Relationship of anxiety, depression and alcohol use disorders to persistent high utilization and potentially problematic under-utilization of primary medical care

Psychiatric disorders in primary medical care are prevalent, frequently undetected, under-treated, and costly. Studies report that psychiatric disorders are associated with high utilization of healthcare, but the stability of high utilization has not been systematically examined. Medical records data for 500 primary care patients in Connecticut, USA, representing high and modal utilization levels were examined over a 2-year period. In multi-variate analyses, only anxiety disorders were associated with persistent high utilization of primary care, as well as with inconsistent attendance. Alcohol use disorders were inversely associated with persistent high utilization, and positively related to inconsistent attendance and low complexity services (determined by evaluation and management coding). Depression was associated with low complexity primary care services and inconsistent attendance. Anxiety disorders and mixed anxiety-depression disorders warrant attention as potential contributors to persistent high or inconsistent utilization of primary healthcare. Alcohol use disorders may be under-treated in primary care due to inconsistent attendance, few visits, and low complexity services.