CJEM Articles: Samuel Campbell
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Intensive short-term dynamic psychotherapy to reduce rates of emergency department return visits for patients with medically unexplained symptoms: preliminary evidence from a pre-post intervention studyNovember 2009 11 6Allan Abbass, Kirk Magee, Robert Tarzwell, Samuel Campbell
Objective: Somatization of emotions accounts for excess emergency department (ED) visits in the form of medically unexplained symptoms (MUS). Intensive short-term dynamic psychotherapy (ISTDP) has been used to diagnose and man age somatization. We examined the effectiveness of this pro cedure for ED patients with MUS.
Methods: We implemented a service that included staff edu cation, timely access to consultation and gathering of out come data.
Results: Patients were assessed and treated shortly after referral. There was a mean reduction of 3.2 (69.0%) ED visits per patient (standard deviation [SD] 6.4) the year afterward (95% confidence interval [CI] 1.3-5.0, p < 0.001). In compari son revisit rates during the same time interval for 3 available ED populations (i.e., those matched by visit rates, those with matching complaints and all patients referred to the service but never seen) showed either smaller reductions or higher ED use (ranging from a 15% reduction to a 43% increase). Treatments averaged 3.8 sessions per patient (SD 5.3). Self-reported symptoms improved significantly with the Brief Symptom Inventory global rating, which changed from a mean of 1.21 (SD 0.58) before assessment to 0.86 (SD 0.63) (p < 0.01) at the end of contact with the service. The service appeared acceptable to both emergency physicians and patients.
Conclusion: This emotion-focused assessment and treatment method appeared to be feasible and may be effective in reducing both symptoms and repeat ED use.