Background
Physical symptoms that are not sufficiently explained somatically are frequently encountered in general practice. The underlying problem is usually psychosocial in nature, a fear of (serious) illness and/or an unrealistic interpretation of physical sensations. Many sufferers do not benefit from referral to mental health care and end up back with their general practitioner, resulting in frequent consultations without a reduction in symptoms. This is a relatively common phenomenon among non-Western, ethnic minority women.
An intervention called ‘Energy in Balance’ was developed for this group of patients and was found to be successful in a pilot study: there was a reduction in contact frequency and the patients felt better. The intervention is intended to be as in line as possible with the living environment and views of this target group, with each participant being given a personal objectives plan. The intervention consists of 13 group meetings, each lasting an hour and a half, and the content is geared to the specific composition of the group. Unlike in usual interventions, this intervention is not problem-oriented; instead, it focuses on positive experiences and thinking in terms of possibilities in the different areas of life (family, relatives/friends/neighbours, health, finances, enjoyment and relaxation, etc.). The main focus is on what the patient wants to achieve. The encouragement of social activities is often part of achieving that aim.
Project leader and secretary:
Study of the cost-effectiveness of the intervention
The Netherlands Organisation for Health Research and Development (ZonMw) has provided a subsidy for a study of the cost-effectiveness of the intervention in comparison to the usual care. The study also aims to demonstrate the implementation possibilities within normal care.
This study requires the cooperation of at least 20 general medical practices, with 10 being offered the intervention and 10 others serving as controls. Cluster randomisation at the level of the general practice will be used. If it is found to be successful, the intervention will be implemented a year later at the practices used as controls. The key study parameters are:
- Quality of life (measured with the SF12) - as primary outcome benchmark
- Costs: The actual costs will be based on the number of contacts multiplied by the price. For the other direct medical costs (use of care), the following types of care are relevant:
- General practice (including out-of-hours consultations with general practitioners, surgery assistants and A&E);
- Referrals to other care providers and the use of care there (including mental health care, social work, internal medicine).
Planning and implementation
In 2012, various activities were performed in preparation for implementing the intervention and the subsequent study. First of all, we looked for general practitioners who wanted to participate. The recruitment process has now been successfully completed.
The participating general practitioners made their patient databases (HIS) available so that patients could be found who were eligible for the intervention. Naturally, this was done under strict conditions so as to safeguard patient privacy.
The list of potential study participants was presented to the general practitioners for comments and so that they could make corrections if necessary. Twenty patients per general practice were then invited by the GPs to participate in the study. It is expected that approximately half of the patients invited will agree to participate. Participants must sign an informed consent form before the study begins. The recruitment of patients will continue until the end of March 2013.
The Abilon agency has developed a course for those conducting the intervention. This course was organised for the first time in autumn 2012. In April 2013, the general practices will be randomly divided into intervention and control groups.
Baseline measurements are now in full swing and will be finished prior to the division into intervention and control groups. The intervention itself will begin in early May 2013 and run until autumn 2013.
Follow-up measurements are planned for the early months of 2014, after which the analyses can commence around April 2014.
Research
- Gerrit Koopmans, PhD
- Dr. Marleen Foets, PhD
- Dr. Anushka Choté, PhD
- Leona Hakkaart-van Roijen, PhD (GE-iMTA)
Sponsor
- The Netherlands Organisation for Health Research and Development (ZonMw) - ‘Benefit through Difference’ [‘Winst door Verschil’] programme
Partners
- DWARS Academic Workplace Diversity Youth Policy Rotterdam-Rijnmond
- MIKADO intercultural care knowledge centre
- General practice medicine - Erasmus MC
- Zorgbelang Zuid-Holland
- Zorgimpuls
- Twenty general medical practices