Do Psychological and Social factors Correspond with Health Care Utilization?
,
Abstract
Background: There is evidence that unhelpful thoughts and distress regarding symptoms are associated with more frequent care utilization. Among people seeing a musculoskeletal specialist in person, we sought relationships between mental and social health factors and the number of 1) self-reported in-person healthcare contacts, 2) remote healthcare contacts, and 3) total healthcare contacts during the 6-week period prior to the visit.
Methods: We enrolled 148 adult patients in a cross-sectional study of people visiting a musculoskeletal specialist for a new or return visit. Patients indicated the number of self-reported remote and in-person healthcare contacts, and completed measures of social health, unhelpful thoughts regarding symptoms, general distress, and demographics.
Results: Accounting for potential confounding in multivariable analysis, more pre-visit self-reported in-person care episodes were independently associated with more unhelpful thoughts about symptoms [higher score on Negative Pain Thoughts Questionnaire (NPTQ), regression coefficient: 0.05, P < 0.05] and household income between $15000 and $29999 or $30000 and $49999. No factors were associated with the total number of pre-visit remote and in-person care contacts.
Conclusion: The observation that patients with greater unhelpful thinking seek out more in-person care episodes for musculoskeletal symptoms supports the concept that comprehensive care strategies attentive to common unhelpful thoughts regarding symptoms could limit resource utilization.
1. Bernstein DN, Crijns TJ, Mahmood B, Ring D, Hammert WC. Patient characteristics, treatment, and presenting PROMIS scores associated with number of office visits for traumatic hand and wrist conditions. Clin Orthop Relat Res. 2019;477(10):2345-55. doi: 10.1097/CORR.0000000000000742. [PubMed: 31107332]. [PubMed Central: PMC6999957].
2. Thomsen DK, Mehlsen MY, Hokland M, Viidik A, Olesen F, Avlund K, et al. Negative thoughts and health: Associations among rumination, immunity, and health care utilization in a young and elderly sample. Psychosom Med. 2004;66(3):363-71. doi: 10.1097/01.psy.0000127688.44363.fb. [PubMed: 15184696].
3. ten Brinke A, Ouwerkerk ME, Zwinderman AH, Spinhoven P, Bel EH. Psychopathology in patients with severe asthma is associated with increased health care utilization. Am J Respir Crit Care Med. 2001;163(5):1093-6. doi: 10.1164/ajrccm.163.5.2004020. [PubMed: 11316641].
4. Barsky AJ, Orav EJ, Bates DW. Distinctive patterns of medical care utilization in patients who somatize. Med Care. 2006;44(9):803-11. doi: 10.1097/01.mlr.0000228028.07069.59. [PubMed: 16932131].
5. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903-10. doi: 10.1001/archpsyc.62.8.903. [PubMed: 16061768].
6. PRAPARE Risk Tally Scoring Methodology [Online 2016]. [cited 2021 Nov 21]; Available from: URL: https://prapare.org/wp- content/uploads/2021/10/PRAPARE-Risk-Tally-Scoring- Methodology_2021.pdf
7. Guattery JM, Dardas AZ, Kelly M, Chamberlain A, McAndrew C, Calfee RP. Floor effect of PROMIS depression CAT associated with hasty completion in orthopaedic surgery patients. Clin Orthop Relat Res. 2018;476(4):696-703. doi:
10.1007/s11999.0000000000000076.
[PubMed Central: PMC6260068].
8. Bernstein DN, Atkinson J, Fear K, Baumhauer JF, Mesfin A, Rubery PT, et al. Determining the generalizability of the PROMIS depression domain's floor effect and completion time in patients undergoing orthopaedic surgery. Clin Orthop Relat Res. 2019;477(10):2215-25. doi: 10.1097/CORR.0000000000000782. [PubMed: 31369439]. [PubMed Central: PMC6999924].
9. Teunis T, Ramtin S, Gwilym SE, Ring D, Jayakumar P. Unhelpful thoughts and distress regarding symptoms are associated withrecovery from upper extremity fracture. Injury. 2023;54(4):
1151-5. doi: 10.1016/j.injury.2023.02.035. [PubMed: 36822916].
10. Vranceanu AM, Safren S, Cowan J, Ring D. The development of the negative pain thoughts questionnaire. Pain Pract. 2008;8(5):
337-41. doi: 10.1111/j.1533-2500.2008.00213.x. [PubMed: 18503620].
11. Dekker AB, Teunis T, Schipper I, Ring D. Development of a short form of the negative pain thoughts questionnaire (NPTQ). J Bone Joint Surg Am. 2021;103(5):439-44. doi:
10.2106/JBJS.20.00571. [PubMed: 33337821].
