T1025 IBS and outpatient services : towards the development of an empirical model of health care utilization

Patients with Irritable Bowel Syndrome (IBS) are described as frequent users of health services(Creed, 1997). Typically, high levels of psychopathology are cited as the main determinantaccounting for 42% of variance on health care use (Herschbach et al., 1999). Adopting anexploratory and patient focused approach, we aimed to identify additional factors potentiallyimplicated in health care use. Methods: Twenty-one outpatients, 19 to 71 yrs (M = 44.23,SD, 15.18), were recruited using a purposive sampling framework for maximum variation.A semi-structured interview was administered and transcribed. Interviews were assessed foremerging themes and principles of grounded theory (Glaser, 1978) were used to developa model of health care utilisation. Results: The model depicts a range of factors potentiallyimpacting on health care use. Whilst some patients noted the existence of psychopathologyA-467 AGA Abstracts(e.g., predominantly anxiety and depression), cognitive factors (e.g., ideas of normalcy, overmonitoringof foods and symptoms, erroneous conclusions, catastrophising, and attributionsmade regarding the cause of symptoms) appear to play a larger role in patients' experienceof IBS symptoms and subsequent health seeking behaviour. Conclusions: It is likely that adirect effects model (i.e., psychopathology causes increased health care use) provides asimplistic and inaccurate explanation concerning why patients are frequent users of healthservices. Such an account will do little to improve efficiency in health care. Instead, attempts to reduce return visits will involve holistic and collaborative approaches to care (e.g., Talley& Spiller, 2002). Specifically, targeting risk factors associated with return visits may involve a focus on patients' cognitions, unrealistic expectations, and the proposal of more adaptive coping strategies. Future research will involve an empirical assessment of the health care utilisation model presented. References Creed, F. (1997). Who needs a doctor for IBS? Gut,41 (3), 415-416 Glaser, B.G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. CA: Sociology Press. Herschbach, P. Henrich, G. & von Rad, M. (1999).Psychological factors in functional bowel disorders: Characteristics of the disorder or the illness behavior? Psychosomatic Medicine, 61(2), 148-153. Talley, N.J. & Spiller, R. (2002).Irritable bowel syndrome: A little understood bowel disease? The Lancet, 360 (9332),555-580.