Cited by 139Primary Care and Health OutcomesChronic Disease Management StrategiesEmergency and Acute Care Studies

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

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Smits, Frans ThM, Brouwer, Henk J, ter Riet, Gerben, van Weert, Henk CP·2009·BMC Public Health

DOI 10.1186/1471-2458-9-36PMC PMC2649070

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Abstract

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.

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Figure 1 Flow diagram: Persistence of Frequent Attendance.CC BY · PubMed Central

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Carney TA, Guy S, Jeffrey G: Frequent attenders in general practice: a retrospective 20-year follow-up study. Br J Gen Pract. 2001, 51: 567-569.

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“Studies have indicated that FA is often temporary and when the underlying health problem has been solved, the use of health care services diminishes, but 15% of one-year FAs continue to attend frequently in the following years [5].”
BackgroundInfluential
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Authors: Smits, F. T., Brouwer, H. J., ter Riet, G., & van Weert, H. C.
Affiliations: Amsterdam UMC Location University of Amsterdam (NL)
Corresponding author: Smits, Frans ThM
ORCID: Smits, Frans ThM
Venue: BMC Public Health
Publisher: Springer Science and Business Media LLC
Published: 2009-01-24
Volume: 9
Issue: 1
Pages: 36-36
ISSN: 1471-2458 (ISSN-L)
DOI: 10.1186/1471-2458-9-36
PMC: PMC2649070
OpenAlex: W1976363983
Cited by: 139
References: 30
Citations by year: 2026: 2 · 2025: 2 · 2024: 5 · 2023: 8 · 2022: 3 · 2021: 10 · 2020: 12 · 2019: 15 · 2018: 12 · 2017: 10 · 2016: 17 · 2015: 8 · 2014: 5 · 2013: 10 · 2012: 6
FWCI: 11.44
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/2.0 (tdm)
Locations: BMC Public Health (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
UvA-DARE (University of Amsterdam) (publishedVersion, cc-by)
Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion)
UvA-DARE (University of Amsterdam) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Pure Amsterdam UMC (submittedVersion)
Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Zurich Open Repository and Archive (University of Zurich)
Funders: Universiteit van Amsterdam
Topics: Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
Keywords: frequent attenders, general practitioner workload, morbidity, prescribing patterns, psychotropic drugs, medically unexplained physical symptoms, mental illness, social problems, chronic somatic diseases, diabetes mellitus, primary care utilization, International Classification of Primary Care
MeSH terms: Adolescent, Adult, Age Factors, Drug Utilization, Family Practice, Female, Health Services Misuse, Humans, Male, Middle Aged, Morbidity, Netherlands, Office Visits, Physician-Patient Relations, Probability, Sensitivity and Specificity, Sex Factors, Cohort Studies, Incidence, Survival Analysis, Health Care Surveys, Prescriptions, Young Adult

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

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