12. Sarwar F, Crijns T, Ramtin S, Ring D, Reichel L, Fatehi A. Patient
symptom exaggeration is associated with communication effectiveness and trust. PEC Innov. 2022;1:100050. doi: 10.1016/j.pecinn.2022.100050. [PubMed: 37213755]. [PubMed Central: PMC10194274].
13. Pierson SR, Ngoue M, Lam R, Rajagopalan D, Ring D, Ramtin S. When musculoskeletal clinicians respond to empathetic opportunities, do patients perceive greater empathy? Clin Orthop Relat Res. 2023;481(9):1771-80. doi: 10.1097/CORR.0000000000002614. [PubMed: 36853843].
14. Rohrback M, Ramtin S, Abdelaziz A, Matkin L, Ring D, Crijns TJ, et al. Rotator cuff tendinopathy: Magnitude of incapability is associated with greater symptoms of depression rather than pathology severity. J Shoulder Elbow Surg. 2022;31(10):2134-9. doi: 10.1016/j.jse.2022.03.007. [PubMed: 35461981].
15. Furlough K, Miner H, Crijns TJ, Jayakumar P, Ring D, Koenig K. What factors are associated with perceived disease onset in patients with hip and knee osteoarthritis? J Orthop. 2021;26:88-93. doi: 10.1016/j.jor.2021.07.013. [PubMed: 34341628]. [PubMed Central: PMC8318889].
16. Crijns TJ, Bernstein DN, Teunis T, Gonzalez RM, Wilbur D, Ring D, et al. The association between symptoms of depression and office visits in patients with nontraumatic upper-extremity illness. J Hand Surg Am. 2020;45(2):159. doi: 10.1016/j.jhsa.2019.03.019. [PubMed: 31300225].
17. Sporinova B, Manns B, Tonelli M, Hemmelgarn B, MacMaster F, Mitchell N, et al. Association of mental health disorders with health care utilization and costs among adults with chronic disease. JAMA Netw Open. 2019;2(8):e199910. doi: 10.1001/jamanetworkopen.2019.991. [PubMed: 31441939]. [PubMed Central: PMC6714022].
18. Fogarty CT, Sharma S, Chetty VK, Culpepper L. Mental health conditions are associated with increased health care utilization among urban family medicine patients. J Am Board Fam Med. 2008;21(5):398-407. doi: 10.3122/jabfm.2008.05.070082. [PubMed: 18772294].
19. van Maren K, Brown LE, Cremers T, Khatiri MZ, Ring D, Fatehi A. In orthopaedic speciality care, longer explanations are not more caring or more satisfying. Clin Orthop Relat Res. 2021;479(12):2601-7. doi: 10.1097/CORR.0000000000001860. [PubMed: 34114977]. [PubMed Central: PMC8726551].
20. Turner JA, Jensen MP, Warms CA, Cardenas DD. Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain. 2002;98(1-2):127-34. doi: 10.1016/s0304-3959(02)00045-3. [PubMed: 12098624].
21. Teunis T, Thornton ER, Jayakumar P, Ring D. Time seeing a hand surgeon is not associated with patient satisfaction. Clin Orthop Relat Res. 2015;473(7):2362-8. doi: 10.1007/s11999-014-4090-z. [PubMed: 25475717]. [PubMed Central: PMC4457762].
22. Kortlever JTP, Ottenhoff JSE, Vagner GA, Ring D, Reichel LM. Visit Duration does not correlate with perceived physician empathy. J Bone Joint Surg Am. 2019;101(4):296-301. doi: 10.2106/JBJS.18.00372. [PubMed: 30801368].
23. Rossano A, Al SA, Ring D, Guzman JM, Fatehi A. Do unhelpful thoughts or confidence in problem solving have stronger associations with musculoskeletal illness? Clin Orthop Relat Res. 2022;480(2):287-95. doi: 10.1097/CORR.0000000000002005. [PubMed: 34705738]. [PubMed Central: PMC8747486].
24. Crijns TJ, Brinkman N, Ramtin S, Ring D, Doornberg J, Jutte P, et al. Are there distinct statistical groupings of mental health factors and pathophysiology severity among people with hip and knee osteoarthritis presenting for specialty care? Clin Orthop Relat Res. 2022;480(2):298-309. doi: 10.1097/CORR.0000000000002052. [PubMed: 34817453]. [PubMed Central: PMC8747586].
25. Filc D, Davidovich N, Novack L, Balicer RD. Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health. 2014;13:115. doi: 10.1186/s12939-014-0115-1. [PubMed: 25431139]. [PubMed Central: PMC4260253].
26. Samuelson MB, Chandra RK, Turner JH, Russell PT, Francis DO. The relationship between social determinants of health and utilization of tertiary rhinology care. Am J Rhinol Allergy. 2017;31(6):376-81. doi: 10.2500/ajra.2017.31.4476. [PubMed: 29122082]. [PubMed Central: PMC5691238].
27. Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res. 2004;56(4):391-408. doi: 10.1016/S0022-3999(03)00622-6. [PubMed: 15094023].
28. Lee S, Black D, Held ML. Factors Associated with Telehealth Service Utilization among Rural Populations. J Health Care Poor Underserved. 2019;30(4):1259-72. doi: 10.1353/hpu.2019.0104. [PubMed: 31680097].
2. Thomsen DK, Mehlsen MY, Hokland M, Viidik A, Olesen F, Avlund K, et al. Negative thoughts and health: Associations among rumination, immunity, and health care utilization in a young and elderly sample. Psychosom Med. 2004;66(3):363-71. doi: 10.1097/01.psy.0000127688.44363.fb. [PubMed: 15184696].
3. ten Brinke A, Ouwerkerk ME, Zwinderman AH, Spinhoven P, Bel EH. Psychopathology in patients with severe asthma is associated with increased health care utilization. Am J Respir Crit Care Med. 2001;163(5):1093-6. doi: 10.1164/ajrccm.163.5.2004020. [PubMed: 11316641].
4. Barsky AJ, Orav EJ, Bates DW. Distinctive patterns of medical care utilization in patients who somatize. Med Care. 2006;44(9):803-11. doi: 10.1097/01.mlr.0000228028.07069.59. [PubMed: 16932131].
5. Barsky AJ, Orav EJ, Bates DW. Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62(8):903-10. doi: 10.1001/archpsyc.62.8.903. [PubMed: 16061768].
6. PRAPARE Risk Tally Scoring Methodology [Online 2016]. [cited 2021 Nov 21]; Available from: URL: https://prapare.org/wp- content/uploads/2021/10/PRAPARE-Risk-Tally-Scoring- Methodology_2021.pdf
7. Guattery JM, Dardas AZ, Kelly M, Chamberlain A, McAndrew C, Calfee RP. Floor effect of PROMIS depression CAT associated with hasty completion in orthopaedic surgery patients. Clin Orthop Relat Res. 2018;476(4):696-703. doi:
10.1007/s11999.0000000000000076.
[PubMed Central: PMC6260068].
8. Bernstein DN, Atkinson J, Fear K, Baumhauer JF, Mesfin A, Rubery PT, et al. Determining the generalizability of the PROMIS depression domain's floor effect and completion time in patients undergoing orthopaedic surgery. Clin Orthop Relat Res. 2019;477(10):2215-25. doi: 10.1097/CORR.0000000000000782. [PubMed: 31369439]. [PubMed Central: PMC6999924].
9. Teunis T, Ramtin S, Gwilym SE, Ring D, Jayakumar P. Unhelpful thoughts and distress regarding symptoms are associated withrecovery from upper extremity fracture. Injury. 2023;54(4):
1151-5. doi: 10.1016/j.injury.2023.02.035. [PubMed: 36822916].
10. Vranceanu AM, Safren S, Cowan J, Ring D. The development of the negative pain thoughts questionnaire. Pain Pract. 2008;8(5):
337-41. doi: 10.1111/j.1533-2500.2008.00213.x. [PubMed: 18503620].
11. Dekker AB, Teunis T, Schipper I, Ring D. Development of a short form of the negative pain thoughts questionnaire (NPTQ). J Bone Joint Surg Am. 2021;103(5):439-44. doi:
10.2106/JBJS.20.00571. [PubMed: 33337821].
12. Sarwar F, Crijns T, Ramtin S, Ring D, Reichel L, Fatehi A. Patient
symptom exaggeration is associated with communication effectiveness and trust. PEC Innov. 2022;1:100050. doi: 10.1016/j.pecinn.2022.100050. [PubMed: 37213755]. [PubMed Central: PMC10194274].
13. Pierson SR, Ngoue M, Lam R, Rajagopalan D, Ring D, Ramtin S. When musculoskeletal clinicians respond to empathetic opportunities, do patients perceive greater empathy? Clin Orthop Relat Res. 2023;481(9):1771-80. doi: 10.1097/CORR.0000000000002614. [PubMed: 36853843].
14. Rohrback M, Ramtin S, Abdelaziz A, Matkin L, Ring D, Crijns TJ, et al. Rotator cuff tendinopathy: Magnitude of incapability is associated with greater symptoms of depression rather than pathology severity. J Shoulder Elbow Surg. 2022;31(10):2134-9. doi: 10.1016/j.jse.2022.03.007. [PubMed: 35461981].
15. Furlough K, Miner H, Crijns TJ, Jayakumar P, Ring D, Koenig K. What factors are associated with perceived disease onset in patients with hip and knee osteoarthritis? J Orthop. 2021;26:88-93. doi: 10.1016/j.jor.2021.07.013. [PubMed: 34341628]. [PubMed Central: PMC8318889].
