On the relationship between weight status and doctor shopping behavior-evidence from Australia

Abstract

Objective: A recent study has suggested that overweight and obese people are more likely to consult a range of physicians (doctor shopping). The consistency of this finding with multiple measures of doctor shopping and controls for socioeconomic circumstances was interrogated. Design and Methods: Ninety-nine thousand four hundred seven Australians aged 45 and over who had sought primary healthcare at least five times within 6 months of a survey (2006)(2007)(2008). (i) The count of different physicians consulted; a binary indicator of (ii) > 5 three different physicians; (iii) > 5 five different physicians; and iv) a measure that took into account multiple consultations with the same physician were investigated. Weight status was measured using Body Mass Index (BMI) based on self-reported height and weight. Controls included socioeconomic circumstances, demographics, health, and neighborhood factors. Results: In comparison to people with "normal" BMI, the likelihood of doctor shopping was lower among overweight (Incidence Rate Ratio: 0.97, 95%CI: 0.96, 0.98) and obese people (0.95: 0.93, 0.96). This negative correlation between doctor shopping behavior and weight status was consistent after full adjustment and across different outcome measures. Conclusions: In contrast with recent evidence from the US, overweight and obese Australians are less prone to doctor shopping behavior than their peers with "normal" BMI.

People with multiple unhealthy lifestyles are less likely to consult primary healthcare

“…This is supported by findings from a recent study in the same geographic area which documented a higher risk of avoidable hospital admissions among people who reported multiple unhealthy lifestyles [23]. For a fuller overview of engagement with the health system, it would be useful for future studies to investigate patterns of overall health service use across primary, secondary and tertiary healthcare [24]. …”

Prior doctor shopping resulting from differential treatment correlates with differences in current patient‐provider relationships

“…In contrast, an analysis of Australian patients did not find a difference in doctor shopping by weight status (17). A few factors may contribute to their null findings.…”

Characteristics of doctor-shoppers: a systematic literature review

“…Narcotics, orthopaedic trauma Okumura 2016 [48] Insurance database Benzodiazepines Pradel 2004 [45] Prescription database Buprenorphine Agrawal 2016 [7] Visiting ≥1-5 doctors during the same illness episode. Questionnaire Diabetes Chang 2012 [28] Insurance database Colorectal cancer Feng 2013 [35] Questionnaire Overweight Gudzune 2014 [13] Internet-based survey Overweight Gudzune 2013 [37] Claims data, health risk assessments Overweight Kappa 2016 [9] Retrospective study, medical records Nephrolithiasis, opioids…”

“…In studies enrolling patients with chronic conditions such as diabetes [7], eye floaters [26], or nephrolithiasis [9], the definition of doctor-shopping specified a higher number of visits, whereas in cases of urgent conditions or infections, definitions specified a timeframe and were, for example, limited to one day [27] or to the same illness episode [6,10,12,[28][29][30][31][32][33][34]. Studies focusing on the evaluation of doctor-shopping in general medicine or primary doctor facilities had longer timeframes of 1 year [35,36], 2 years [37], or even 3 years [38]. Definitions of doctorshopping in the studies identified are presented in Table 3.…”

“…Overall, 17 (39.5%) studies were conducted in the USA, out of which 9 were based solely on retrospective data from large databases [9,11,13 [6,8,10,29,33], and 4 (9.3%) in Japan [12,31,32,48]. There was a one study from Australia and one from India [7,35]. The studies were performed in countries where patients can visit medical institutions freely under the national health system and/or have access to all institutions and specialists without a referral.…”