The Discharged Chronic Patient's Utilization of Health Resources: A Preliminary Report

Abstract

The results of this preliminary study suggest that chronic psychiatric patients upon returning to the community do not pose a burden to physicians. This would appear to apply for at least a two-year period. In the present sample of 211 patients those relatively few exceptions tended to be individuals who developed illnesses requiring either surgical intervention or hospitalization for a major medical condition. One question that arises from the low utilization observed in the present study involves the adequacy of follow-up medical care received by these patients. This area poses problems for future investigation involving clinical work in the field.

Psychotherapeutic interventions in physical health: Effectiveness and economic efficiency.

“…The earliest research to suggest that psychiatric treatment reduced medical and surgical utilization was Avnet's (1962) observation, a year after initiation of claims for short-term psychiatric treatment, of a slight drop in what had been steadily increasing insurance claims from a group of subscribers. In another study, Cassell, Grunberg, and Fraser (1968) noted that discharged chronic mental patients, presumably treated while institutionalized, were significantly lower in utilization: of physician services following return to the community when compared to Saskatchewan Medical Insurance Commission statistics for the general population during a 3-year period. Only a minority of patients exceeded average utilization expenditures.…”

“…Only a minority of patients exceeded average utilization expenditures. While Cassell et al (1968) entertained the hypothesis that the study group was healthier after treatment in a sheltered environment, five other explanations, including availability of alternative sources of medical care and patient characteristics such as fear of being rehospitalized and incompetence in seeking medical advice, were considered by the investigators to be equally or perhaps even more plausible. Considering low utilization to be underutilization may be justified on economic as welf as humanitarian grounds; the patient who ignores obvious early symptoms of problems requiring medical treatment may eventually develop costly complications (Densen, Shapiro, & Einhorn, 1959).…”

Psychotherapeutic interventions in physical health: Effectiveness and economic efficiency.

“…T h e earliest research to suggest that psychiatric treatment reduced medical and surgical utilization was Avnet's (1 962) observation, a year after initiation of claims for short-term psychiatric treatment, of a slight drop in what had been steadily increasing insurance claims from a group of subscribers. In another study, Cassell, Grunberg, and Fraser (1968) noted that discharged chronic mental patients, presumably treated while institutionalized, were significantly lower in utilization of physician services following return to the community when compared to Saskatchewan Medical Insurance Commission statistics for the general population during a 3-year period. Only a minority of patients exceeded average utilization expenditures.…”

“…Only a minority of patients exceeded average utilization expenditures. While Cassell et al (1968) entertained the hypothesis that the study group was healthier after treatment in a sheltered environment, five other explanations, including availability of alternative sources of medical care and patient characteristics such as fear of being rehospitalized and incompetence in seeking medical advice, were considered by the investigators to be equally or perhaps even more plausible. Considering low utilization to be underutilization may be justified on economic as well as humanitarian grounds; the patient who ignores obvious early symptoms of problems requiring medical treatment may eventually develop costly complications (Densen, Shapiro, & Einhorn, 1959).…”

Methods of Evaluating Community Mental Health Programs

“…1) How far is the program reaching those who need its help 2) Is it providing adequate help to those it reaches 3) What results are achieved by its services 4) How efficiently and economically is the work carried out? In theory, these matters can only be assesed after their terms have been fully agreed upon and after a base for comparison has been found.…”