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Symptom Management in Older Primary Care Patients: Feasibility of an Experimental, Written Self-Disclosure Protocol

Joshua C. Klapow, PhD; Steven M. Schmidt, BA; Lloyd Adam “Chip” Taylor, MA; Paul Roller, MD; Qing Li, MD, PhD; Jaimee W. Calhoun, MAEd; Jan Wallander, PhD; and James Pennebaker, PhD
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From the University of Alabama at Birmingham, Birmingham, Alabama; and the University of Texas at Austin, Austin, Texas. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “ Investigating Symptoms: Frontiers in Primary Care Research—Perspectives from The Seventh Regenstrief Conference ” To see a complete list of the articles included in this supplement, please view its Table of Contents.

Copyright ©2004 by the American College of Physicians

Grant Support: In part by grant 431537 from the Lister Hill Center for Health Policy, University of Alabama at Birmingham, and grant AG00932-01 from the National Institute on Aging.

Requests for Single Reprints: Joshua Klapow, PhD, University of Alabama at Birmingham, 330 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294-0022; e-mail, jklapow@uab.edu.

Current Author Addresses: Dr. Klapow: University of Alabama at Birmingham, 330 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294-0022.

Mr. Schmidt and Ms. Calhoun: University of Alabama at Birmingham, 427 Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL 35294-0022.

Mr. Taylor: University of Alabama at Birmingham, Department of Psychology, Room 415 Campbell Hall, 1300 University Boulevard, Birmingham, AL 35294-1170.

Dr. Roller: University of Alabama at Birmingham, 933 19th Street, CHB 219, Birmingham, AL 35294.

Dr. Li: University of Alabama at Birmingham, 412 Medical Towers, 1717 11th Avenue South, Birmingham, AL 35205.

Dr. Wallander: University of Alabama at Birmingham, 1719 Sixth Avenue South, Birmingham, AL 35294-0017.

Dr. Pennebaker: University of Texas at Austin, Mezes Hall, Room 330, Austin, TX 78712.

Ann Intern Med. 2001;134(9_Part_2):905-911. doi:10.7326/0003-4819-134-9_Part_2-200105011-00015
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Background: Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.

Objective: To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.

Design: Randomized, single-blind feasibility study.

Setting: University-based geriatric and internal medicine primary care clinics.

Patients: 45 patients 66 years of age or older without a psychiatric diagnosis.

Intervention: Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).

Measurements: The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.

Results: One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.

Conclusions: Findings support the feasibility of implementing the protocol as a primary care intervention.


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Appendix Figure. Dementia was defined as a Mini-Mental Status Examination score less than 24.
Patient recruitment and exclusion.
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