Diagnosing and Treating Patients with Medically Unexplained Symptoms: A Training Program for Primary Care Clinicians in Integrated Care

Transcription

1 Session # track letter and number Diagnosing and Treating Patients with Medically Unexplained Symptoms: A Training Program for Primary Care Clinicians in Integrated Care Cynthia Stone, DBH, Director of BH, Community Care Physicians Lesley Manson, PsyD, Clinical Assistant Professor, Assistant Chair of Integrated Initiatives Holly Cleney, MD, Managing Physician, Latham Medical Group Kristine Campagna, MD, Board Member, Community Care Physicians CFHA 19 th Annual Conference October 19-21, 2017 Houston, Texas

2 Faculty Disclosure The presenters of this session have NOT had any relevant financial relationships during the past 12 months.

3 Conference Resources Slides and handouts shared in advance by our Conference Presenters are available on the CFHA website at Slides and handouts are also available on the mobile app.

4 Learning Objectives At the conclusion of this session, the participant will be able to: Identify the importance of diagnosis and treatment in primary care of MUS patient leading to improved physician-patient care, reduced physician stress, enhanced patient satisfaction, reduced cost of care and improved. Understand how diagnosis and treatment of MUS patient in primary care supports the quadruple aim Describe key components of the intervention in the diagnosis and treatment of MUS patients that will improve patient care and reduce both clinician stress and healthcare costs.

5 Bibliography / Reference Barsky, A. J., Orav, E. J., & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62, Clarke, D. D. (2007). They can t find anything wrong! 7 keys to understanding, treating, and healing stress illness. Boulder, CO: Sentient Publications. Clarke, D. D. (2016). Diagnosis and treatment of medically unexplained symptoms and chronic functional syndromes. Families, Systems, & Health, 34(4), 309. Escobar, J. I., Gara, M. A., Diaz-Martinez, A. M., Interian, A., Warman, M., Allen, L. A.,... Rodgers, D. (2007). Effectiveness of a time-limited cognitive behavior therapy type intervention among primary care patients with medically unexplained symptoms. Annals of Family Medicine, 5, Weiland, A., Blankenstein, A. H., Van Saase, J. L., Van der Molen, H. T., Kosak, D., Vernhout, R. M., & Arends, L. R. (2016). Training Medical Specialists in Communication about Medically Unexplained Physical Symptoms: Patient Outcomes from a Randomized Controlled Trial. International Journal of Person Centered Medicine, 6(1),

6 Learning Assessment A learning assessment is required for CE credit. A question and answer period will be conducted at the end of this presentation.

7 Medically Unexplained Symptoms

8 MUS Explained Dr. clarke

9 Case Study Dr. Locke

10 Importance of Diagnosis and Treatment in Primary Care Of MUS Patients Leading to Improved physician-patient care Enhanced patient satisfaction Lower cost of care Reduced physician stress improved outcomes

11 Improved PCP-Patient Care

12 Enhanced Patient Satisfaction Leading to increased adherence to medical advice Stronger provider/ patient relationship Patients feeling heard and supported Drop in no show rates for MUS patients

13 Reduced Cost Medical testing Lab work Referral to specialty care (multispeciality) Hospital admission/ readmissions Medication

14 Reduced Stress for PCPs

15 Pre-Post: PCP Stress Primary Care Provider- Stress Checklist Adapted (PCP-SC Adapted) Interactions with patients- 8 items Patients who: Don t manage chronic disease Complain of chronic pain, depression, anxiety other common psychological problems, Are angry and demanding Have problems stemming form PTSD** Lead unhealthy lifestyles, Are non-adherence** With MUS** Practice management- 2 items Time in schedule Education/Learning- 1 item Learning new procedures of treatment modalities **added items -Robinson, P.J., Gould, D. A., & Strosahl, K.D. (2011)

16 PCP-SC Adapted: Score Interpretation Interaction with Patients Practice Management Education/ Learning Increase in Scores Decrease In Scores Reasons behind increases: Interactions with patients Awareness, Opening door, discussions Content Discomfort; feelings of lack of Competency Training Practice management Excess time visit structure- controlling visit Education Time, out of school many years, not accustomed to ongoing didactic learning

17 Training Impact: PCP Stress Research Question: Will a 3-hour training enhanced by 6 online didactic and interactive modules on the diagnosis and treatment of patients with medically unexplained symptoms for primary care providers (PCPs) decrease PCP stressors in treating MUS patients? Results Paired Sample T-Test results were significant t(7) = 4.58, p =.004. Results indicate: PCPs stress in treating patients with MUS (PCP-SC Adapted), significantly decreased by an average of 1.0 point as a result of training.

18 Table 1: Descriptive Statistics of Study Outcome Variables Pretest Posttest Variable PCP-SC- Adapted M SD M SD *Note: PCP-SC-Adapted n =10

19 Training Impact: Diagnosis and Treatment Research Question: Will a 3-hour training enhanced by 6 online didactic and interactive modules on the diagnosis and treatment of medically unexplained symptoms for primary care providers (PCPs) increase the importance of and confidence in diagnosing and treating MUS patients in primary care? Measured Success Through: Diagnosis and Treatment of Medically Unexplained Symptoms Primary Care Provider Importance and Confidence Scale (MUS-PCPICS)* Results indicate: PCPs perception of the importance of and their confidence in diagnosing and treating patients with medically unexplained symptoms (MUS-PCP-ICS), significantly increased by an average of points. *instrument not validated

20 MUS Primary Care Provider Importance and Confidence Scale (MUS-PCPICS) Medically Unexplained Symptoms Primary Care Provider Importance and Confidence Scale (MUS-PCPICS) Discuss Stress Illness with your patients Diagnose Stress Illness with your patients Treat Stress Illness with your patients

21 Score Went Up?

22 Improved Outcomes

23 Key Components in the Diagnosis and Treatment of MUS Patients SCREENING DISC USSION LEARNING/ENGAGING with patients in uncomfortable and new ways

24 Screening

25 Screening Tools PHQ-9 GAD-7 PC-PTSD ACES HSST

26 Discussion

27 Learning/ Engaging

28 Training Impact: On Patients Research Question: Will a 3-hour training enhanced by 6 online didactic and interactive modules on the diagnosis and treatment of medically unexplained symptoms for primary care providers (PCPs) have an impact on the PCPs patients with medically unexplained symptoms? Measured Through: Symptom Report PHQ-9 GAD-7 ACEs Hidden Stress Screening Results indicate:

29 Study Notes Dr. Campagna Why scores went up?

30 Case Study Dr. Cleney

31 What Worked

32 What Need s Revision

33 What s Next: Recommendations

34 Questions?

35 Session Evaluation Use the CFHA mobile app to complete the evaluation for this session. Thank you!