Ford Julian D, Trestman Robert L, Steinberg Karen, Tennen Howard, Allen Scott
Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Ave. MC 1410, Farmington, CT 06030, USA.
Soc Sci Med. 2004 Jun;58(11):2145-8. doi: 10.1016/j.socscimed.2003.08.017.
The empirical evidence concerning the relationship of psychiatric disorders to health care utilization and costs is mixed and primarily retrospective. Therefore, a case-control study was conducted to prospectively examine the association of psychiatric disorders with health care utilization in an adult primary care internal medicine patient population, controlling for the effects of medical morbidity, adverse events, age, race, gender, employment status, and health insurance coverage. Samples of primary care high utilizer (HU; 125 men, 125 women with primary care visits in 1998 above the 95th percentile) vs. mid-range utilizer (MU; 125 men, 125 women; two primary care visits in 1998) patients were compared using archival automated medical record data from the index year (1998), and from the following year (1999) for prospective analyses. HU (compared to MU) participants were younger, had higher medical and psychiatric morbidity, and had higher levels of outpatient specialty medical care utilization. In multivariate analyses, (a) anxiety disorder diagnoses uniquely contributed to identifying HU patients, and (b) after controlling for initial primary care utilization status, anxiety, depressive and addictive disorders were prospectively associated with medical illness complexity and primary, specialty, and emergency medical care utilization. Although behavioral health disorders (including addictive as well as depressive and anxiety diagnoses) and high utilization of primary health care services are related, these prospective findings suggest that behavioral health disorders make an independent contribution to non-psychiatric health care utilization.
关于精神疾病与医疗保健利用及成本之间关系的实证证据参差不齐，且主要是回顾性的。因此，开展了一项病例对照研究，以前瞻性地考察成年初级保健内科患者群体中精神疾病与医疗保健利用之间的关联，并控制医疗发病率、不良事件、年龄、种族、性别、就业状况和医疗保险覆盖范围等因素的影响。利用索引年份（1998年）及次年（1999年）的档案自动化医疗记录数据，对初级保健高利用者（HU；1998年初级保健就诊次数高于第95百分位数的125名男性和125名女性）与中等利用者（MU；1998年进行两次初级保健就诊的125名男性和125名女性）样本进行比较，以进行前瞻性分析。与MU相比，HU参与者更年轻，有更高的医疗和精神疾病发病率，以及更高水平的门诊专科医疗保健利用。在多变量分析中，（a）焦虑症诊断对识别HU患者有独特作用，（b）在控制初始初级保健利用状况后，焦虑症、抑郁症和成瘾性疾病与医疗疾病复杂性以及初级、专科和急诊医疗保健利用存在前瞻性关联。尽管行为健康障碍（包括成瘾性以及抑郁症和焦虑症诊断）与初级卫生保健服务的高利用有关，但这些前瞻性研究结果表明，行为健康障碍对非精神科医疗保健利用有独立影响。
