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Frequent attenders with medically unexplained symptoms: service use and costs in secondary care

SIMON WESSELY, MD

Academic Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London

TIM CRAYFORD, MFPHM

Bromley Health Authority

MATTHEW HOTOPF, PhD

Academic Department of Psychological Medicine, Guy's, King's and St Thomas' School of Medicine and Institute of Psychiatry, London

Correspondence: Dr S. Reid, Paterson Centre for Mental Health, St Mary's Hospital, 20 South Wharf Road, London W2 IPD, UK. Tel: 020 7886 1968; Fax: 020 7886 6667

Declaration of interest Funded by the National Health Service Executive National Research and Development Programme.

Background Frequent attenders in medical settings account for a disproportionate amount of health-care resources. Little is known about service use and costs of secondary care in those frequent attenders presenting with medically unexplained symptoms.

Aims To compare health-care use and costs of patients with medically unexplained symptoms with other frequent attenders in secondary care.

Method In a sample of 400 frequent attenders of secondary care services, those presenting with medically unexplained symptoms were identified by a review of medical records. Their use of health-care resources was compared with that of other frequent attenders.

Results Of the frequent attenders 17% had at least two medically unexplained consultation episodes. These patients had a greater number of referrals to secondary care and were more likely to undergo particular investigations.

Conclusions Frequent attenders with medically unexplained symptoms account for levels of service use and expenditure that are comparable with other frequent attenders, but the use and cost of medical investigations in this group are significantly greater.

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