Psychopathology and emotional distress among older high-utilizing health maintenance organization patients

Background. Rates of psychopathology are often underestimated in primary ca re populations, especially older patient groups. High medical utilization i s often a reflection of psychopathology and/or emotional distress. Increase d awareness of primary care patients' emotional distress can help To improv e well-being and reduce unnecessary high utilization of medical services. T his study aimed to assess the degree of psychopathology present in a sample of older health maintenace organization (HMO) patients who utilized higher -than-average amounts of medical services. Methods. Patients in a large HMO aged 55 years old and older who exceeded t he mean number of inpatient and outpatient visits in the past year were rec ruited. Sixty-nine patients, mostly female (69%) and white (93%), volunteer ed. Patients were assessed with the Medical Outcomes Study SF-36 health sur vey and the Symptom Checklist-90-Revised (SCL-90-R). Results. Respondents made a mean of 41 visits in the previous year to medic al providers, versus 24 visits per year for the average patient of this age in the HMO. Significant elevations on SCL-90-R global psychopathology, obs essive-compulsive, somatization, and depression scales were found. All pati ents met SCL-90-R criteria for psychiatric caseness. SF-36 health ratings w ere comparable with those of patients with chronic medical conditions asses sed in other SF-36 samples. Conclusions. Older high-utilizing HMO patients show significantly more psyc hopathology and view their health status as poorer than that of other medic al subpopulations: results suggest that care for these problems is rarely r eceived.