AN INSTRUMENT FOR THE PSYCHOLOGICAL ASSESSMENT OF CHRONICITY IN PATIENTS

Abstract

Almost everyone experiences an incident, illness, or concern that requires clinical advice or assistance. Most persons obtain the desired care and renew their daily activities. Some people, however, appear to be (medical) problem-prone, wellness-resistant or reinforced by illness sequelae. Individuals who maintained illness behaviors are often called, for example, chronic pain, asthma, or psychiatric patients by caregivers who focus on diagnoses. Some patients may be viewed as primarily chronic, with specific diagnoses considered secondary. Chronicity is here defined as a measure of individual, situation, exposure, and provider interaction outcomes. Independent of disease processes, chronicity-producing interactions often predict inappropriate and atypical medical utilization patterns. The assessment of chronicity, its precursors, and dynamics may identity high risk person, situation, provider, and environment combinations and permit more effective and relevant prevention and treatment strategies. The study patient chronicity, the Pre-Assistance Questionnaire (PAQ) was developed with 320 items on medical, personal, and situational topics. PAQ responses from 60 medical and 40 psychiatric VA outpatients were correlated with three estimators of patient chronicity: PAQ totals (from an empirically-derived key), clinicians' subjective ratings of patients' chronicity, and indices of subjects' 2 year use of VA medical center resources. PAQ totals correlated significantly with 240 items, medical usage with 119, and clinicians' ratings with 100. For replication, a 40 item short form was given to 120 medical and 80 psychiatric outpatients. Thirty-four items correlated significantly with two of the three measures, 26 with all three. The short form demonstrated high reliability (alpha = .91; test-retest reliability = .90; split-half reliability = .89). PAQ totals, chronicity ratings, and use indices showed no significant differences across from administrations although the psychiatric patients scored significantly higher (more chronic) on all measures. The findings support a general chronicity construct and suggest many applications from the screening of potential employees to the development of specific treatment plans matched to particular PAQ patterns. The major message, however, is that public health, medical, psychological, and sociological constructs may be integrated into a comprehensive model of medical utilization patterns that provides views of illness, wellness, and health care delivery and assessment.