Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: A prospective cohort study
Abstract
Background Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. Methods Two-year prospective cohort study in 623 incident adult frequent attenders (>90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. Results Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3years and the number of life events in 3years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28-point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. Conclusion Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effectiv…
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The results are representative of FAs in general.
“Although only a low proportion of FAs and NAs responded to the study, there is enough similarity with anonymized record-based studies involving other varied practice samples ( 6 , 8 , 9 , 23 , 24 ) to believe that our results are representative of FAs in general.”
From Clinical characteristics of persistent frequent attenders in primary care: Case-control study (2015) · cites this paper as [9]
Cites
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“Although treatment of anxiety and depression has been shown to be effective [51–57], its effect in preventing persistence of FAs is unclear and needs to be demonstrated in research [58].”
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Clinical characteristics of persistent frequent attenders in primary care: Case-control study
Patel, S., Kai, J., Atha, C., Avery, A., Guo, B., James, M., Malins, S., Sampson, C., Stubley, M., & Morriss, R. (2015) · Family Practice · doi:10.1093/fampra/cmv076 · Cited by 56 · see citing works
Cognitive behavioral therapy for frequent attenders in primary care
Strömbom, Y., Karlsson, J., Fredrikson, M., Melin, L., & Magnusson, P. (2018) · Health Science Reports · doi:10.1002/hsr2.80 · Cited by 4 · see citing works
- Authors
- Smits, F. T., Brouwer, H. J., Zwinderman, A. H., Mohrs, J., Schene, A. H., van Weert, H. C. P. M., & ter Riet, G.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Smits, Frans T
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 2014-12
- Volume
- 77
- Issue
- 6
- Pages
- 492-503
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W2051533635
- Cited by
- 58
- References
- 8
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 3 · 2022: 4 · 2021: 5 · 2020: 11 · 2019: 9 · 2018: 6 · 2017: 2 · 2016: 7 · 2015: 4
- FWCI
- 7.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- frequent attenders, primary care, psychosocial factors, anxiety, panic disorder, life events, illness behavior, mastery, health care utilization, multimorbidity, health care costs
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Mental Disorders, Female, Follow-Up Studies, Humans, Life Change Events, Male, Middle Aged, Primary Health Care, Prospective Studies, Surveys and Questionnaires, Time Factors, Logistic Models, Odds Ratio, Panic Disorder
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