Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness.
Under-recognition of medically unexplained symptom conditions among US Veterans with Gulf War Illness.
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DOI：
10.1371/journal.pone.0259341
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
McAndrew LM
中科院分区：
文献类型：
--
作者：
Kane NS;Anastasides N;Litke DR;Helmer DA;Hunt SC;Quigley KS;Pigeon WR;McAndrew LM
由持续的“医学上无法解释的”身体症状和综合征（MUS）定义的疾病是常见的和致残的。海湾战争的退伍军人（1990-1991年部署）因MUS条件而患病率和残疾率非常高。患有MUS的个人报告说，医疗服务提供者不承认他们的MUS状况。我们的目标是确定患有MUS的退伍军人是否接受了MUS条件的ICD-10诊断或接受了这些条件的残疾福利。对符合海湾战争疾病（一种复杂MUS疾病）病例标准的美国退伍军人进行了病历审查（N = 204，M = 53岁，SD = 7）。三名编码员独立审查了退伍军人的医疗记录，以确定MUS状况诊断或服务联系沿着精神和身体健康状况。服务连接是指美国退伍军人事务部残疾福利资格的条件或受伤期间经历或加剧了兵役。29%的人在他们的医疗记录中诊断出MUS疾病，最常见的是结肠易激综合征/肠易激综合征（16%）和纤维肌痛（11%）。与诊断相比，更多的退伍军人因MUS条件而服务连接（38%）。精神健康（诊断76%，服务连接74%），肌肉骨骼（诊断86%，服务连接79%）和疾病相关疾病（诊断98%，服务连接49%）的诊断和服务连接率很高。考虑到所有参与者都是符合MUS条件标准的海湾战争退伍军人，我们的研究结果表明，海湾战争退伍军人的MUS条件在临床诊断和服务相关残疾方面未得到充分认识。退伍军人更有可能被诊断和服务连接的肌肉相关和心理健康状况比MUS条件。提供者可能需要教育和培训，以促进MUS条件的诊断和服务连接。我们相信，对MUS条件的更多认可和验证将增加患者对医疗保健的参与，以及提供者和患者对护理的满意度。
Conditions defined by persistent “medically unexplained” physical symptoms and syndromes (MUS) are common and disabling. Veterans from the Gulf War (deployed 1990–1991) have notably high prevalence and disability from MUS conditions. Individuals with MUS report that providers do not recognize their MUS conditions. Our goal was to determine if Veterans with MUS receive an ICD-10 diagnosis for a MUS condition or receive disability benefits available to them for these conditions. A chart review was conducted with US Veterans who met case criteria for Gulf War Illness, a complex MUS condition (N = 204, M = 53 years-old, SD = 7). Three coders independently reviewed Veteran’s medical records for MUS condition diagnosis or service-connection along with comorbid mental and physical health conditions. Service-connection refers to US Veterans Affairs disability benefits eligibility for conditions or injuries experienced during or exacerbated by military service. Twenty-nine percent had a diagnosis of a MUS condition in their medical record, the most common were irritable colon/irritable bowel syndrome (16%) and fibromyalgia (11%). Slightly more Veterans were service-connected for a MUS condition (38%) as compared to diagnosed. There were high rates of diagnoses and service-connection for mental health (diagnoses 76% and service-connection 74%), musculoskeletal (diagnoses 86%, service-connection 79%), and illness-related conditions (diagnoses 98%, service-connection 49%). Given that all participants were Gulf War Veterans who met criteria for a MUS condition, our results suggest that MUS conditions in Gulf War Veterans are under-recognized with regard to clinical diagnosis and service-connected disability. Veterans were more likely to be diagnosed and service-connected for musculoskeletal-related and mental health conditions than MUS conditions. Providers may need education and training to facilitate diagnosis of and service-connection for MUS conditions. We believe that greater acknowledgement and validation of MUS conditions would increase patient engagement with healthcare as well as provider and patient satisfaction with care.
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