McFarland B H, Freeborn D K, Mullooly J P, Pope C R
Med Care. 1985 Nov;23(11):1221-33. doi: 10.1097/00005650-198511000-00001.
Criteria used in this study established that 13% of long-term adult members of a prepaid group practice health maintenance organization (HMO) were consistently high users of outpatient medical care services. This population accounted for 31% of the total doctor office visits (DOVs), 35% of the hospital admissions, and 30% of the outpatient surgical services for long-term members. The most frequent reason for DOVs in this high user group was treatment and/or follow-up of chronic conditions. Patterns of utilization were unrelated to marital status, income, occupation, and perceived social class. Smoking and alcohol use also were not associated with utilization patterns. However, the consistently high users were more likely to perceive their health status as fair or poor and to report a higher number of physical symptoms. They were also more likely to be characterized by a higher degree of psychological distress, especially depression. Contacts with the HMO's mental health department constituted less than 1% of their total medical care contacts, and only 13% made at least one mental health contact over the study period. The findings are discussed in terms of their health and medical care implications.
本研究采用的标准确定，在一家预付团体医疗健康维护组织（HMO）的长期成年成员中，13%的人一直是门诊医疗服务的高使用者。这一人群占长期成员总门诊就诊次数（DOVs）的31%、住院人数的35%以及门诊手术服务的30%。该高使用人群中门诊就诊最常见的原因是慢性病的治疗和/或随访。利用模式与婚姻状况、收入、职业和感知社会阶层无关。吸烟和饮酒也与利用模式无关。然而，一直的高使用者更有可能认为自己的健康状况为一般或较差，并报告更多的身体症状。他们也更有可能表现出较高程度的心理困扰，尤其是抑郁。与HMO心理健康部门的接触占其总医疗接触的不到1%，在研究期间，只有13%的人至少有一次心理健康接触。将根据研究结果对其健康和医疗意义进行讨论。
