Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders

Smits, Frans ThM.; Brouwer, Henk J.; ter Riet, Gerben; van Weert, Henk C. P.
January 2009
BMC Public Health;2009, Vol. 9 Issue 1, p1
Academic Journal
Background: General Practitioners spend a disproportionate amount of time on frequent attenders. So far, trials on the effect of interventions on frequent attenders have shown negative results. However, these trials were conducted in short-term frequent attenders. It would be more reasonable to target intervention at persistent frequent attenders. Typical characteristics of persistent frequent attenders, as opposed to 1-year frequent attenders and non-frequent attenders, may generate hypotheses regarding modifiable factors on which new randomized trials may be designed. Methods: We used the data of all 28,860 adult patients from 5 primary healthcare centers. Frequent attenders were patients whose attendance rate ranked in the (age and sex adjusted) top 10 percent during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). All other patients on the register over the 3-year period were referred to as non-frequent attenders. The lists of medical problems coded by the GP using the International Classification of Primary Care (ICPC) were used to assess morbidity. First, we determined which proportion of 1-year frequent attenders was still a frequent attender during the next two consecutive years and calculated the GPs' workload for these patients. Second, we compared morbidity and number of prescriptions for non-frequent attenders, 1-year frequent attenders and persistent frequent attenders. Results: Of all 1-year frequent attenders, 15.4% became a persistent frequent attender equal to 1.6% of all patients. The 1-year frequent attenders (3,045; 10.6%) were responsible for 39% of the face-to-face consultations; the 470 patients who would become persistent frequent attenders (1.6%) were responsible for 8% of all consultations in 2003. Persistent frequent attenders presented more social problems, more psychiatric problems and medically unexplained physical symptoms, but also more chronic somatic diseases (especially diabetes). They received more prescriptions for psychotropic medication. Conclusion: One out of every seven 1-year-frequent attenders (15.4%) becomes a persistent frequent attender. Compared with non-frequent attenders, and 1-year frequent attenders, persistent frequent attenders consume more health care and are diagnosed not only with more somatic diseases but especially more social problems, psychiatric problems and medically unexplained physical symptoms.


Related Articles

  • Consider clinical trials.  // Family Practice Management;Feb2007, Vol. 14 Issue 2, p48 

    The article discusses the benefits of clinical trials for medical practitioners. Clinical trials can provide new treatment options, generate new revenue and boost the reputation of physicians. Clinical trials can help curtail elevating financial nursing costs and other expenses. Additional...

  • Diagnosis and treatment in inflammatory neuropathies. M P T Lunn // Postgraduate Medical Journal;Aug2009, Vol. 85 Issue 1006, p437 

    The inflammatory neuropathies are a large diverse group of immune-mediated neuropathies that are amenable to treatment and may be reversible. Their accurate diagnosis is essential for informing the patient of the likely course and prognosis of the disease, informing the treating physician of the...

  • US FDA-approved disease-modifying treatments for multiple sclerosis: review of adverse effect profiles. Galetta, Steven L.; Markowitz, Clyde // CNS Drugs;2005, Vol. 19 Issue 3, p239 

    Several disease-modifying agents (DMAs) are approved for the treatment of multiple sclerosis, including three interferon (IFN)-beta products, glatiramer acetate and mitoxantrone. This article reviews the adverse event profiles of these DMAs based on the pivotal phase III trials, and provides...

  • Patient agendas in primary care. Hamilton, William // BMJ: British Medical Journal (International Edition);5/27/2006, Vol. 332 Issue 7552, p1225 

    The article presents and comments on a trial of a self completed agenda form in primary care, that was included in a trial of general practitioner education. The general practitioners were randomized to either take part in an educational workshop to learn how to use the form, or to a control...

  • Does dictating the letter to the GP in front of a follow-up patient improve satisfaction with the consult? A randomised controlled trial. Ahmed, Jahangir; Roy, Amit; Abed, Tarik; Kotecha, Bhik // European Archives of Oto-Rhino-Laryngology;Apr2010, Vol. 267 Issue 4, p619 

    Various studies have shown that receiving a copy of the letter to the General Practitioner (GP) improves patient satisfaction with the consult. We aimed to establish whether dictating the letter to the GP in front of a listening patient does likewise. Follow-up patients have shorter allotted...

  • Primary care research: beyond statistics. Jiwa, Moyez // Quality in Primary Care;2007, Vol. 15 Issue 2, p71 

    The article contemplates on primary care research in Great Britain. The author considers the report which shows that hypertensive patients who are attending general practitioners are older compared to those recruited to clinical trials, an indication why stroke reduction guidelines were not...

  • GP Business: Diabetes care helped by nurse specialist.  // GP: General Practitioner;6/7/2004, p46 

    Nurse specialists can improve patient care, and help achieve quality targets, writes Lucie Benson. Nurse specialists in general practice may help reduce GPs' workload, and their skills in chronic disease management could help practices gain more quality points under new GMS. The Willow Wood...

  • Suivi partagé des patients atteints de cancers: projet d’essai clinique franco-britannique. Senn, A.; Coussens, E.; Czernichow, P. // Oncologie;Dec2007, Vol. 9 Issue 12, p870 

    The follow-up of cancer patients is a major challenge faced by Western healthcare systems, given demographic and epidemiological constraints. Within this context, patient follow-up involves basic organisational issues: how do you ensure the continuity of follow-up, while efficiently using the...

  • Bereavement care in general practice: a cluster-randomized clinical trial. Guldin, Mai-Britt; Vedsted, Peter; Jensen, Anders Bonde; Olesen, Frede; Zachariae, Robert // Family Practice;Apr2013, Vol. 30 Issue 2, p134 

    Background. The loss of a loved person may lead to complicated grief (CG). General practitioners (GPs) consider bereavement care to be important but find training for this task to be insufficient. We hypothesized that improvement in skills that facilitate early identification of CG and enhance...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics