Characteristics and behavioral health needs of patients with patterns of high hospital use: implications for primary care providers

Abstract

BackgroundA small percentage of patients relies extensively on hospital-based care and account for a disproportionately high share of health care spending in the United States. Evidence shows that behavioral health conditions are common among these individuals, but understanding of their behavioral health needs is limited. This study aimed to understand the behavioral health characteristics and needs of patients with high hospital utilization patterns in Camden, New Jersey.MethodsThe sample consisted of patients in a care management intervention for individuals with patterns of high hospital utilization who were referred for behavioral health assessments (N = 195). A clinical psychologist conducted the assessments, which informed a multiaxial evaluation with diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders and a Mental Status Examination, to facilitate accurate diagnosis. Demographic characteristics, housing instability, exposure to trauma, and health care service utilization data were also collected through self-report and chart reviews.ResultsNinety percent of patients were diagnosed with a psychiatric and/or active substance use disorder. Depression was the most common psychiatric disorder and alcohol use was the most common substance use disorder. However, only 10% of patients with an active substance use disorder were in treatment, and only 17% of patients with a mental health diagnosis were receiving mental health treatment. Nearly all (91%) patients reported having a primary care provider at the time of assessment and most had seen their primary care provider within three months of their last hospital discharge. Non-medical barriers to health and wellness, specifically housing instability and exposure to trauma, were also common (35 and 61% of patients, respectively) among patients.ConclusionFindings highlight the importance of identifying and treating patients with behavioral health needs in the primary care setting. Developing connections with community agencies who provide behavioral health and substance use treatment can enhance primary care providers’ efforts to address their patients’ non-medical barriers to treatment, as can embedding behavioral health providers within primary care offices. The study also underscores the need for trauma-informed care in primary care settings.

Opportunity to inform social needs within a hospital setting using data-driven patient engagement

“…9 10 This difference in rates of healthcare use among high-risk patients and the majority of healthcare users is especially pronounced when comparing those with and without a mental health disorder. 23 24 Such findings also serve to illustrate the importance of addressing another often-overlooked and systemically marginalising social need: substance use disorders, which was also found to be a frequent reason for emergency department visits by high-risk patients in the present study. Indeed, more than 50% of the patients in the study conducted by Rentas et al 23 had an ongoing substance disorder.…”

“…23 24 Such findings also serve to illustrate the importance of addressing another oftenoverlooked and systemically marginalising social need: substance use disorders, which was also found to be a frequent reason for emergency department visits by highrisk patients in the present study. Indeed, more than 50% of the patients in the study conducted by Rentas et al 23 had an ongoing substance disorder.…”

A unity of opposites: A prototypical case for the importance of primary-care providers in addressing mental health issues

“…PCPs are often the first point of contact for patients, putting them into a pivotal position to address mental illness in their community. This is attributed to the closer relationship patients may have with their PCP,[ 2 ] ease of access, and the stigma associated with seeing a psychiatrist. [ 6 ] Therefore, the PCP plays a crucial role in breaking barriers to initial treatment but also in facilitating treatment by mental health experts for the more complex cases.…”

“…Serving as critical pillars in the health-care network, primary-care providers (PCPs) are often the first point of contact for patients with mental health needs. [ 2 ] Unfortunately, mental illness is often underestimated and underprioritized by PCPs. [ 3 4 ] This case illustrates the potential deleterious consequences of unaddressed mental illness and the need for greater attention and priority by PCPs.…”

Expanding the Population Health Workforce: Strategic Priorities of Hospital Organizations in the United States

“…This finding is important because there is recent evidence that behavioral health needs are common in patients utilizing hospital care and that these needs are often identified, though not necessarily addressed as part of the regular cycle of CHNAs for nonprofit hospitals. 39,40 Though behavioral health was listed as the first choice in similar numbers to data-driven and business functions, it was only included in the rankings overall by 41% of hospitals. Other research has shown that hospitals are hesitant to address behavioral health as part of their population health efforts and show a tendency to cede behavioral health issues to other types of facilities, 41,42 which may be the case here as well.…”