Successful GP intervention with frequent attenders in primary care: randomised controlled trial
Open accessAbstract
BACKGROUND: Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results. AIM: To assess the effectiveness of a GP intervention to reduce frequent-attender consultations. DESIGN OF STUDY: Randomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention). SETTING: A health centre in southern Spain. METHOD: Six GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year post-intervention. Baseline measurements were recorded of sociodemographic characteristics, provider-user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used. RESULTS: A multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI]=11.39 to 14.94); in the CG1 group was 19.37 (95% CI=17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI=4.84 to 18.72). CONCLUSION: The new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders.
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Close medication management, GP training, care coordination and psychological interventions such as CBT have been effective in either improving mental health or reducing service use.
“Close medication management, GP training, care coordination and psychological interventions such as cognitive behaviour therapy (CBT) have been effective in either improving mental health or reducing service use, 9,10”
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 [10]
The ‘7 hypothesis + team’ intervention section describes GP training, and the Results report significantly fewer consultations among frequent attenders receiving the intervention than in either control group. The paper does not establish that close medication management, care coordination, or CBT were effective interventions, and it did not assess improvement in mental health after the intervention. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis study further supports liaison between GPs and mental health professionals to manage frequent attendance.
“This study further supports liaison between GPs and mental health professionals to manage frequent attendance. 10”
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 [10]
The ‘7 hypothesis + team’ intervention section describes GPs working together to plan care for frequent attenders, and the Implications for clinical practice recommend team-based strategies. Neither passage supports the more specific claim of liaison between GPs and mental health professionals. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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- Authors
- Bellón, J. Á., Rodríguez-Bayón, A., de Dios Luna, J., & Torres-González, F.
- Affiliations
- Universidad de Málaga (ES)
- ORCID
- Bellón, Juan Ángel
- Venue
- British Journal of General Practice
- Published
- 2008-05-01
- Volume
- 58
- Issue
- 550
- Pages
- 324-330
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC2435670
- OpenAlex
- W2118013607
- Cited by
- 49
- References
- 42
- Citations by year
- 2026: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 2 · 2013: 5 · 2012: 7
- FWCI
- 8.36
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Sociedad Española de Medicina de Familia y Comunitaria
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- frequent attenders, primary care workload, biopsychosocial model, physician-patient relationship, general practice training
- MeSH terms
- Adolescent, Adult, Aged, Appointments and Schedules, Family Practice, Female, Health Services Misuse, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Practice Management, Medical, Spain
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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