Abstract
OBJECTIVE: To define the prevalence and detection rates of mental disorders among high utilizers as compared with typical utilizers, and to examine the effect of case-mix adjustment on these parameters.
DESIGN: Cross-sectional study.
SETTING: General internal medicine outpatient clinic associated with an urban, academic medical center.
PATIENTS: From patients attending a general medicine clinic, 304 were selected randomly in three utilization groups, defined by number of clinic visits: (1) high utilizers; (2) case-mix adjusted high utilizers; and (3) typical utilizers (control patients).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: The presence of any mental disorder was ascertained by the PRIME-MD screening instrument. Chart review on all patients was performed to ascertain mental disorders detected by primary care physicians. The prevalence of mood disorders was markedly higher in high utilizers (29%) than in adjusted high utilizers (15%) or controls (10%) (p<.001). Anxiety disorders were slightly, but not statistically, more prevalent in the group adjusted for case mix (16%) than in other high utilizers (12%) or controls (9%). Alcoholism was significantly more prevalent in controls (12%) than in adjusted (6%) or other high utilizers (3%) (p<.03). The discrepancy in detection rates between PRIME-MD and chart review for any mental disorder was less for high utilizers (37% vs 31%) as compared with adjusted high utilizers (31% vs 11%) or controls (24% vs 8%).
CONCLUSIONS: Mood disorders are associated with a high overall burden of illness, while anxiety disorders are more predominant among outliers after case-mix adjustment. Detection rates differ substantially by utilization pattern. Screening efforts can be more appropriately targeted with knowledge of these patterns.
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References
Saravay S. Psychiatric interventions in the medically ill: outcome and effectiveness research. Psychiatr Clin North Am. 1996;19:467–80.
Hall RCW, Wise MG. The clinical and financial burden of mood disorders: cost and outcome. Psychosomatics. 1995;36(suppl):S11–8.
Katzelnick DJ, Kobak KA, Greist JH, et al. Effect of primary care treatment of depression on service use by patients with high medical expenditures. Psychiatr Serv. 1997;48:59–64.
Simon GE, Katzelnick DJ. Depression, use of medical services and cost-offset effects. J Psychosomat Res. 1997;42:333–44.
Broadhead WE, Leon AC, Weissman MM, et al. Development and validation of the SDDS-PC screen for multiple mental disorders in primary care. Arch Fam Med. 1995;4:211–9.
Spitzer RL, Williams JBW, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994;272:1749–56.
Karlsson H, Lehtinen V, Joukamaa M. Psychiatric morbidity among frequent attender patients in primary care. Gen Hosp Psychiatry. 1995;17:19–25.
Karlsson H, Lehtinen V, Joukamaa M. Are frequent attenders of primary health care distressed? Scand J Health Care. 1995;13:32–8.
Katon W, Von Korff M, Lin E, et al. Distressed high utilizers of medical care: DSM-III-R diagnoses and treatment needs. Gen Hosp Psychiatry. 1990;12:355–62.
Johnson J, Weissman MM, Klerman JL. Service utilization and social morbidity associated with depressive symptoms in the community. JAMA. 1992;267:1478–83.
Simon GE, VonKorff M, Barlow W. Health care costs of primary care patients with recognized depression. Arch Gen Psychiatry. 1995;52:850–6.
Levitan SJ, Kornfeld DS. Clinical and cost benefits of liason psychiatry. Am J Psychiatry. 1981;138:790–3.
Mumford E, Schlesinger HJ, Glass GV, Patrick C, Cuerdon T. A new look at evidence about reduced cost of medical utilization following mental health treatment. Am J Psychiatry. 1984;141:1145–58.
Levenson JL. Psychosocial interventions in chronic medical illness: an overview of outcome research. Gen Hosp Psychiatry. 19;14(suppl):S43–9.
Simon G, Ormel J, VonKorff M, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry. 1995;152:352–7.
Barsky AJ, Wyshak G, Klerman GL. Medical and psychiatric determinants of outpatient medical utilization. Med Care. 1986;24:548–60.
Miranda J, Perez-Stable EJ, Munoz RF, et al. Somatization, psychiatric disorder and stress in utilization of ambulatory medical services. Health Psychol. 1991;10(1):46–51.
Mechanic D, Cleary PD, Greenley JR. Distress syndromes, illness behavior, access to care and medical utilization in a defined population. Med Care. 1981;20(4):361–72.
Wells KB. Cost containment and mental health outcomes: experiences from US studies. Br J Psychiatry. 1995;27:43–51.
Weiner JP, Starfield BH, Steinwachs DM, Mumford LM. Development and application of a population-oriented measure of ambulatory case-mix. Med Care. 1991;29:452–72.
Starfield B, Weiner J, Mumford L, Steinwachs D. Ambulatory care groups: a categorization of diagnoses for research and management. Health Serv Res. 1991;26:53–74.
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Presented as an oral abstract at the Society of General Internal Medicine meeting, Chicago, Ill, May 2, 1998.
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Lefevre, F., Reifler, D., Lee, P. et al. Screening for undetected mental disorders in high utilizers of primary care services. J GEN INTERN MED 14, 425–431 (1999). https://doi.org/10.1046/j.1525-1497.1999.07238.x
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DOI: https://doi.org/10.1046/j.1525-1497.1999.07238.x