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 <.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 <.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.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Lefevre F,Reifler D,Lee P,Sbenghe M,Nwadiaro N,Verma S,Yarnold PRdoi
10.1046/j.1525-1497.1999.07238.xsubject
Has Abstractpub_date
1999-07-01 00:00:00pages
425-31issue
7eissn
0884-8734issn
1525-1497pii
jgi7238journal_volume
14pub_type
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