Functional versus Structural Social Support and Health Care Utilization in a Family Medicine Outpatient Practice

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Abstract
Three hundred forty-three family-practice patients were surveyed by questionnaire and medical record audit to evaluate the relationships between social support and medical care utilization. Social support was not associated with laboratory test ordering. The mean number of office visits per year was higher for patients with low versus high confidant support (4.71 vs. 3.81, P < 0.10) and affective support (5.21 vs. 3.60, P < 0.05). Mean total charges in 1 year were higher for patients with low versus high confidant support ($232 vs. $148, PP < 0.05). Poor confidant and affective support were both associated with longer visits. Structural measures of social support were not related significantly to any utilization indicator. These findings were maintained in multiple-regression models controlling for physical health and seven demographic characteristics. Second-order regression models revealed interaction by race, employment status, and sex. Blacks showed no effect of confidant support on office visits. Poor confidant support resulted in $201 more in total charges for the unemployed (P= 0.003) versus $49 more for the employed (P = 0.15). Women with low affective support had $119 more in charges P=0.001) versus $16 less for men (P = 0.82). The results suggest that low functional social supports are important determinants of increased medical service utilization and that they may have differential effects by race, sex, and employment status, all of which should be considered independently in future studies.

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