February 8, 2010 — 根據發表於2月8日內科醫學誌(Archives of Internal Medicine)的一篇前瞻、一般內科醫師為基礎的世代研究結果,標準醫療照護可能無法緩解非特定胸痛的症狀。
德國馬堡Philipps大學的Julia Anna Glombiewski博士等人寫道,在一線照護中常看到非特定胸痛,然而,關於它的療程和結果,以及其最適當健康照護的知識很少,我們觀察到以下情況:(1)一線照護中出現非特定胸痛的許多病患其症狀持續6個月,(2)許多非特定胸痛病患顯示有過度檢查的情況,以及(3)許多慢性胸痛病患被轉診到心智健康專科醫師。
Standard Medical Care May Not Relieve Symptoms of Nonspecific Chest Pain
By Laurie Barclay, MD
Medscape Medical News
February 8, 2010 — Standard medical care may not relieve symptoms of nonspecific chest pain, according to the results of a prospective, general physician–based cohort study reported in the February 8 issue of the Archives of Internal Medicine.
"Nonspecific chest pain is common in primary care, yet knowledge is sparse about its course and outcome and how they relate to optimum health care usage," write Julia Anna Glombiewski, PhD, from Philipps-University of Marburg, Germany, and colleagues. "We investigated the following observations: (1) many patients who present with nonspecific chest pain in primary care show symptom persistence for 6 months, (2) many patients with nonspecific chest pain showed signs of overinvestigation, and (3) many patients with chronic chest pain were referred to mental health specialists."
From October 1, 2005, to July 31, 2006, approximately 190,000 consecutive patients visited their general physicians at 74 primary care offices in Hessen, Germany. An expert committee identified 807 of these patients as having nonspecific chest pain, with no underlying heart condition. Follow-ups were performed at 6 weeks and 6 months, with a dropout rate of 2.7%.
The primary study endpoints were persistent chest pain at 6-month follow-up and healthcare use at 6 months. Inappropriate healthcare use was defined as at least 2 visits to a cardiologist or at least 3 cardiac diagnostic investigations.
At 6-month follow-up, 55.5% of patients had persistent chest pain, 10.7% of patients had inappropriate healthcare use, and fewer than 2% were referred to mental health specialists. Most patients with persistent nonspecific chest pain were referred to a cardiologist.
"For most patients with nonspecific chest pain, standard medical care does not offer sufficient help for symptom relief," the study authors write. "One-tenth of patients with persistent chest pain underwent additional diagnostic testing of no known clinical benefit. Psychological referrals were rarely given...[which] is surprising because psychological factors are known to contribute to the development of chronic pain, and psychological consultations are covered by the health care system in Germany."
Limitations of this study include the low response rate of general practitioners approached to participate in the study, use of a proposed new cutoff for inappropriate healthcare use, limited generalizability, and use of an informal definition of nonspecific chest pain.
"Patients with psychologically caused non-specific chest pain showed more problematic health care–seeking behavior but were rarely referred to mental health professionals," the study authors conclude. "Patients, general practitioners or both seem to be hesitant to involve psychological interventions.... Future research should investigate the development of effective interventions for non-specific chest pain and their implementation within health care systems."
The German Federal Ministry of Education and Research supported this study. The study authors have disclosed no relevant financial relationships.