Psychiatric symptoms and medical utilization in primary care patients

In two studies, the authors evaluated the impact of psychiatric disorders o n medical care utilization in a primary care setting. In the first study, 5 26 consecutive patients in a teaching hospital primary care practice comple ted the 18-item RAND Mental Health Inventory to identify clinically signifi cant depression and/or anxiety and a questionnaire about the use of psychia tric treatment and psychoactive medications. The medical utilization of tho se patients defined as depressed and/or anxious was compared with those def ined as not depressed and/or anxious. Patients identified as depressed and/ or anxious reported significantly increased medical utilization, but this w as not confirmed by the hospital's computerized record system. In the secon d study, the authors analyzed medical care utilization for the years before and after the first outpatient psychiatry appointment of a sample of 91 pa tients referred from the same primary care practice to the hospital's outpa tient psychiatry clinic over a 1-year period. In both studies there was not a statistically significant difference in medical utilization among those patients receiving psychiatric treatment. The findings demonstrate the diff iculties in examining cost offset in a primary care population and raise qu estions about it as a realistic outcome measure of the effect of psychiatri c treatment.