Psychosocial assessment of the high utilizer of occupational health services

Abstract

The reasons for high utilization of services are many and complex. They range from major, long-term psychiatric problems to a more general need for reassurance and information. This article has outlined the major psychosocial reasons for this pattern and offered an assessment for use by occupational health nurses. The primary areas of assessment include: - Determine whether a somatization disorder may exist and refer for psychiatric consultation if the client meets the criteria. - Determine whether a history of symptoms of depression and/or an anxiety/panic disorder is present. - Explore any situational stresses or problems in the social or work environment. - Evaluate the meaning of the symptoms, expectations for the visit, and need for reassurance/information. - Analyze the social network in relationship to the symptoms and the illness. The occupational health nurse is in an excellent position to identify and assess the high utilizer of services. This assessment can lead to identification of the needs of the client so that an ongoing pattern of over-utilization does not occur. This process hopefully will decrease symptoms, need for testing, medication, and possible iatrogenic disease, and their costs to the client and the employer. Management of the care of the high utilizer over time is not addressed here. Rather, the beginning process of a careful assessment which is the first step in good management is outlined.