Preferences for sources of support for management of symptoms amongst primary care attendees with unexplained physical symptoms

Talk Code: 
EP3C.02
Presenter: 
Kethakie Lamahewa
Co-authors: 
Kethakie Lamahewa, Marta Buszewicz, Kate Walters, Louise Marston, Irwin Nazareth
Author institutions: 
UCL

Problem

Unexplained physical symptoms (UPS) are common in primary care. They are distressing for patients, difficult for doctors to manage and costly to investigate and treat. A few studies have explored needs of patients with UPS from their own perspective and that of their doctors. However, the way people view their health, expectations of care and how they view their own role in the management of their health is changing. Increasingly, people are using the internet to find explanations for their symptoms and identify potential diagnoses. There has also been a growing emphasis on patient self-management of long-term conditions. It would be very helpful to understand how such changing trends are reflected in preferences for management of symptoms amongst those with UPS.

Approach

The aim of this presentation is to describe preferred sources of support in management of symptoms, amongst primary care attendees with UPS, in the UK. Self-reported information on management of somatic symptoms was collected, along with other potential prognostic data, for a longitudinal study which aimed to investigate outcome of primary care attendees with UPS. Adult attendees (>=18 years) from nine general practices in socio-economically diverse locations were screened using the somatic symptom module of the Patient Health Questionnaire (PHQ-15). Eligible respondents with UPS and a PHQ-15 score >=5 were invited to complete the baseline questionnaire, which enquired about a range of potential prognostic factors including: somatic symptoms, quality of life, psychological well-being, self-efficacy and socio-demographic characteristics. Descriptive analyses were used to explore patients’ preferred sources of support for management their symptoms.

Findings

294 participants (231 females, median age 44 years (IQR 32, 57)) had a mean baseline PHQ-15 score of 11 (SD 12). The majority of participants (74%) reported that they would seek help for their symptoms. Most (74%) reported that they would seek help from their general practitioners (GPs), the next preferred source of help seeking was the internet (35%) followed by family (30%) and friends (28%). As symptom severity increased, more were likely to identify GPs as their preferred source of support. There were no major differences by gender however preferences varied slightly by age.

Consequences

The preferred source of support amongst the study cohort were GPs, however, the fact that respondents were identified whilst attending primary care may have influenced this response. The second largest preference was the internet, particularly amongst younger people, however, access to poor quality websites and unreliable information may result in increasing distress and repeated GP consultations. Future work must consider the development of sources of reliable online information for those with unexplained symptoms, which may also aide in reducing, burden on the health care system.

Submitted by: 
Kethakie Lamahewa
Funding acknowledgement: 
This study is funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.