Novel primary care treatment package for patients with medically unexplained symptoms: a cohort intervention study

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Figure 1 CONSORT flow diagram. ^a1 patient aged <18 years with dementia, 1 patient out of area, 5 patients aged >75 years with high-level multimorbidity. BOPT = body oriented psychological therapy. DNA = did not attend. MBSR = mindfulness-based stress reduction. SBLG = Short Form for Strategies for Better Living Group.

Table 1. Participants' characteristics.

	n (%)
Mean age, years (range)	48 (21–75)
Sex
Female	76 (81.7)
Male	17 (18.3)
Ethinicity
White British	17 (18.3)
White other	7 (7.5)
Afro-Caribbean	6 (6.5)
Black African	10 (10.8)
Indian	11 (11.8)
Pakistani	16 (17.2)
Bangladeshi	23 (24.7)
Other	3 (3.2)
Employment status
Unemployed	59 (63.4)
Benefits received
State retirement pension	6
Statutory sick pay	9
Working Tax Credit	9
Housing Benefit	41
Council tax benefit	35
Disability Living Allowance mobility component	12
Disability Living Allowance care component	10
Incapacity benefit	5
Income support	20

Table 2. Clinical baseline and follow-up comparison of somatic complaints and quality-of-life scores, using paired samples t-tests.

	n	Mean	SD	Difference (95% CI)	P-value
PHQ-15 total symptom score
Baseline	51	17.8	5.7
Follow-up	51	14.2	6.8	3.79 (2.28 to 5.29)	<0.01
SF-36 physical health component
Baseline	43	25.5	23.3
Follow-up	43	33.5	35.9	–8.0 (–16.63 to 0.64)	0.69
SF-36 mental health component
Baseline	42	35.8	25.5
Follow-up	42	45.6	29.5	–9.8 (–18.44 to –1.18)	<0.05
EQ-5D health score
Baseline	48	39.6	24.6
Follow-up	48	47.4	25.8	–7.8 (–16.11 to 0.38)	0.61

PHQ-15 = 15-item Patient Health Questionnaire. SD = standard deviation. SF=36 = 36-item Short Form Survey.

Table 3. Service utilisation and cost data comparison, using paired samples t-tests.

	n	Mean	SD	Difference (95% CI)	Unit cost, £	Service cost calculation, £^²²
GP contacts					39.72^a
Baseline	90	14.5	10.3			51 835
Follow-up	88	9.7	6.8	4.8 (2.88 to 6.77)^b		33 905
Specialist outpatient attendance contacts					113
Baseline	87	3.0	2.9			29 493
Follow-up	87	2.3	2.4	0.6 (0.03 to 1.19)^c		22 611
Hospital day case A&E visits					140
Baseline	87	0.9	1.5			10 962
Follow-up	87	0.4	0.8	0.5 (0.15 to 0.86)^c		4872
Physiotherapy sessions					28
Baseline	89	1.7	3.1			4236
Follow-up	88	0.4	1.2	1.3 (0.68 to 1.96)^b		986
Total cost, £
Baseline						96 526
Follow-up						62 374
Difference						34 152
Mean per participant						367
Prescribed non-specific medication
Baseline	49	4.0	2.5
Follow-up	49	4.1	3.8	–0.04 (–0.92 to 0.84)^d
Hours of support from family/friends
Baseline	33	16.2	20.9
Follow-up	33	15.0	22.3	1.27 (–2.49 to 5.04)^d

A&E = accident and emergency. SD = standard deviation. ^aAveraged cost per patient contact (lasting 11.7–17.2 minutes) or telephone consultation, prescription cost. ^b P<0.01. ^c P<0.05. ^dNot significant.