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Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention

Morriss, Richard K.; Kai, Joe; Atha, Christopher; Avery, Anthony; Bayes, Sara; Franklin, Matthew; George, Tracey; James, Marilyn; Malins, Samuel; McDonald, Ruth; Patel, Shireen; Stubley, Michelle; Yang, Min

Authors

Richard K. Morriss richard.morriss@nottingham.ac.uk

Joe Kai

Christopher Atha

Anthony Avery

Sara Bayes

Matthew Franklin

Tracey George

Marilyn James marilyn.james@nottingham.ac.uk

Samuel Malins

Ruth McDonald ruth.mcdonald@manchester.ac.uk

Shireen Patel

Michelle Stubley

Min Yang min.yang@nottingham.ac.uk



Abstract

Background:

The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context.
Methods/design:

A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined.
Discussion:

The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.

Journal Article Type Article
Publication Date May 20, 2012
Journal BMC Family Practice
Electronic ISSN 1471-2296
Publisher Humana Press
Peer Reviewed Peer Reviewed
Volume 13
Issue 39
Institution Citation Morriss, R. K., Kai, J., Atha, C., Avery, A., Bayes, S., Franklin, M., …Yang, M. (2012). Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Family Practice, 13(39), doi:10.1186/1471-2296-13-39
DOI https://doi.org/10.1186/1471-2296-13-39
Publisher URL http://www.biomedcentral.com/1471-2296/13/39
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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