting of the study is five general practices in Scotland, UK. The cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. The controls were (i) patients referred only once over 5 years and (ii) patients with three or more referrals with symptoms always diagnosed as medically explained. The measures of the study are SF-12 physical and mental component summaries; symptom count; and number of referrals, number of different GPs who had referred and number of specialist follow-up appointments.
Results. A total of 1.1% [95% confidence interval (CI) 1.0–1.2%] of patients had repeated (median 3, range 2–6) referrals with MUS. Compared to infrequently referred controls, they were older and more likely to be female, living alone and unemployed. Compared to controls with medically explained symptoms, their health status was comparable or worse: odds ratio for SF-12 physical component summary <40, 1.2 (95% CI 0.72–2.0); SF-12 mental component summary <40, 1.8 (95% CI 1.1–3.0); reporting eight or more physical symptoms, 2.2 (95% CI 1.2–3.8). They were referred by more GPs and received less specialist follow-up.
Conclusions. A small proportion of primary care patients are repeatedly referred to specialist clinics where they receive multiple diagnoses of MUS. The needs of these patients and how they are managed merits greater attention.
Original languageEnglish
Pages (from-to)479-486
Number of pages8
JournalFamily Practice
Volume27
Issue number5
Early online date2 Aug 2010
DOIs
Publication statusPublished - Oct 2010

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Secondary Care
Referral and Consultation
Confidence Intervals
Scotland
General Practice
Health Status
Primary Health Care
Appointments and Schedules
Odds Ratio
Medically Unexplained Symptoms

Keywords

  • clinical diagnosis
  • family medicine
  • medically unexplained symptoms
  • mental health
  • somatisation

Cite this

Patients repeatedly referred to secondary care with symptoms unexplained by organic disease : prevalence, characteristics and referral pattern. / McGorm, Kelly; Burton, Christopher; Weller, David; Murray, Gordon; Sharpe, Michael.

In: Family Practice, Vol. 27, No. 5, 10.2010, p. 479-486.

Research output: Contribution to journalArticle

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abstract = "Background. Patients with medically unexplained symptoms (MUS) are commonly referred to specialist clinics. Repeated referrals suggest unmet patient need and inefficient use of resources. Objectives. How often does this happen, who are the patients and how are they referred? Methods. The design of the study is a case-control survey. The setting of the study is five general practices in Scotland, UK. The cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. The controls were (i) patients referred only once over 5 years and (ii) patients with three or more referrals with symptoms always diagnosed as medically explained. The measures of the study are SF-12 physical and mental component summaries; symptom count; and number of referrals, number of different GPs who had referred and number of specialist follow-up appointments. Results. A total of 1.1{\%} [95{\%} confidence interval (CI) 1.0–1.2{\%}] of patients had repeated (median 3, range 2–6) referrals with MUS. Compared to infrequently referred controls, they were older and more likely to be female, living alone and unemployed. Compared to controls with medically explained symptoms, their health status was comparable or worse: odds ratio for SF-12 physical component summary <40, 1.2 (95{\%} CI 0.72–2.0); SF-12 mental component summary <40, 1.8 (95{\%} CI 1.1–3.0); reporting eight or more physical symptoms, 2.2 (95{\%} CI 1.2–3.8). They were referred by more GPs and received less specialist follow-up. Conclusions. A small proportion of primary care patients are repeatedly referred to specialist clinics where they receive multiple diagnoses of MUS. The needs of these patients and how they are managed merits greater attention.",
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N2 - Background. Patients with medically unexplained symptoms (MUS) are commonly referred to specialist clinics. Repeated referrals suggest unmet patient need and inefficient use of resources. Objectives. How often does this happen, who are the patients and how are they referred? Methods. The design of the study is a case-control survey. The setting of the study is five general practices in Scotland, UK. The cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. The controls were (i) patients referred only once over 5 years and (ii) patients with three or more referrals with symptoms always diagnosed as medically explained. The measures of the study are SF-12 physical and mental component summaries; symptom count; and number of referrals, number of different GPs who had referred and number of specialist follow-up appointments. Results. A total of 1.1% [95% confidence interval (CI) 1.0–1.2%] of patients had repeated (median 3, range 2–6) referrals with MUS. Compared to infrequently referred controls, they were older and more likely to be female, living alone and unemployed. Compared to controls with medically explained symptoms, their health status was comparable or worse: odds ratio for SF-12 physical component summary <40, 1.2 (95% CI 0.72–2.0); SF-12 mental component summary <40, 1.8 (95% CI 1.1–3.0); reporting eight or more physical symptoms, 2.2 (95% CI 1.2–3.8). They were referred by more GPs and received less specialist follow-up. Conclusions. A small proportion of primary care patients are repeatedly referred to specialist clinics where they receive multiple diagnoses of MUS. The needs of these patients and how they are managed merits greater attention.

AB - Background. Patients with medically unexplained symptoms (MUS) are commonly referred to specialist clinics. Repeated referrals suggest unmet patient need and inefficient use of resources. Objectives. How often does this happen, who are the patients and how are they referred? Methods. The design of the study is a case-control survey. The setting of the study is five general practices in Scotland, UK. The cases were 193 adults with three or more referrals over 5 years, at least two of which resulted in a diagnosis of MUS. The controls were (i) patients referred only once over 5 years and (ii) patients with three or more referrals with symptoms always diagnosed as medically explained. The measures of the study are SF-12 physical and mental component summaries; symptom count; and number of referrals, number of different GPs who had referred and number of specialist follow-up appointments. Results. A total of 1.1% [95% confidence interval (CI) 1.0–1.2%] of patients had repeated (median 3, range 2–6) referrals with MUS. Compared to infrequently referred controls, they were older and more likely to be female, living alone and unemployed. Compared to controls with medically explained symptoms, their health status was comparable or worse: odds ratio for SF-12 physical component summary <40, 1.2 (95% CI 0.72–2.0); SF-12 mental component summary <40, 1.8 (95% CI 1.1–3.0); reporting eight or more physical symptoms, 2.2 (95% CI 1.2–3.8). They were referred by more GPs and received less specialist follow-up. Conclusions. A small proportion of primary care patients are repeatedly referred to specialist clinics where they receive multiple diagnoses of MUS. The needs of these patients and how they are managed merits greater attention.

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KW - family medicine

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KW - mental health

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