Frequent use of medical services. Patient reports of intentions to seek care
P. J. Wagner, W. Phillips, M. Radford and J. L. Hornsby
Department of Family Medicine, Medical College of Georgia, Augusta, USA.
OBJECTIVE: To examine differences between frequent and infrequent users in
decisions to seek medical care based on symptom type and duration of
experience of the symptom. DESIGN: Retrospective study. SETTING: University
family practice clinic. PATIENTS: Fifty-eight of 130 patients returned the
completed instruments, a response rate of 45%. MAIN OUTCOME MEASURES: The
following two instruments were used: the Intentions to Seek Care
questionnaire, which measures intention to see a physician, self-treat, or
use medications for 11 different symptoms after three time periods--1 day,
3 days, and 1 week of symptom duration--and the SF-36 Health Survey
measure. RESULTS: Initial analyses suggested that patients perceive three
clusters of symptoms, which we have labeled as serious, mild, and
psychological. Scale scores for these groups of symptoms yielded
significant reliability and were used in subsequent analyses. Multivariate
analysis of variance comparing source of care, symptom duration, and
frequent vs infrequent user groups indicated that both user groups are more
likely to seek care from physicians for symptoms that are serious. Analysis
of mild and psychological symptoms yielded significant three-way
interactions, with frequent users more likely than infrequent users to seek
care from physicians at a 1-day duration. Such differences disappear by 7
days. Significantly lower scores were obtained on five of the eight SF-36
Health Survey dimensions for the infrequent users. CONCLUSIONS: Frequent
users are more likely than infrequent users to report that they would seek
care for minor symptoms. Infrequent users tend to self-treat for 3 to 7
days, after which time physician advice is sought. Efforts to teach
patients optimal timing of use for different symptoms may be an effective
intervention.
