Ambulatory Care Pilot Project
Principal Investigator: Don Ciccone, PhD
Medically unexplained symptoms (MUS) are physical complaints in the absence of objective findings that have no known cause. While these symptoms occur in the general population, they are also common among veterans following deployment or combat exposure. The presence of MUS in veterans may signal a variety of untreated illnesses ranging from psychological illness to clinically defined syndromes such as fibromyalgia and chronic fatigue syndrome.
MUS can significantly decrease a patient's quality of life and ability to function physically, socially, and emotionally. The perceived need for medical treatment can lead to inappropriate utilization of health services and potential for iatrogenic harm. In light of these potentially serious problems, the primary aim of this project is to achieve a better understanding of the rate of MUS and somatoform illness in veterans attending the East Orange primary care clinic. The project also has several additional aims: 1. To determine the prevalence of psychiatric comorbidity among these veterans, 2. To determine the association between MUS and behavioral outcomes and between somatoform illness and behavioral outcomes, 3. To compare veterans receiving outpatient medical treatment for MUS to veterans with similar symptoms who are not receiving treatment, and 4. To determine if these patients experience a higher rate of perceived communication failure, loss of trust, and lower satisfaction with their medical care and primary care providers.
The study will enroll a series of veterans attending the ambulatory care clinics (i.e. Primary Provider Groups or PPG's) at the East Orange, New Jersey VA Medical Center. All subjects will be recruited while waiting for their scheduled outpatient appointments and will be given a self-report questionnaire once they have been determined to meet inclusion criteria. The assessment process will include 1. medical record review, to document medical diagnosis, treatment, and utilization; 2. brief questionnaire completed by the patient's primary care provider to classify physical symptoms as medically explained or unexplained; and 3. survey completed by the patient to assess health related beliefs, psychological status, and perceived disability.