Identifying people who present with a medically unexplained symptom
is difficult, and requires excellent consultation skills from the GP. If
somebody presents with abdominal pain (for example) it may take several
consultations to disentangle whether the pain is due to cancer of the
stomach, or stress caused by a recent job redundancy, or somebody
presenting with depression. Whilst identifying the individual patient
is of course important, it is also important for commissioners of
services to have a better understanding of the numbers of people who are
likely to have a medically unexplained symptom. It is important so that
appropriate services can be planned and commissioned.
Nottingham Medical School was commissioned to develop a tool that would do exactly that - identify patients who are likely to have medically unexplained symptoms. The Nottingham Tool searches a GP Practice Database, to identify a cohort of patients that fulfil the criteria for medically unexplained symptoms. This cohort provides an overview to the commissioners, or the practice, about the number of people likely to have a medically unexplained symptom.
The tool does NOT identify an individual that will, or will not, have a medically unexplained symptom with a 100% certainty. The tool is not intended to be used as a clinical tool, but to be used as a commissioning tool. If practices wish to use the tool clinically they will need to review all the patients on the list, and make a clinical judgement based on their knowledge of the patient. The tool is not intended to replace clinical judgement. The clinical assessment may be assisted by the use of the PHQ-15 (somatisation questionnaire), but the assessment has to be the responsibility of the clinician. The tool will only identify people who have a likelihood of having a medically unexplained symptom.
The Nottingham Tool has been converted to a computer query by APOLLO-MEDICAL services. APOLLO-MEDICAL have two main areas of expertise, audit and document management. Their users are mainly Primary Care computer system users i.e. General Practitioners, their staff and those that support them such as Practice Based Commissioning groups (PBC's), Primary Care Trusts (PCT's) and the Department of Health (DoH).
The computer query can be downloaded from a dedicated website www.apollo-medical.com/mus that allows only general practices to download and run the query on its own practice database. This means that the output from this query is only available to the practice, and is not available to APOLLO, or any other outside agency. The query amounts to a (sophisticated) audit of the practice database. The use of that audit is the responsibility of the practice, and the practice alone.
Comments about the use of the query are welcomed, and should be addressed to firstname.lastname@example.org whilst technical queries about the download process should be addressed to APOLLO at email@example.com