RT Journal Article
SR Electronic
T1 Frequent Users of Rural Primary Care: Comparisons With Randomly Selected Users
JF The Journal of the American Board of Family
                Practice
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 105
OP 115
DO 10.3122/15572625-11-2-105
VO 11
IS 2
A1 Lewis E. Mehl-Madrona
YR 1998
UL http://www.jabfm.org/content/11/2/105.abstract
AB Background: Frequent users of primary care have not been adequately characterized. The unique characteristics of this population was sought—why they come so often, what their care costs, and whether psychosocial factors play a role in their high utilization of health care. Methods: The billing system of a rural primary care clinic was used to find the frequency of visits for all patients attending the clinic for the previous 12 months. The 211 most frequent visitors were selected. A comparison group of 250 patients was drawn from the billing records using a random number generator. Charts were reviewed to compare diagnoses (by frequency), number of procedures, amount billed for care, amount received from those billings, number of psychotropic medications prescribed, and response to medication. A subgroup of each group was interviewed to confirm chart review findings and to inquire about personal reasons for coming to the clinic. Results: Compared with patients who were random users, patients who were frequent users were more likely to come from the younger and older age groups, they averaged significantly more emergency department visits and visits to other specialists (P < 0.0001), and they had more mental health problems diagnosed (P < 0.01). Significantly more frequent users were insured by Medicaid and fewer were insured by Medicare. They had more detailed office visits and more laboratory tests. They received twice as much psychotherapy and had a higher percentage of problem-focused office visits. Chart audits and interviews of selected patients revealed that many nonmedical reasons were related to visits in addition to psychosocial stressors. Conclusions: Nonmedical factors are important among the most frequent users of a primary care clinic. Proposals to improve care for frequent users should consider the psychosocial needs of this population.