Screening for undetected mental disorders in high utilizers of primary care services

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 Ͻ .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 Ͻ .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.

Are Frequent Callers to Family Physicians High Utilizers?

“…Our frequent callers closely mirror patients with high rates of offi ce utilization. 3 They are often female patients who are suffering from anxiety, depression, chronic illnesses, or pain. They go to the emergency department and are hospitalized more frequently.…”

“…Health services researchers typically identify high utilizers by their number of visits to the offi ce. [2][3][4] Patients who come to the offi ce frequently have been described as older, divorced or widowed, members of lower socioeconomic groups, anxious and depressed, and having multiple physical and psychosocial ills and medically unexplained symptoms. 5,6 The purpose of this study was to describe frequent after-hours callers, categorize their medical problems, and examine their resource utilization.…”

Frequent attendance in primary care: comparison and implications of different definitions

“…1,2 Previous studies have shown that frequent attenders have more chronic physical conditions, 3 mental disorders [4][5][6] and psychological distress, 7 poorer health beliefs, 8 and more need of information and/or reassurance, 9 compared with non-frequent attenders. However, the use of diverse definitions of frequent attendance avoids a comprehensive interpretation of these findings.…”

Information-Seeking in Cancer Survivors: Application of the Comprehensive Model of Information Seeking to HINTS 2007 Data

“…Many health care providers face challenges in dealing with psychological difficulties, in cancer survivors, and the inability to attend to the needs is generally demonstrated by the poor detection of psychological mood disturbance in health care setting (Lefevre et al, 1999;Schwenk, Coyne, & Fechner-Bates, 1996). Thus, understanding the extent of this problem is critical and necessary for the purposes of screening, prevention, and treatment.…”