title: Predictors of medical and mental health care use in patients with irritable bowel syndrome in the United States.
abstract: Because health care demand among IBS patients imposes a heavy economic burden, identifying high utilizers has potential for improving quality and efficiency of care. Previous research has not identified reliable predictors of utilization of IBS patients. We sought to identify factors predictive of health care utilization among severe IBS patients. 291 IBS patients completed testing whose content mapped onto the Andersen model of health care utilization. 2-stage hurdle models were used to determine predictors of health care use (probability and frequency). Separate analyses were conducted for mental health and medical services. Whether patients used any medical care was predicted by diet and insurance status. Tobacco use, education, and health insurance predicted the probability of using mental health care. The frequency of medical care was associated with alcohol use and physical health status, while frequency of mental health services was associated with marital status, tobacco use, education, distress, stress, and control beliefs over IBS symptoms. For IBS patients, the demand for health care involves a complex decision-making process influenced by many factors. Particularly strong determinants include predisposing characteristics (e.g., dietary pattern, tobacco use) and enabling factors (e.g., insurance coverage) that impede or facilitate demand. Which factors impact use depends on whether the focus is on the decision to use care or how much care is used. Decisions to use medical and mental health care are not simply influenced by symptom-specific factors but by a variety of lifestyle (e.g., dietary pattern, education, smoking) and economic (e.g., insurance coverage) factors.
authors.affiliation: Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Gudleski
authors.affiliation: Department of Family Medicine, University at Buffalo, SUNY, Buffalo, NY, United States.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Satchidanand
authors.affiliation: Behavioral Health Economics, RTI International, Research Triangle Park, NC, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Dunlap
authors.affiliation: Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States.
authors.forename: Varnita
authors.initials: V
authors.lastname: Tahiliani
authors.affiliation: Department of Biostatistics, School of Public Health and Health Professions University at Buffalo, Buffalo, NY, United States.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
authors.forename: Laurie
authors.initials: L
authors.lastname: Keefer
authors.affiliation: Department of Medicine, University at Buffalo School of Medicine, SUNY, Buffalo, NY, United States. Electronic address: lackner@buffalo.edu.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Lackner
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000523:psychology*; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008960:Models, Psychological; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012307:Risk Factors; D014481:United States
keywords: Comorbidity; Cost; Diet; Disease management; Psychosocial factors; Utilization