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Cluster randomised controlled trial of training practices in reattribution for medically unexplained symptoms

Division of Psychiatry, School of Community Health Sciences, University of Nottingham Nottingham

Christopher Dowrick, MD, FRCGP

Division of Primary Care

Peter Salmon, DPhil, FBPsS

Division of Clinical Psychology, School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool

Sarah Peters, PhD

Division of Psychological Sciences

Graham Dunn, PhD

Biostatisitics, Informatics and Health Economics Research Group, School of Community Based Medicine

Anne Rogers, PhD

National Primary Care Research and Development Centre, University of Manchester, UK

Barry Lewis, FRCGP

Department of Postgraduate GP Education, North Western Deanery, Manchester

Huw Charles-Jones, PhD, MRCGP

National Primary Care Research and Development Centre, University of Manchester, Manchester

Judith Hogg, MA, Rebecca Clifford, PhD and Christine Rigby, MA

Division of Psychiatry, School of Behavioural, Community and Population Science, University of Liverpool, Liverpool

Linda Gask, PhD, FRCPsych

National Primary Care Research and Development Centre, University of Manchester, Manchester, UK

Correspondence: Professor Richard Morriss, Division of Psychiatry, School of Community Health Sciences, University of Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7 2UH, UK. Tel: 44 115 826 0427; fax: 44 115 826 0433; email: richard.morriss{at}nottingham.ac.uk

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Reattribution is frequently taught to general practitioners (GPs) as a structured consultation that provides a psychological explanation for medically unexplained symptoms.

Aims To determine if practice-based training of GPs in reattribution changes doctor–patient communication, thereby improving outcomes in patients with medically unexplained symptoms of 3 months' duration.

Method Cluster randomised controlled trial in 16 practices, 74 GPs and 141 patients with medically unexplained symptoms of 6 hours of reattribution training v. treatment as usual.

Results With training, the proportion of consultations mostly consistent with reattribution increased (31 v. 2%, P=0.002). Training was associated with decreased quality of life (health thermometer difference –0.9, 95% CI –1.6 to –0.1; P=0.027) with no other effects on patient outcome or health contacts.

Conclusions Practice-based training in reattribution changed doctor–patient communication without improving outcome of patients with medically unexplained symptoms.

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				H. J. van Ravesteijn, P. L. Lucassen, and T. C. o. Hartman Reattribution for medically unexplained symptoms The British Journal of Psychiatry, April 1, 2008; 192(4): 314 - 315. [Full Text] [PDF]

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