Clinical characteristics of persistent frequent attenders in primary care: case–control study

Patel, Shireen; Kai, Joe; Atha, Christopher; Avery, Anthony; Guo, Boliang; James, Marilyn; Malins, Samuel; Sampson, Christopher; Stubley, Michelle; Morriss, Richard

Abstract

Background. Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status.

Objective. To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice.

Methods. Case–control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years.

Results. Compared to NAs, FAs were more likely to report a lower quality of life (P < 0.001), be unmarried (P = 0.03) and have no educational qualifications (P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety (P < 0.001), morbid obesity (P = 0.02), pain (P < 0.001) and long-term pathological and ill-defined physical conditions (P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001).

Conclusions. Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity.

Citation

Patel, S., Kai, J., Atha, C., Avery, A., Guo, B., James, M., …Morriss, R. (2015). Clinical characteristics of persistent frequent attenders in primary care: case–control study. Family Practice, cmv076. https://doi.org/10.1093/fampra/cmv076

• Journal Article Type: Article
• Acceptance Date: Oct 1, 2015
• Online Publication Date: Oct 8, 2015
• Publication Date: Oct 8, 2015
• Deposit Date: Oct 14, 2015
• Publicly Available Date: Oct 14, 2015
• Journal: Family Practice
• Print ISSN: 0263-2136
• Electronic ISSN: 1460-2229
• Publisher: Oxford University Press
• Peer Reviewed: Not Peer Reviewed
• Pages: cmv076
• DOI: https://doi.org/10.1093/fampra/cmv076
• Keywords: Medically Unexplained Symptoms, Primary Care, mental health, Depression, Mood Disorder, Quality of Life, Anxiety, Anxiety; Disorder, Access to Care
• Public URL: https://nottingham-repository.worktribe.com/output/764363
• Publisher URL: http://fampra.oxfordjournals.org/content/early/2015/10/07/fampra.cmv076
• Additional Information: This article has been accepted for publication in Family Practice. Published by Oxford University Press.