High utilizers of ambulatory care services: 6-year followup at Alaska Native Medical Center.

In a retrospective study, 100 randomly selected, high utilizers of ambulatory care services in 1972 were followed for a 6-year period, 1973-78. The 22 men and 78 women had visited the Alaska Native Medical Center in Anchorage 15 or more time in 1972. Each patient was matched by age and sex with a control patient who had made three or fewer visits. There were predominately more women than men in all age groups in the high-utilizer group and in all but one age group in the general clinic population. High-utilizer men as a group were older than high-utilizer women. In the followup period, the men in the high-utilizer group had three times the number of hospitalizations as the controls, and women had two times the number. At the end of the followup period, 1 of every 4 men in the high-utilizer group had died, and 1 of every 10 women had died. One-half of these deaths were associated with alcohol. Several approaches to high-utilizer patients are useful. A well-organized medical record, with a complete problem list and index, is imperative. Just as helpful is only having one or several health care providers consistently see the patient at each encounter. Until there is more study of these complex issues, high utilizers must be recognized as a subgroup of patients at high risk for hospitalization and early death.