Literature Collection

81

Adult health care services and psychiatric disorders: The use and costs of health care services in a low income, minority population coming to an urban primary care clinic

Type: Web Resource

Authors: Sarah Elizabeth Bledsoe

Year: 2007

Publication Place: US

Abstract: Background. Psychiatric disorders are associated with increased rates of medical problems and reduced life expectancies. Undiagnosed psychiatric disorders are associated with "overuse" or "misuse" of general medical health care services placing a burden on the general medical health care services delivery system. This problem is particularly relevant in low income, minority patients because the burden of psychiatric disorders is disproportionate. This group of patients has higher prevalence of psychiatric disorders. Furthermore, low-income, minority patients are less likely to seek mental health services, less likely to receive quality, specialty mental health services, and rely heavily on general medical health care services providers for mental health treatment. This study aims to determine the role of psychiatric disorders in the cost and utilization of general medical health care services (excluding mental health care services) for a low-income, minority patient population coming to a primary health care clinic. This research is guided by prior research in two distinct areas: the cost-offset effect and the behavioral health care model. Method. Secondary data analysis of a cross-sectional survey was used to test the relationship between psychiatric disorders and the types, rates, level of utilization, and cost of general medical health care services in a sample consisting of 1,063 primary care patients at an urban primary care clinic that serves a predominantly immigrant and low-income community. Separate multiple linear regression analyses were conducted both with and without the dichotomous variable indicating presence of a current psychiatric disorder to examine whether there was a significant positive relationship between the presence of a current psychiatric disorder and the level of general medical health care services utilization and the cost of general medical health care services. Separate analyses were run to determine the effects of hypothesized moderating variables: enabling resources and past use of mental health services. Multiple logistic regression analysis was used to examine the hypothesized differences between low and high utilizers of general medical health care services. Results. In a sample of primarily low-income, minority, and immigrant primary care patients participants with current psychiatric disorders had greater levels of utilization (M = 11.85, SD = 8.15) and cost (M= $4,901.94, SD = 11, 226.29) related to general medical health care services when compared to the sample of participants without current psychiatric disorders (utilization M = 10.86, SD = 8.15; cost M = $3,606.03, SD = 5,673.47) after controlling for predisposing characteristics, need, and enabling factors. Having comorbid psychiatric disorders was not significantly associated with either the level of utilization or the cost of general medical health care services. Furthermore, the category of psychiatric disorder (mood, anxiety, or substance related) was not associated with utilization or cost of general medical health care services. The hypothesized moderating relationship of enabling resources and past use of mental health services on the association between having a current psychiatric disorder and both cost and utilization of general medical health care services was not supported. Significant differences were detected in the psychiatric sample between the subset of participants who utilized low levels of general medical health care services and the subset of those who utilized high levels of general medical health care services. The low level utilizers were more likely to be Spanish speaking, have alcohol use disorder, and be exposed to more categories of traumatic events. Participants with psychiatric disorders who had Medicaid and those who were disabled were more likely to be high level utilizers of general medical health care service. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

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This grey literature reference is included in the Academy's Literature Collection in keeping with our mission to gather all sources of information on integration. Grey literature is comprised of materials that are not made available through traditional publishing avenues. Often, the information from unpublished resources can be limited and the risk of bias cannot be determined.

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