The DOI matches its Crossref record; 30 of the 30 references it cites were found in a registry or an index.
Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders
Open accessAbstract
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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“Defined in this way, most frequent attenders return to normal consultation rates within 12months. 12”
From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [12]
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“Even then the threshold was not high enough to apply the clinical differentiation suggested, 12 and did not report change in service use.”
From Cognitive behaviour therapy for long-term frequent attenders in primary care: A feasibility case series and treatment development study (2016) · cites this paper as [12]
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A structural approach to selection bias
Hernán, M. A., Hernández-Díaz, S., & Robins, J. M. (2004) · Epidemiology · doi:10.1097/01.ede.0000135174.63482.43 · Cited by 2,844
International Classification of Primary Care
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Frequent attenders with medically unexplained symptoms: service use and costs in secondary care
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Persistent presentation of medically unexplained symptoms in general practice
Verhaak, P. F. M. (2006) · Family Practice · doi:10.1093/fampra/cml016 · Cited by 211
Cost-effectiveness of Systematic Depression Treatment for High Utilizers of General Medical Care
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Research works printed but not linked: 1
- 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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Somatoform Disorders and Medically Unexplained Symptoms in Primary Care
Haller, H., Cramer, H., Lauche, R., & Dobos, G. (2015) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2015.0279 · Cited by 284
Frequent users of US emergency departments: characteristics and opportunities for intervention
Vinton, D. T., Capp, R., Rooks, S. P., Abbott, J., & Ginde, A. A. (2014) · Emergency Medicine Journal · doi:10.1136/emermed-2013-202407 · Cited by 155
The Unifying Concept of Illness Behavior
Sirri, L., Fava, G. A., & Sonino, N. (2013) · Psychotherapy and Psychosomatics · doi:10.1159/000343508 · Cited by 121
Hudon, C., Chouinard, M., Pluye, P., Sherif, R. E., Bush, P. L., Rihoux, B., Poitras, M.-È., Lambert, M., Zomahoun, H. T. V., & Légaré, F. (2019) · The Annals of Family Medicine · doi:10.1370/afm.2419 · Cited by 99
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 57
Metadata
- 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
- Published
- 2009-01-24
- Volume
- 9
- Issue
- 1
- Pages
- 36-36
- ISSN
- 1471-2458 (ISSN-L)
- 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
- 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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