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The Patients’ Illness Perceptions and the Use of Primary Health Care

From the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark (L.F., P.F., K.S.C., T.T., E.O.); Research Unit of General Practice, Aarhus University, Aarhus, Denmark (F.O.); Health Psychology Section, Department of Psychology (at Guy’s), Institute of Psychiatry, Thomas Guy House, London, United Kingdom (J.W.).

Address correspondence and reprint requests to Lisbeth Frostholm, MSc, The Research Clinic for Functional Disorders and Psychosomatics, Noerrebrogade 44, Aarhus University Hospital, DK-8000 Aarhus C, Denmark. E-mail: frost{at}as.aaa.dk

Objective: To investigate if primary care patients’ perceptions of a current health problem were associated with use of health care.

Method: One thousand seven hundred eighty-five patients presenting a new health problem to 1 of 38 physicians from 28 general practices in Aarhus County, Denmark. Patients completed a questionnaire on their illness perceptions and emotional distress before the consultation. The physicians completed a questionnaire for each patient on diagnostics and prognostics. Register data on primary health care utilization 3 years before and 2 years after baseline were obtained. Odds ratios were estimated to examine associations between previous health care use and illness perceptions. Linear regression analysis was performed to examine if illness perceptions predicted later health care use.

Results: Previous use: Higher use was associated with psychosocial, stress, and lifestyle attributions. Accident/chance attributions were associated with higher use for patients with a chronic disorder but with lower use for patients without a chronic disorder. A strong illness identity (number of self-reported symptoms), illness worry, a long timeline perspective, a belief that the symptoms would have serious consequences, and all emotional distress variables were associated with higher use. Use during follow-up: Infection/lowered immunity attributions were associated with higher use for patients with a chronic disorder, whereas psychosocial and lifestyle attributions were associated with higher use for all patients. Illness worry and all emotional distress variables predicted higher health care use. A strong illness identity, a long timeline perspective, a belief in serious consequences, and stress and accident/chance attributions were among the strongest predictors of health care use in a multivariate model including all variables.

Conclusions: Patients’ perceptions of a current health problem are associated with health care use and may offer an obvious starting point for a biopsychosocial approach in primary care.

Key Words: illness perception • health care use • primary care

Abbreviations: CI = confidence interval; IPQ = Illness Perception Questionnaire; IR = interquartile range; SCL-SOM = the Symptom Check List-Somatization Subscale; DKK = Danish Kroners.

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