Abstract
ObjectiveFew studies have been published on health care utilization in Crohn's disease and the influence of psychological treatment on high utilizers.MethodsThe present sub study of a prospective multi center investigation conducted in 87 of 488 consecutive Crohn's disease (CD) patients was designed to investigate the influence of the course of Crohn's disease on health care utilization (hospital days (HD) and sick leave days (SLD) collected by German insurance companies) and to examine the conditions of high-utilizing patients. Predictors of health care utilization should be selected. Based on a standardized somatic treatment, high health care utilizing patients of the psychotherapy and control groups should be compared before and after a one-year treatment.ResultsMultivariate regression analysis identified disease activity at randomization as an important predictor of the clinical course (r2 = 0.28, p < 0.01). Health care utilization correlated with duration of disease (p < 0.04), but the model was not significant (r2 = 0.15, p = 0.09). The patients' level of anxiety, depression and lack of control at randomization predicted their health-related quality of life at the end of the study (r2 = 0.51, p < 0.00001). Interestingly, steroid intake and depression (t1) predicted the combined outcome measure (clinical course, HRQL, health care utilization) of Crohn's disease at the end of the study (r2 = 0.22, p < 0.001).Among high utilizers, a significantly greater drop in HD (p < 0.03) and in mean in SLD were found in the treatment compared to the control group.ConclusionThe course of Crohn's disease is influenced by psychological as well as somatic factors; especially depression seems important here. A significant drop of health care utilization demonstrates the benefit of psychological treatment in the subgroup of high-utilizing CD patients. Further studies are needed to replicate the findings of the clinical outcome in this CD subgroup.
Highlights
Thought to influence perceived health in inflammatory bowel disease (IBD), patients' care-seeking behavior has aroused increasing medical and economic interest, especially since high users of medical care have turned out to be a serious therapeutic problem [1]
Physical complaints and psychological factors like coping style may influences the health-related quality of life in Crohn's disease (CD) patients [11,12,13,14]
There is evidence that psychosocial factors accelerate the progression of Crohn's disease [15,16], and the individual health status of CD patients seems to be more closely related to psychological factors than to somatic ones [4]
Summary
Thought to influence perceived health in inflammatory bowel disease (IBD), patients' care-seeking behavior has aroused increasing medical and economic interest, especially since high users of medical care have turned out to be a serious therapeutic problem [1]. Physical conditions as well as psychosocial factors are thought to influence the health status perception of IBD patients and their medical care utilization [4]. Crohn's disease (CD) leads to physical complaints and causes many patients to develop psychological symptoms [5,6,7,8,9,10] that may influence their care-seeking behavior. Physical complaints and psychological factors like coping style may influences the health-related quality of life in CD patients [11,12,13,14]. There is evidence that psychosocial factors accelerate the progression of Crohn's disease [15,16], and the individual health status of CD patients seems to be more closely related to psychological factors than to somatic ones [4]. The medically defined severity of illness failed to correlate significantly with variables of health care utilization in Crohn's disease patients [17]
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