Primary care utilization and mental health diagnoses among adult patients requiring interpreters: a retrospective cohort study.
BACKGROUND
Patients requiring interpreters may utilize the health care system differently or more frequently than patients not requiring interpreters; those with mental health issues may be particularly difficult to diagnose.


OBJECTIVE
To determine whether adult patients requiring interpreters exhibit different health care utilization patterns and rates of mental health diagnoses than their counterparts.


METHODS
Retrospective cohort study examining patient visits to primary care (PC), express care (EC), or the emergency department (ED) of a large group practice within 1 year.


METHODS
Adult outpatients (n = 63,525) with at least one visit within the study interval and information regarding interpreter need.


METHODS
Mean visit counts, counts of mental disorders, and somatic symptom diagnoses between patients requiring interpreters (IS patients) and not requiring interpreters (non-IS patients).


RESULTS
IS patients (n = 1,566) had a higher mean number of visits overall (3.10 vs. 2.52), in PC (2.54 vs. 1.95), and in ED (0.53 vs. 0.44) than non-IS patients (all p < 0.01). IS patients had a lower mean number of visits in EC than non-IS patients (0.03 vs. 0.13; p < 0.01). Interpreter need remained a significant predictor of visit count in multivariate analyses including age, sex, insurance, and clinical complexity. A greater proportion of IS patients were high utilizers (10+ visits) than non-IS patients (3.6 % vs. 1.7 %; p < 0.01). IS patients had a lower frequency of mental health diagnoses (13.9 % vs. 16.7 %), but a higher frequency of diagnoses recognized as potential somatic symptoms including diseases of the nervous (29.3 % vs. 24.2 %), digestive (22.6 % vs. 14.5 %), and musculoskeletal systems (43.2 % vs. 34.5 %), and ill-defined conditions (61 % vs. 49.9 %), all p < 0.01.


CONCLUSIONS
IS patients visited PC more often than their counterparts and were more often high utilizers of care. Two sources of high utilization, mental health diagnoses and somatic symptoms, differed appreciably between our populations and may be contributing factors.
Office of Women's Health, Mayo Clinic, Rochester, MN 55905, USA.
Priscilla M
PM
Flynn
Jennifer L
JL
Ridgeway
Mark L
ML
Wieland
Mark D
MD
Williams
Lindsey R
LR
Haas
Walter K
WK
Kremers
Carmen Radecki
CR
Breitkopf
D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007802:Language; D008297:Male; D001523:Mental Disorders / Q000208:ethnology* / Q000628:therapy; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009819:Office Visits / Q000706:statistics & numerical data*; D010045:Outpatients / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies