The University of Liverpool - MERSEY PRIMARY CARE R&D CONSORTIUM - Randomised control trial of teaching general practitioners to manage patients with persistent medically unexplained symptoms (MUST)

Randomised control trial of teaching general practitioners to manage patients with persistent medically unexplained symptoms (MUST)

Contact - Judith Hogg            email : judehogg@liv.ac.uk

 
Academic Leaders

• Prof. Richard Morris
• Prof Chris Dowrick

Researchers

• Judith Hogg (Trial Manager)
• Rebecca Clifford (Research Associate Liverpool;
• Maria Towey (Research Associate Manchester)

Project Status

Ongoing Completion June 2006

Collaborating Institutions

• University of Liverpool
• University of Manchester

Funding

• MRC £397k
• MPCRDC (NHS R and D funding) £5352 for service support costs

Aim

1. To determine the effects of health facilitator delivered reattribution training in practices on GP communication behaviour with patients presenting with persistent MUS compared to practices where no training has been undertake
2. To determine if the effects of reattribution training on GP communication are maintained over 12 months
3. To determine if health facilitator delivered reattribution training changes symptoms of beliefs of patients, reduces emotional distress and increases patient satisfaction with GP care
4. To identify barriers (attitudinal, educational, service related) and potential solutions to barriers and to the delivery of reattribution training to GPs by health facilitators
5. To identify barriers (attitudinal, educational, service related) and potential solution to barriers to the delivery of reattribution by GPs to patients in clinical practice
6. To identify barriers (symptom attribution, openness to change, trajectory of illness, attitude to psychosocial issues, demographic feature) and potential solutions to barriers in persistent MUS patients to the effectiveness of reattribution
7. To identify a costing methodology that can be used as the basis for an accurate power calculation of health and social costs in a definitive randomised controlled trial

Method

Four geographical areas were used (Merseyside, Cheshire, Lancashire and Greater Manchester). Practices were selected to represent the fill range of social deprivation, range of practice size and variety of geographical areas so that the results are generalisable to NHS practice. After randomisation, the trained health facilitator in each area delivered 3 two hour training sessions to the intervention (reattribution training)arm. In the control arm the GPs were invited to managed their identified cases in the usual manner. Consultations were audiotape. After consenting patients to the trial and before consultation with their GP, patients were asked to complete a short questionnaire to establish; that the primary reason for consultation was a physical symptom; symptoms were longer than 6 months, patient not receiving antidepressants, anxiolytic or systemic psychological treatment and that they were over 18 years of age.

Results

Anticipated outcomes include: recruitment process; quantitative outcome paper from the main trial results; qualitative paper on barriers to delivering a complex intervention; predictors of outcome and model of action; economic paper.

Data under analysis at present.