• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Pain  • Psychosocial Issues  • Primary Care/ Family Medicine  • Psychiatry  • Psychiatry, Other  • Cardiovascular System  • Diagnosis  • Prognosis/ Outcomes  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic  Social Bookmarking   What's this?

Symptom Persistence and Health Care Usage

Julia Anna Glombiewski, PhD; Winfried Rief, PhD; Stefan Bösner, MD, MPH; Heidemarie Keller, PhD; Alexandra Martin, PhD; Norbert Donner-Banzhoff, MD

Arch Intern Med. 2010;170(3):251-255.

Background  Nonspecific chest pain is common in primary care, yet knowledge is sparse about its course and outcome and how they relate to optimum health care usage. We investigated the following observations: (1) many patients who present with nonspecific chest pain in primary care show symptom persistence for 6 months, (2) many patients with nonspecific chest pain showed signs of overinvestigation, and (3) many patients with chronic chest pain were referred to mental health specialists.

Methods  We conducted a prospective, general physician–based cohort study with 6-week and 6-month follow-ups in 74 primary care offices in Hessen, Germany. Of approximately 190 000 consecutive patients who visited their general physicians from October 1, 2005, to July 31, 2006, 807 patients with nonspecific chest pain were identified by an expert committee (delayed-type reference standard). The dropout rate was 2.7%. Main outcome measures were persistent chest pain at a 6-month follow-up visit and health care usage at 6 months.

Results  The rate of persistent chest pain was 55.5%. A total of 10.7% of patients had inappropriate health care usage, defined as 2 or more visits to a cardiologist or 3 or more cardiac diagnostic investigations. Most patients with persistent nonspecific chest pain were referred to a cardiologist, and less than 2% were referred to mental health specialists.

Conclusions  For most patients with nonspecific chest pain, standard medical care does not offer sufficient help for symptom relief. One-tenth of patients with persistent chest pain underwent additional diagnostic testing of no known clinical benefit. Psychological referrals were rarely given.

Author Affiliations: Departments of Clinical Psychology and Psychotherapy (Drs Glombiewski and Rief) and General Practice/Family Medicine (Drs Bösner, Keller, and Donner-Banzhoff), Philipps-University of Marburg, Marburg, and Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen (Dr Martin), Erlangen, Germany.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

In This Issue of Archives of Internal Medicine
Arch Intern Med. 2010;170(3):226.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Standard medical care does not offer sufficient relief of non-specific chest pain leading to additional diagnostic testing of no clinical benefit
Taylor and McManus
Evid. Based Med. 2010;15:86-87.
FULL TEXT