Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial

Background: Somatisation is highly prevalent in primary care (present in 2596 of Visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services. Aim: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs). Design of study. Cluster randomised controlled trial, with practices as the randomisation unit. Setting Twenty-seven general practices (with a total of 43 GP in Vejle County, Denmark. Method: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their dia gnoses in another questionnaire. The primary outcome was diagnosis of somatisation and agreement with the screening questionnaire. Results: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs The difference between groups in the number of diagnoses of somatisation failed to reach the 5961 significance (P = 0.094). However the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups. Conclusion: Brief training increased GTs' awareness of medically unexplained physical symptoms Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.