Cluster randomised controlled trial of training practices in reattribution

1: Br J Psychiatry. 2007 Dec;191:536-42.

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

Morriss R, Dowrick C, Salmon P, Peters S, Dunn G, Rogers A, Lewis B,
Charles-Jones H, Hogg J, Clifford R, Rigby C, Gask L.

Division of Psychiatry, School of Community Health Sciences, University of
Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7
2UH, UK. richard.morriss@nottingham.ac.uk.

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.

PMID: 18055958 [PubMed - in process]