Elsevier

General Hospital Psychiatry

Volume 33, Issue 4, July–August 2011, Pages 343-346
General Hospital Psychiatry

Psychiatry and Primary Care
Utilization of primary care physicians in borderline personality

https://doi.org/10.1016/j.genhosppsych.2011.04.006Get rights and content

Abstract

Objective

Individuals with borderline personality disorder (BPD) consistently demonstrate high patterns of utilization in both mental health and non-psychiatric settings. However, utilization of primary care physicians by these individuals has not been examined. In this study, we examined physician use patterns and hypothesized that primary care outpatients with BPD features would evidence higher numbers of primary care physicians seen, primary care treatment settings experienced, and specialists seen.

Method

Using a cross-sectional consecutive sample of 389 internal medicine outpatients and a self-report survey methodology, we examined the number of primary care physicians seen, primary care treatment settings experienced, and specialists seen by participants during the past 5 years in relationship to two self-report measures for BPD, the BPD scale of the Personality Diagnostic Questionnaire-4 and the Self-Harm Inventory.

Results

There were statistically significant between-group differences in the number of primary care physicians and specialists seen (not the number of primary care treatment settings) over 5 years, and BPD status according to both measures of BPD, with BPD patients reporting higher rates.

Conclusions

Patients with borderline personality symptomatology appear to see a greater number of primary care physicians and specialists than patients without these Axis II symptoms. These findings may reflect the underlying psychological processes of the disorder as well as a general pattern of over-utilization of healthcare services by these types of patients.

Introduction

In a number of studies, individuals with borderline personality disorder (BPD) have been found to be high utilizers of various types of healthcare services. For example, in mental health settings, we found that, compared to nonBPD psychiatric inpatients, inpatients with BPD had significantly higher rates of psychiatric hospitalization, numbers of psychiatrists/therapists seen, and numbers of psychotherapy courses [1]. Bender and colleagues found that, compared to individuals with major depression, those with BPD were significantly more likely to use most types of psychiatric treatment [2]. In a study of psychiatric outpatients, we found that those with BPD evidenced a significantly greater number of psychotherapy sessions as well as a greater number of prescriptions than nonBPD patients [3]. Finally, in an Australian community sample, Jackson and Burgess found that individuals with BPD were more likely than other individuals to seek psychiatric or psychological consultation [4]. On a side note, some evidence suggests that women with BPD may use more mental health services than men with BPD [5].

In addition to high utilization of mental health services, individuals with BPD appear to be high utilizers of various medical services, as well. In this regard, studies have found that compared with nonBPD participants, individuals with BPD demonstrate significantly higher utilization patterns that are characterized by more frequent office visits [6], [7], [8], greater numbers of prescriptions [7], [8], and more telephone calls to the office [8]. In a sample of veterans, Black and colleagues found that those with BPD features also demonstrated more outpatient and emergency-room visits as well as a greater number of inpatient stays [9]. Finally, Frankenburg and Zanarini found that BPD patients in remission used significantly fewer analgesics, fewer hypnotics, and had fewer visits to the emergency room than BPD patients not in remission [10]. According to Blum and colleagues, high utilization of medical services among those with BPD tends to increase with age, as expected [11].

Given the seemingly consistent pattern of high utilization of mental health and medical services among individuals with BPD, we wondered about the utilization of primary care physicians—an area of investigation that to our knowledge has not been explored or reported in either the PubMed or PsycINFO databases. We hypothesized that individuals with BPD would evidence a greater number of contacts with different primary care physicians as well as specialists, and a greater number of different primary care treatment settings.

Section snippets

Method

Participants were males and females, ages 18 years or older, being seen at an outpatient internal medicine clinic for non-emergent medical care. The outpatient clinic is staffed by both faculty and residents in the department of internal medicine, and is located in a mid-sized, mid-western city. The majority of patients recruited for this study were seen by resident providers. The recruiter excluded individuals with compromising medical (e.g., severe pain), intellectual (e.g., mental

Results

Although the possible response choices for each of the three measures of physician usage during the previous five years ranged from 1 to 10, between 7.3-12.5% wrote in 0, depending on the question. So, “0” responses were coded as such. With regard to the number of primary care physicians seen, actual responses ranged from 0-“10 or more” (M=1.97, SD=1.59). However, the majority of respondents indicated 1 (37.8%) or 2 (32.1%). With regard to the number of primary care offices used, actual

Discussion

Our findings indicate that compared to outpatients without borderline personality symptomatology, those with such symptoms tend to experience significantly greater turn-over in primary care physicians and see a greater number of specialists. However, they do not report a greater number of different primary care office sites. This utilization pattern of primary care physicians suggests a possible lack in the continuity of medical care.

What might explain the relatively higher turnover in primary

References (19)

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