WHO IS AT RISK FOR DETERIORATION AFTER AN INTEGRATED AND BLENDED PRIMARY CARE TREATMENT IN PATIENTS WITH MODERATE MUPS

S. Konings^1,2, S. Toonders^3,1,4, E. van Westrienen^1,4,3, M. Pisters^1,2,4,3

Background: Medically unexplained physical symptoms (MUPS) can be considered as a continuum of mild, moderate to chronic stages, classified according to severity, duration and both psychiatric and medical comorbidities. Chronic MUPS has a major impact on physical and mental health. To prevent chronic MUPS, it is important to offer indicated prevention, which is aimed at preventing that mild or moderate stages of MUPS develop into chronic stages of MUPS. It is known that patients with chronic stages of MUPS have a high risk of deterioration after treatment. These insights cannot be directly translated to patients with moderate MUPS as these patients differ from patients with chronic MUPS. It is known that deterioration after treatment is an important point of attention, but it is not yet known whether this also applies to this patient group.

Purpose: The first aim of this study is to identify which patients deteriorate in physical and mental health after treatment for patients with moderate MUPS who participated in an indicated preventive blended primary care program. The second aim is to identify factors that are associated with this deterioration.

Methods: This prospective cohort study included patients (≥ 18 years) with moderate MUPS who participated in a blended primary care program. Deterioration in physical or mental health was measured with the Physical Components Summary and the Mental Components Summary of the RAND-36. Data was collected at baseline, post treatment and 12-months follow-up. Age, gender, education level, duration of complaints, psychosocial comorbidity, pain level and self-management skills were included as possible prognostic factors for deterioration. With univariate logistic regressions, it was tested which predictors were associated with a deterioration on physical or mental health between post treatment and follow-up.

Results: A total of 80 participants were included in this study. On average, the treatment gains for physical and mental health are maintained at follow-up, but the percentage of participants who had a significant clinically relevant deterioration in physical and mental health was 30.6% and 39.4%, respectively. The prognostic factors do not appear to be significant predictors for deterioration at 12-months follow-up. A sensitivity analysis showed that the highest percentage of deterioration after treatment was found in the subgroup of patients who improved clinically relevant during the treatment period (38.8% deteriorate in physical health and 64.4% deteriorate in mental health) compared to participants who remained stable or had a clinically relevant deterioration during the treatment period.

Conclusion(s): For the overall group the treatment gains for physical and mental health appears to be maintained at follow-up, implying sustainable results. This seems to prevent moderate stages of MUPS from developing into chronic stages of MUPS. It is not known what factors predict deterioration in patients with moderate MUPS. More research is needed into factors that influence deterioration after treatment and which aftercare is appropriate to reduce deterioration.

Implications: Implications are part of the conclusion

Funding, acknowledgements: This work was supported by SIA-RAAK-public [Grant No. 2015-02-24P].

Keywords: deterioration, indicated prevention, medically unexplained physical complaints

Topic: Primary health care

Did this work require ethics approval? Yes

Institution: University Medical Center Utrecht

Committee: Medical Ethical Committee Utrecht, Netherlands

Ethics number: Trial Register NTR6755.