High Utilization Group Research Articles

Responses to illness and health in chronic pain patients and healthy adults.

Although it is clear that health care utilization rates differ among individuals, what is not so obvious is the explanation for the variation in illness responses, nor is it known whether responses to illness are consistent or predictable. This pilot study compared responses to common symptoms and health maintenance activities in 1) healthy subjects with no medical visits in the previous year, 2) patients with chronic headaches with high medical utilization who remained functional at work and home, and 3) patients with nonmalignant chronic pain who were seriously dysfunctional in work and home responsibilities. The chronic pain samples differed primarily in level of functioning with similar outpatient utilization levels; they reported greatly differing response tendencies to common symptoms, with the more functional group endorsing numerous self-help strategies along with medical care seeking. The dysfunctional pain patients responded consistently with only one illness behavior: they went to the doctor. Among all three groups, the severely impaired individuals were most likely to say that they made special efforts to maintain their health; however, there was no single pro-health activity they engaged in more than the other groups. There appear to be attitudinal as well as behavioral differences in response to health and illness issues between these groups of high and low utilizers and, within the high utilizer group, between those who are more or less impaired by their pain.

Depressives syndromes in a primary care setting: Evaluation, classification, and outcome

Fifteen percent of the general population may experience a major disorder of mood during their lives. 1 Their care falls to the greatest degree upon the primary physician. 2 A general practitioner may be chosen for the first contact by an estimated 88% of individuals fearing an experiencing psychologic disturbance. 3 As many as 63% of community based mentally ill ( n = 490,000) may receive their psychiatric treatment from a general practitioner. 4 This prevalence is further enhanced by the observation that psychiatric patients represents a high medical utilization group when contrasted with nonpsychiatric controls. 5 Since the depressive syndrome is of diverse etiology, and may present under the guise of a physical complaint, a comprehensive evaluation should include a personal and family history, physical and mental status examination, and appropriate laboratory tests. While family practitioners may spend from 17% to 27% of patients care time dealing with emotionally related problems, 6 some 60% of the American Academy of Family Physicians reported “insufficient training in medical school” to deal with their patients' emotional problems. A comprehensive data base (Table 1) was contrasted with the practices of second and third year family practice residents by a prospective study of recently diagnosed “depression” at a community primary care center.

Utilization of medical services by psychiatric patients.

The relationship between medical and psychiatric utilization of services was examined in a two-year study of two groups of psychiatric patients: high users of psychiatric services (more than ten visits in one year) and low users of psychiatric services (ten or fewer visits in one year). The high-utilization group made more than 60 per cent of the total psychiatric visits in the two-year period, but only 21 per cent of the total medical visits. However, patients in this group increased their utilization of medical services when psychiatric utilization was reduced, raising the question of whether high-utilization patients tend to substitute medical visits for psychiatric visits. In contrast, patients in the low-utilization group were able to hold their medical utilization constant when they reduced psychiatric utilization. Analysis of factors influencing utilization patterns might allow illness behavior in patients to be predetermined and lead to better and more cost-effective health care.