The effects of interventions on quality of life, morbidity and consultation frequency in frequent attenders in primary care: A systematic review
Open accessAbstract
BACKGROUND: Patients visiting their GPs exceptionally often (frequent attenders, FAs) have high rates of somatic disease, emotional distress, psychiatric illnesses and social problems and require a disproportionate amount of their GPs' time. OBJECTIVES: To summarize which types of FA have been studied and what the effects of interventions were on quality of life (QoL), symptom severity of underlying illness(es) and consultation frequency. To discover when patients are considered FAs. METHODS: Systematic review of RCTs using a comprehensive search (MEDLINE, PsycINFO, CINAHL and EMBASE, from 1980 to August 2015) and no language restrictions. Two investigators extracted data. Results were summarized qualitatively. RESULTS: We included 17 RCTs. Heterogeneity at the level of populations, interventions and outcomes precluded statistical pooling. In-depth analysis by GPs assessing a patient's reasons for frequent attendance decreased consultation frequency by four to six per year. A small effect on symptom severity was noted in depressed FAs, although this finding was not replicated in a recent trial. Multi-component therapy and medication in FAs with medically unexplained symptoms (MUS) improved QoL (SF36 odds ratio: 1.92; 95%CI: 1.08-3.40) and morbidity (CES-D 3.17; 95%CI: 1.27-5.08). CONCLUSION: RCTs on intervention effects in frequent attenders to primary care used different patient populations, interventions, comparators and outcome measures. Consistent evidence on the effects of particular interventions in specific patient domains is lacking. A tailored approach based on in-depth analysis among GPs of potential reasons for frequent attendance may decrease consultation frequency. Research involving the screening and treating for FAs with MUS may be useful in future trials.
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A recent review showed that consistent evidence on the effects of particular interventions in specific frequent-attender patient domains is lacking.
“A recent review [7] showed that consistent evidence on the effects of particular interventions in specific FA patient domains is lacking.”
From One-session cognitive behavior treatment for long-term frequent attenders in primary care: randomized controlled trial (2019) · cites this paper as [7]
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- Authors
- Haroun, D., Smits, F., van Etten-Jamaludin, F., Schene, A., van Weert, H., & ter Riet, G.
- Affiliations
- University of Amsterdam (NL)
- Medical Library, Academic Medical Center, Amsterdam, The Netherlands;
- Amsterdam UMC Location University of Amsterdam (NL)
- Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands;
- Corresponding author
- Haroun, Dany
- Venue
- European Journal of General Practice
- Publisher
- Informa UK Limited
- Published
- 2016-04-02
- Volume
- 22
- Issue
- 2
- Pages
- 71-82
- ISSN
- 1381-4788 (ISSN-L)
- 1751-1402
- OpenAlex
- W2343707852
- Cited by
- 31
- References
- 30
- Citations by year
- 2026: 2 · 2023: 4 · 2022: 2 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 7 · 2017: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- European Journal of General Practice (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Radboud Repository (Radboud University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Figshare (cc-by)
- 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, quality of life, consultation frequency, morbidity, medically unexplained symptoms, depression, intervention effects
- MeSH terms
- Mental Disorders, Humans, Office Visits, Primary Health Care, Quality of Life, Severity of Illness Index, Somatoform Disorders, Randomized Controlled Trials as Topic, General Practice
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