The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients.
BACKGROUND
Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain.


OBJECTIVE
To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients.


METHODS
Cross-sectional study.


METHODS
English speaking patients at an academic, urban primary care clinic.


METHODS
Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities.


RESULTS
Among 592 subjects, 80% had > or =1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1-14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9-11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4-3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4-5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1-4.1) but no increase in outpatient and emergency department visits.


CONCLUSIONS
PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association.
Kartha
Anand
A
Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.
Brower
Victoria
V
Saitz
Richard
R
Samet
Jeffrey H
JH
Keane
Terence M
TM
Liebschutz
Jane
J
D003430:Cross-Sectional Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*