Prevalence of MUS in adults who are high users of healthcare services and magnitude of associated costs: a systematic review 2022 Jadhakhan et al

[Andy]

Full title: Prevalence of medically unexplained symptoms in adults who are high users of healthcare services and magnitude of associated costs: a systematic review

Abstract

Introduction
Medically unexplained symptoms (MUS) is a common clinical syndrome in primary and secondary healthcare service. Outcomes for patients with persistent MUS include increased disability, poorer quality of life and higher healthcare costs. The aim of this systematic review was to determine the prevalence of MUS in patients who are high users of healthcare or high-cost patients in comparison with routine users and the magnitude of associated costs.

Design
A systematic review of the available literature.

Data sources and eligibility criteria
The following electronic databases were systematically searched without language restriction from inception to June 2018 and updated on 22 October 2021: MEDLINE, PsycINFO, EMBASE, CINAHL and PROSPERO. Inclusion criteria included studies investigating adults aged ≥18 years, who were high healthcare users or accrued high healthcare costs, in which the prevalence and/or associated costs of MUS was quantified. Two reviewers independently extracted information on study characteristics, exposure and outcomes.

Results
From 5622 identified publications, 25 studies from 9 countries involving 31 650 patients were selected for inclusion. Due to high risk of bias in many studies and heterogeneity between studies, results are described narratively. There were wide variations in prevalence estimates for MUS in high users of healthcare (2.9%–76%), but MUS was more prevalent in high use groups compared with low use groups in all but one of the 12 studies that included a comparator group. Only three studies investigated healthcare costs associated with MUS, and all three reported greater healthcare costs associated with MUS.

Conclusion
MUS has been found to be more prevalent in high use healthcare populations than comparator groups, but the magnitude of difference is difficult to estimate due to considerable heterogeneity between studies and potential for bias. Future studies should prioritise a standardised approach to this research area, with agreed definitions of MUS and high healthcare use.

Open access, https://bmjopen.bmj.com/content/12/10/e059971

 

[BrightCandle]

People who don't have a diagnosis yet are using more medical resources than those that do? Interesting finding sort of but the diagnostic process is pretty poor in the NHS so its not a wonder that when they continue to run the same tests for the 50th time with the same results it does ultimately come out as a waste of time and money.

 

[rvallee]

Outcomes for patients with persistent MUS include increased disability

It's often said as a joke but this is basically saying "water is wet" but being unable to process what it means. Amazing.

And I see that they are now moving on to calling this a syndrome, a generic, vague list of issues medicine has yet to understand. And they are pretending that it's all one thing. What the hell is this mess of regression?

MUS was more prevalent in high use groups compared with low use groups in all but one of the 12 studies that included a comparator group

More water. More wet. Somehow, confusing. Instructions to add more water very unclear.

Due to high risk of bias in many studies and heterogeneity between studies, results are described narratively

Yes, narratives can only be described narratively. Somehow doesn't bother anyone here.

This kind of thinking is basically as clownish as looking at dry regions, finding they have more extensive irrigation systems, and concluding that irrigation systems possibly causes the region to be dry. It's completely clownish. What is even happening that this generic nonsense is ruling our lives?

 

[Ariel]

I would be interested in how many of us have lower than usual healthcare use due to avoiding healthcare due to bad experiences/futility, inaccessibility, or being neglected by practitioners. I have avoided treatment for injuries and so on. Maybe that would be considered a good thing by some! My healthy relatives use services more than I do in an average year. That is not because I am healthier than them.

ETA: "Finding" so-called "MUS" in high healthcare users is a joke. There is no such thing as "MUS".

 

[Peter T]

Does this study distort the results by looking at high users of medical services but not inappropriately low users of medical services?

I suspect in relation to MUS there is a bipolar distribution of levels of medical service users, people initially being high users while trying t get a diagnosis and then low users once it is realised that medical services have nothing useful to offer them and may also hold them in contempt. To address this issue research needs to look at the whole spectrum. However, presumably research will struggle to access those that have given up on medical science who would be harder for doctors to identify and who are more likely to reject participation in research studies.

 

[BrightCandle]

Does this study distort the results by looking at high users of medical services but not inappropriately low users of medical services?

I suspect in relation to MUS there is a bipolar distribution of levels of medical service users, people initially being high users while trying t get a diagnosis and then low users once it is realised that medical services have nothing useful to offer them and may also hold them in contempt. To address this issue research needs to look at the whole spectrum. However, presumably research will struggle to access those that have given up on medical science who would be harder for doctors to identify and who are more likely to reject participation in research studies.

I think you are right, you have people still seeking diagnostics and treatment because they don't know better, they are pretty high users of services for a period (I certainly was in the beginning). Then they work out all they are getting is abuse and prejudice and they disappear from the medical system completely as it refuses to treat even unrelated medical conditions as they have been marked as a faker by their doctors. I also think there is no one from the NHS that could possibly reach most of those, they wouldn't be willing to participate in NHS run research into it, many will have complained and found the NHS to be institutionally corrupt as well and that will have sealed the deal. What I think is astonishing is the number of people lacking diagnosis is so large and so consuming its actually significant cost, despite having excluded 90% of ME and other "MUS" patients already. There is a massive hidden cost here of chronic illness that they failed to diagnose. Were the NHS to ever to fix its systemic prejudice (unlikely) , there could be an influx of hundreds of thousands maybe millions of previously excluded patients all demanding their due treatments.