Predictors of health care utilization in patients with inflammatory bowel disease: a longitudinal study

OBJECTIVES: To predict health care utilization in patients with inflammatory bowel disease (IBD). METHODS: The health care utilization of 222 consecutive IBD patients was studied twice over the course of one year. Utilization consisted of medical care, including visits to the gastroenterologist and the general practitioner, and non-medical care, including use of a psychotherapist, a dietitian or home care nurse in the last six months. Prior and concurrent socio-demographic, disease-related and psychosocial factors were measured and their association with patient health care utilization was determined. RESULTS: Poor quality of life, disease burden experienced and depression were significantly (P <0.01) associated with more visits to both gastroenterologist and GP. Disease activity was found to be significantly correlated to gastroenterologist visits, while female gender was associated with GP visits. Other socio-demographic and disease-related factors were not related to medical care utilization. Results of regression analysis indicated that prior disease burden experienced, social functioning and female sex are the best predictors of physician visits a year later. Of the concurrent factors, the best predictors were disease activity, emotional and social functioning, and disease burden experienced. Psychotherapy and home care were significantly correlated (P <0.01) with co-morbidity, disease activity, quality of life and depression. Non-medical care utilization was not related to the majority of sociodemographic factors. CONCLUSION: Psychosocial factors, such as poor quality of life and disease burden experienced, are important predictors of health care utilization in IBD patients. Addressing these problems should not only increase the patient's quality of life, but also minimize health care utilization