Resource utilization of patients with hypochondriacal health anxiety and somatization

OBJECTIVES. TO examine the resource utilization of patients with high level s of somatization and health-related anxiety. DESIGN. Consecutive patients on randomly chosen days completed a self-repor t questionnaire assessing somatization and health-related, hypochondriacal anxiety. Their medical care utilization in the year preceding and following completion of the questionnaire was obtained from an automated patient rec ord. The utilization of patients above and below a predetermined threshold on the questionnaire was then compared. PATIENTS AND SETTING. Eight hundred seventy-six patients attending a primar y care clinic in a large, urban, teaching hospital. OUTCOME MEASURES. Number of ambulatory physician visits (primary care and s pecialist), outpatient costs (total, physician services, and laboratory pro cedures), proportion of patients hospitalized, and proportion of patients r eceiving emergency care. RESULTS. Patients in the uppermost 14% of the clinic population on somatiza tion and hypochondriacal health anxiety had appreciably and significantly h igher utilization in the year preceding and the year following completion o f the somatization questionnaire than did the rest of the patients in the c linic. After adjusting for group differences in sociodemographic characteri stics and medical comorbidity, significant differences in utilization remai ned. In the year preceding the assessment of somatization, their adjusted t otal outpatient costs were $1,312 (95% CI $1154, $1481) versus $954 (95% CI $868, $1057) for the remainder of the patients and the total number of phy sician visits was 9.21 (95% CI 7.94, 10.40) versus 6.33 (95% CI 5.87, 6.90) . In the year following the assessment of somatization, those above the thr eshold had adjusted total outpatient costs of $1,395 (95% CI $1243, $1586) versus; $1,145 (95% CI $1038, $1282), 9.8 total physician visits (95% CI 8. 66, 11.07) versus 7.2 (95% CI 6.62, 7.77), and had a 24% (95% CI 19%, 30%) versus 17% (95% CI 14%, 20%) chance of being hospitalized. CONCLUSIONS. Primary care patients who somatize and have high levels of hea lth-related anxiety have considerably higher medical care utilization than nonsomatizers in the year before and after being assessed. This differentia l persists after adjusting for differences in sociodemographic characterist ics and medical morbidity.