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Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study

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


Samuel Malins

Christopher Atha

Professor of Health Economics

Christopher Sampson

Michelle Stubley

Professor of Psychiatry & Community Mental Health


Background: Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use.

Aim: To explore the feasibility and acceptability of cognitive-behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost-effectiveness.

Design and Setting: A CBT case series was carried out in five GP practices.

Method: Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments.

Results: Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over median three months. Twenty-four (75%) attended > 6 sessions. Eighteen FAs (86%, n=21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (55%, n=24) achieved clinically important improvement on the SF-36 Mental-Component Scale at six month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from median eight contacts in three months at baseline (n=32) to three contacts in three months at one year (n=18).

Conclusion: CBT appears feasible and acceptable to a sub-set of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach might contribute to decreasing GP workload and merits larger-scale evaluation.


Malins, S., Kai, J., Atha, C., Avery, A., Guo, B., James, M., …Morriss, R. K. (2016). Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study. British Journal of General Practice, 66(651), e729-e736.

Journal Article Type Article
Acceptance Date Apr 20, 2016
Online Publication Date Sep 29, 2016
Publication Date 2016-10
Deposit Date Jun 5, 2016
Publicly Available Date Sep 29, 2016
Journal British Journal of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 66
Issue 651
Pages e729-e736
Keywords Frequent attendance; primary health care; cognitive behaviour therapy; health anxiety; medically unexplained symptoms; quality of life; costs
Public URL
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