Determinants of health care use in chronic fatigue syndrome patients: a cross-sectional study.
BACKGROUND
Chronic fatigue syndrome (CFS) is associated with a high use of health care services. To reduce the related costs for patients and society, it will be useful to know which factors determine CFS patients' amount of health care use. Little is known, however, about these factors.


METHODS
The present study retrospectively performed a cross-sectional analysis to investigate the possible factors determining CFS patients' health care use. A total of 263 CFS patients, derived from two subgroups (149 from tertiary care and 114 from primary/secondary care), participated. Health care use was measured with a questionnaire asking details on consumption over the past 6 months. Fatigue severity and physical functioning were measured with the subscale Experienced Fatigue of the Checklist Individual Strength (CIS-20) and the subscale Physical Functioning of the SF-36, respectively. Multiple regression analysis, T-tests, and chi(2) tests were performed.


RESULTS
The regression analysis revealed that, after controlling for patient characteristics (explaining 13%), fatigue factors added 4% predictive value and certain perpetuating factors of fatigue, including focus on bodily symptoms and attributions of fatigue, added another 5%. The analysis of subgroups revealed that, compared to the tertiary care population, fewer patients from primary/secondary care had visited a medical specialist (50% vs. 71%), used antidepressants (16% vs. 25%) and tranquilizers (3% vs. 18%), and had spent a night in hospital (7% vs. 10%). However, overall costs of health care between these subgroups did not differ.


CONCLUSIONS
This study showed that illness duration, physical impairment due to fatigue, and psychological perpetuating factors of fatigue do determine the variance in CFS patients' health care use. These results give clear directions for treating CFS patients and managing health care for CFS.
Scheeres
Korine
K
Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. k.scheeres@nkcv.umcn.nl
Wensing
Michel
M
Severens
Hans
H
Adang
Eddy
E
Bleijenberg
Gijs
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D015673:Fatigue Syndrome, Chronic / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010555:Personality Inventory / Q000706:statistics & numerical data; D010809:Physical Fitness / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D012044:Regression Analysis; D012893:Sleep Wake Disorders; D011795:Surveys and Questionnaires; D014149:Tranquilizing Agents / Q000627:therapeutic use
D000928:Antidepressive Agents; D014149:Tranquilizing Agents