Patterns of medical utilization before the first hospitalization for women with anorexia nervosa in Taiwan

Objective The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. Method We selected female anorexia nervosa patients (n = 239) and control participants hospitalized for peptic ulcers (n = 478) or appendectomy (n = 478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed. Results Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6 ± 45.0 visits; peptic ulcers, 45.3 ± 37.3 visits; appendectomy, 32.5 ± 26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency. Conclusions We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted.