Predictability of persistent frequent attendance: a historic 3-year cohort study
Open accessAbstract
BACKGROUND: Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders. AIM: To develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records. DESIGN OF STUDY: A historic 3-year cohort study. METHOD: Data of 28 860 adult patients from 2003 to 2005 were examined. Frequent attenders were patients whose attendance rate ranked in the (age- and sex-adjusted) top 10% during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). Bootstrapped multivariable logistic regression analysis was used to determine which predictors contained information on persistent frequent attendance. RESULTS: Of 3045 1-year frequent attenders, 470 (15.4%) became persistent frequent attenders. The prediction rule could update this prior probability to 3.3% (lowest value) or 43.3% (highest value). However, the 10th and 90th centiles of the posterior probability distribution were 7.4% and 26.3% respectively, indicating that the model performs modestly. The area under the receiver operating characteristic curve was 0.67 (95% confidence limits 0.64 and 0.69). CONCLUSION: Among 1-year frequent attenders, six out of seven are transient frequent attenders. With the present indicators, the rule developed performs modestly in selecting those more likely to become persistent frequent attenders.
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Those who continue to frequently attend for a second year are likely to continue attending at a high rate.
“Those who continue to frequently attend for a second year are likely to continue attending at a high rate. 4”
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 [4]
The ‘Persistent frequent attenders’ section (page unavailable) reports that 1,008 patients attended frequently in both 2003 and 2004, and 470 of them also did so in 2005. This supports an increased chance of continued frequent attendance after a second year, but fewer than half (about 47%) continued into the third year, so ‘likely’ overstates the result if it means more likely than not. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn this study, the frequency of consultation was not adjusted for age and sex, so the study may have engaged older patients and more female patients as these groups are likely to be overrepresented among frequent attenders.
“In this study, the frequency of consultation was not adjusted for age and sex so the study may have engaged older patients and more female patients as these groups are likely to be overrepresented among FAs. 4”
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 [4]
The Selection of 1-year frequent attenders section defines frequent attendance within age and sex groups. Table 1 (p. e47) associates older age and female sex with *persistent* frequent attendance, which lends support to the concern about an unadjusted sample. It does not establish that older patients and women are overrepresented among frequent attenders generally; the statement that the citing study did not adjust consultation frequency describes that study, not this source. (LLM, conf=0.82)
Experimental — accuracy not yet measuredA small group of patients are consistently in the top decile of frequent GP consulters over at least a 3 year period.
“A small group of patients are consistently in the top decile of frequent GP consulters over at least a 3 year period. 4”
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 [4]
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- Authors
- Smits, F. T., Brouwer, H. J., van Weert, H. C., Schene, A. H., & ter Riet, G.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- University of Zurich (CH)
- Amsterdam Neuroscience (NL)
- Venue
- British Journal of General Practice
- Published
- 2009-02-01
- Volume
- 59
- Issue
- 559
- Pages
- e44-e50
- ISSN
- 0960-1643 (ISSN-L)
- 1478-5242
- PMC
- PMC2629841
- OpenAlex
- W2135981299
- Cited by
- 44
- References
- 31
- Citations by year
- 2023: 1 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 6 · 2015: 4 · 2014: 2 · 2013: 3 · 2012: 7
- FWCI
- 7.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of General Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- ZonMw
- Universiteit van Amsterdam
- Topics
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- prediction rules, electronic health records, GP workload, job satisfaction, prior probability, posterior probability, primary care
- MeSH terms
- Adolescent, Adult, Aged, Appointments and Schedules, Epidemiologic Methods, Family Practice, Female, Health Services Misuse, Humans, Male, Middle Aged, Netherlands, Patient Acceptance of Health Care, Workload, Young Adult
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