Resource utilization of patients with hypochondriacal health anxiety and somatization.
OBJECTIVE
To examine the resource utilization of patients with high levels of somatization and health-related anxiety.


METHODS
Consecutive patients on randomly chosen days completed a self-report questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient record. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared.


METHODS
Eight hundred seventy-six patients attending a primary care clinic in a large, urban, teaching hospital.


METHODS
Number of ambulatory physician visits (primary care and specialist), outpatient costs (total, physician services, and laboratory procedures), proportion of patients hospitalized, and proportion of patients receiving emergency care.


RESULTS
Patients in the uppermost 14% of the clinic population on somatization and hypochondriacal health anxiety had appreciably and significantly higher utilization in the year preceding and the year following completion of the somatization questionnaire than did the rest of the patients in the clinic. After adjusting for group differences in sociodemographic characteristics and medical comorbidity, significant differences in utilization remained. In the year preceding the assessment of somatization, their adjusted total outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of physician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90). In the year following the assessment of somatization, those above the threshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8.66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized.


CONCLUSIONS
Primary care patients who somatize and have high levels of health-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differential persists after adjusting for differences in sociodemographic characteristics and medical morbidity.
Barsky
A J
AJ
Department of Psychiatry, Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts 02115, USA. ajbarsky@rics.bwh.harvard.edu
Ettner
S L
SL
Horsky
J
J
Bates
D W
DW
D000328:Adult; D000368:Aged; D001900:Boston; D016022:Case-Control Studies; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000191:economics; D006801:Humans; D006998:Hypochondriasis / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013001:Somatoform Disorders / Q000175:diagnosis / Q000191:economics / Q000628:therapy*