title: Clinical and psychological characteristics predict future healthcare use in adults with congenital heart disease.
abstract: BACKGROUND
  To deliver adequate care to patients with congenital heart disease (CHD), it is important to know which patients use what type of care. This knowledge is valuable, as modification of these factors may be used as means to regulate healthcare use. Our objective was to examine the predictive value of psychological characteristics for future healthcare use, independent of clinical characteristics.
  
  
  METHODS
  In total 845 adult CHD-patients participated in a longitudinal questionnaire study, with a two-year follow-up period. Linear regression analyses with negative binomial log link function were performed predicting healthcare used during the previous year. Psychological predictors were Type D personality, quality of life (QoL), depressive symptoms, trait-anxiety, happiness, optimism, and illness perceptions, independent of the number of co-morbidities, disease complexity and functional status. To control for clustering we included the variable type of centre (regional versus tertiary referral).
  
  
  RESULTS
  Patients who reported more healthcare use had a complex defect, a poor functional status, no Type D personality, and a poor QoL. They moreover felt their CHD had a severe impact on their life and believed their CHD could be managed by themselves or treatment.
  
  
  CONCLUSIONS
  Healthcare use is not entirely determined by disease complexity and functional status but also by psychological patient characteristics. It can by hypothesised that reducing the negative impact experienced and informing patients about strategies to manage their CHD, will modify their future healthcare use. Additional research is necessary to examine this possibility.
authors.affiliation: Department of Medical Psychology, Academic Medical Centre, the Netherlands Interuniversity Cardiology Institute of the Netherlands, the Netherlands d.schoormans@uvt.nl.
authors.forename: Dounya
authors.initials: D
authors.lastname: Schoormans
authors.affiliation: Department of Medical Psychology, Academic Medical Centre, the Netherlands.
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, the Netherlands.
authors.forename: Joost P
authors.initials: JP
authors.lastname: van Melle
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, the Netherlands.
authors.forename: Petronella G
authors.initials: PG
authors.lastname: Pieper
authors.affiliation: Department of Cardiology, Radboud University Nijmegen Medical Centre, the Netherlands.
authors.forename: Arie P J
authors.initials: AP
authors.lastname: van Dijk
authors.affiliation: Department of Cardiology, University Medical Centre Utrecht, the Netherlands.
authors.forename: Gertjan T J
authors.initials: GT
authors.lastname: Sieswerda
authors.affiliation: Department of Cardiology, TweeSteden Hospital, the Netherlands.
authors.forename: Mariët S
authors.initials: MS
authors.lastname: Hulsbergen-Zwarts
authors.affiliation: Department of Cardiology, Saint Antonius Hospital, the Netherlands.
authors.forename: Thijs Hwm
authors.initials: TH
authors.lastname: Plokker
authors.affiliation: Department of Cardiology, Orbis Medical Centre, the Netherlands.
authors.forename: Leo G H
authors.initials: LG
authors.lastname: Brunninkhuis
authors.affiliation: Leiden University Medical Centre, the Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, Academic Medical Centre, the Netherlands Interuniversity Cardiology Institute of the Netherlands, the Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D005260:Female; D006330:Heart Defects, Congenital / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010361:Patients / Q000523:psychology*; D011237:Predictive Value of Tests; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D064415:Type D Personality; D055815:Young Adult
keywords: Congenital heart disease; healthcare use; illness perceptions; quality of life; type D personality