Costly patients with unexplained medical symptoms: A high-risk population

ObjectivesTo identify a group of costly patients with unexplained medical symptoms (UMS), and address their needs.MethodsProspective controlled trial; 42 patients with annual costs of care of $6500 or more were randomized into an intervention and a usual care group. A primary care team with expertise in the biopsychosocial (BPS) approach implemented the intervention.ResultsIn the intervention group, the annual number of visits to consultants declined from 31.8 to 12.6 (p < .0001) and 14.6 (p = .72) after 1 and 2 years, respectively; visits to hospital emergency wards declined from 33.5 to 4.1 (p < .0001) and 3.5 (p = .18); and in-hospital days declined from 112.7 to 19 (p < .0001) and 6.5 (p = .25). Those parameters remained unchanged in the control group.Five years follow-up demonstrated a reduction in mortality rates between the two groups: 6/21 versus 17/21 (p < 0.001).ConclusionsWhen compared to usual care, a BPS intervention was followed by a decline in patients’ visits to medical settings and health-care expenditures, along with significant decline in mortality rate.Practice implicationCostly UMS patients should be identified every year and treated using a BPS approach.