Frequent users of rural primary care: comparisons with randomly selected users.
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.
Mehl-Madrona
L E
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Department of Family and Community Medicine, University of Arizona College of Medicine, Tucson, USA.
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D003625:Data Collection; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D009511:New England; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data*; D011897:Random Allocation; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012494:Sampling Studies; D017678:Sex Distribution