16. Crijns TJ, Bernstein DN, Teunis T, Gonzalez RM, Wilbur D, Ring D, et al. The association between symptoms of depression and office visits in patients with nontraumatic upper-extremity illness. J Hand Surg Am. 2020;45(2):159. doi: 10.1016/j.jhsa.2019.03.019. [PubMed: 31300225].
17. Sporinova B, Manns B, Tonelli M, Hemmelgarn B, MacMaster F, Mitchell N, et al. Association of mental health disorders with health care utilization and costs among adults with chronic disease. JAMA Netw Open. 2019;2(8):e199910. doi: 10.1001/jamanetworkopen.2019.991. [PubMed: 31441939]. [PubMed Central: PMC6714022].
18. Fogarty CT, Sharma S, Chetty VK, Culpepper L. Mental health conditions are associated with increased health care utilization among urban family medicine patients. J Am Board Fam Med. 2008;21(5):398-407. doi: 10.3122/jabfm.2008.05.070082. [PubMed: 18772294].
19. van Maren K, Brown LE, Cremers T, Khatiri MZ, Ring D, Fatehi A. In orthopaedic speciality care, longer explanations are not more caring or more satisfying. Clin Orthop Relat Res. 2021;479(12):2601-7. doi: 10.1097/CORR.0000000000001860. [PubMed: 34114977]. [PubMed Central: PMC8726551].
20. Turner JA, Jensen MP, Warms CA, Cardenas DD. Catastrophizing is associated with pain intensity, psychological distress, and pain-related disability among individuals with chronic pain after spinal cord injury. Pain. 2002;98(1-2):127-34. doi: 10.1016/s0304-3959(02)00045-3. [PubMed: 12098624].
21. Teunis T, Thornton ER, Jayakumar P, Ring D. Time seeing a hand surgeon is not associated with patient satisfaction. Clin Orthop Relat Res. 2015;473(7):2362-8. doi: 10.1007/s11999-014-4090-z. [PubMed: 25475717]. [PubMed Central: PMC4457762].
22. Kortlever JTP, Ottenhoff JSE, Vagner GA, Ring D, Reichel LM. Visit Duration does not correlate with perceived physician empathy. J Bone Joint Surg Am. 2019;101(4):296-301. doi: 10.2106/JBJS.18.00372. [PubMed: 30801368].
23. Rossano A, Al SA, Ring D, Guzman JM, Fatehi A. Do unhelpful thoughts or confidence in problem solving have stronger associations with musculoskeletal illness? Clin Orthop Relat Res. 2022;480(2):287-95. doi: 10.1097/CORR.0000000000002005. [PubMed: 34705738]. [PubMed Central: PMC8747486].
24. Crijns TJ, Brinkman N, Ramtin S, Ring D, Doornberg J, Jutte P, et al. Are there distinct statistical groupings of mental health factors and pathophysiology severity among people with hip and knee osteoarthritis presenting for specialty care? Clin Orthop Relat Res. 2022;480(2):298-309. doi: 10.1097/CORR.0000000000002052. [PubMed: 34817453]. [PubMed Central: PMC8747586].
25. Filc D, Davidovich N, Novack L, Balicer RD. Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health. 2014;13:115. doi: 10.1186/s12939-014-0115-1. [PubMed: 25431139]. [PubMed Central: PMC4260253].
26. Samuelson MB, Chandra RK, Turner JH, Russell PT, Francis DO. The relationship between social determinants of health and utilization of tertiary rhinology care. Am J Rhinol Allergy. 2017;31(6):376-81. doi: 10.2500/ajra.2017.31.4476. [PubMed: 29122082]. [PubMed Central: PMC5691238].
27. Creed F, Barsky A. A systematic review of the epidemiology of somatisation disorder and hypochondriasis. J Psychosom Res. 2004;56(4):391-408. doi: 10.1016/S0022-3999(03)00622-6. [PubMed: 15094023].
28. Lee S, Black D, Held ML. Factors Associated with Telehealth Service Utilization among Rural Populations. J Health Care Poor Underserved. 2019;30(4):1259-72. doi: 10.1353/hpu.2019.0104. [PubMed: 31680097].
| Files | ||
| Issue | Vol 10 No 2 (2024) | |
| Section | Research Articles | |
| DOI | https://doi.org/10.18502/jost.v10i2.15512 | |
| Keywords | ||
| Health Care Utilization Psychological Factors Social Factors | ||
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How to Cite
1.
Ramtin S, Fatehi A, Ring D, Gallagher S, Johnson A. Do Psychological and Social factors Correspond with Health Care Utilization?. J Orthop Spine Trauma. 2024;10(2):55-9.
