Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-29T14:28:46.706Z Has data issue: false hasContentIssue false

37 - Frequent attenders in primary care

from Part V - Different treatment settings

Published online by Cambridge University Press:  10 December 2009

By
Navneet Kapur
Edited by
Geoffrey Lloyd  and
Elspeth Guthrie
Geoffrey Lloyd
Affiliation:
Priory Hospital, London
Elspeth Guthrie
Affiliation:
University of Manchester
Get access

Summary

Introduction

Why do people consult their doctors? Some individuals never consult medical practitioners while others consult unusually frequently. A number of factors contribute to patients' help-seeking behaviour (Campbell & Roland 1996; Gill & Sharpe 1999). Organizational factors such as distance from the surgery, the appointment system and access to other healthcare facilities may influence the decision to seek care. Doctor-related factors are also likely to be important. For instance, there is evidence that some doctors appear to attract a disproportionate number of frequently attending patients, and it is possible that some doctors actively encourage frequent attendance (Neal et al. 2000a). This chapter reviews the patient factors associated with frequent attendance in primary care and suggests strategies for managing patients who attend unusually frequently.

Concepts and definitions

There are two conceptual issues which have important implications for the interpretation of research findings.

The first concerns the concept of ‘a consultation’. There is no standard definition. Different approaches include defining consultations as entries in primary care notes or computerized records, contact with any member of the primary-care team, or face-to-face consultation with a general practitioner. Some studies have included only patient-initiated consultations. Others have excluded attendance for ‘routine’ reasons such as contraception and pregnancy. Home visits have been counted as consultations in some studies but not in others.

The second issue is more complex and concerns the definition of ‘frequent consultation’. Three main approaches have been adopted in the literature.

Keywords

anxietycase-note datadepressionfrequent attenderspsychiatric morbidityprimary carepsychiatric disorder
Type
Chapter
Information
Handbook of Liaison Psychiatry , pp. 871 - 895
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anderson, R. (1995). Revisiting the behavioural model and access to care: does it matter?Journal of Health and Social Behaviour, 36, 1–10.Google Scholar
Anderson, S. O., Mattson, B. and Lynoe, N. (1995). Patients frequently consulting general practitioners at a general practice in Sweden – a comparative study. Scandinavian Journal of Social Medicine, 23, 251–7.Google Scholar
Baez, K., Aiarzaguena, J. M., Grandes, G., et al. (1998). Understanding patient-initiated frequent attendance in primary care: a case-control study. British Journal of General Practice, 48, 1824–7.Google Scholar
Bellon, J. A., Delgado, A., Luna, J. D., et al. (1999). Psychosocial and health belief variables associated with frequent attendance in primary care. Psychological Medicine, 29, 1347–57.Google Scholar
Browne, G. B., Humphrey, B., Pallister, R., et al. (1982). Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice. Journal of Family Practice, 14, 63–71.Google Scholar
Campbell, S. and Roland, M. (1996). Why do people consult the doctor?Family Practice, 13, 75–83.Google Scholar
Clarke, D. M., Salkovskis, P. M., Hackmann, A., et al. (1998). Two psychological treatments for hypochondriasis. A randomized controlled trial. British Journal of Psychiatry, 173, 218–25.Google Scholar
Conroy, R. M., Smyth, O., Siriwardena, R., et al. (1999). Health anxiety and characteristics of self-initiated general practitioner consultations. Journal of Psychosomatic Research, 46, 45–50.Google Scholar
Corney, R. H. (1990). Sex differences in general practice attendance and help seeking for minor illness. Journal of Psychosomatic Research, 34, 525–34.Google Scholar
Craig, T. K., Boardman, A. P., Mills, K.et al. (1993). The South London Somatisation Study. I: Longitudinal course and the influence of early life experiences. British Journal of Psychiatry, 163, 579–88.Google Scholar
Dickinson, L. M., deGruy, F. V. III, Dickinson, W. P., et al. (1999). Health-related quality of life and symptom profiles of female survivors of sexual abuse. Archives of Family Medicine, 8, 35–43.Google Scholar
Dowrick, C. F., Bellon, J. A. and Gomez, M. J. (2000). GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms. (See comments.) British Journal of General Practice, 50, 361–5.Google Scholar
Fearon, P. and Hotopf, M. (2001). Relation between headache in childhood and physical and psychiatric symptoms in adulthood: national birth cohort study. British Medical Journal, 322, 1145.Google Scholar
Fiscella, K., Franks, P. and Shields, C. G. (1997). Perceived family criticism and primary care utilization: psychosocial and biomedical pathways. Family Process, 36, 25–41.Google Scholar
Gill, D. and Sharpe, M. (1999). Frequent consulters in general practice: a systematic review of studies of prevalence, associations and outcome. Journal of Psychosomatic Research, 47, 115–30.Google Scholar
Gill, D., Dawes, M., Sharpe, M., et al. (1998). GP frequent consulters: their prevalence, natural history, and contribution to rising workload. British Journal of General Practice, 48, 1856–7.Google Scholar
Guthrie, E. A., Creed, F., Dawson, D., et al. (1991). A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterology, 100, 450–7.Google Scholar
Guthrie, E. A., Moorey, J., Margison, F., et al. (1999). Cost effectiveness of brief Psychodynamic Interpersonal Therapy in high utilizers of psychiatric services. Archives of General Psychiatry, 56, 519–26.Google Scholar
Helman, C. G. (1981). Disease versus illness in general practice. Journal of the Royal College of General Practitioners, 31, 548–52.Google Scholar
Heywood, P. L., Blackie, G. C., Cameron, I. H., et al. (1998). An assessment of the attributes of frequent attenders to general practice. Family Practice, 15, 198–204.Google Scholar
Hobson, R. F. (1985). Forms of Feeling. London: Tavistock Publications.
Hotopf, M., Carr, S., Mayou, R., et al. (1998). Why do children have chronic abdominal pain, and what happens to them when they grow up? Population based cohort study. (See comments.)British Medical Journal, 316, 1196–200.Google Scholar
Hotopf, M., Mayou, R., Wadsworth, M., et al. (1999a). Childhood risk factors for adults with medically unexplained symptoms: results from a national birth cohort study. American Journal of Psychiatry, 156, 1796–800.Google Scholar
Hotopf, M., Mayou, R., Wadsworth, M., et al. (1999b). Psychosocial and developmental antecedents of chest pain in young adults. Psychosomatic Medicine, 61, 861–7.Google Scholar
Hotopf, M., Wilson-Jones, C., Mayou, R., et al. (2000). Childhood predictors of adult medically unexplained hospitalisations. Results from a national birth cohort study. British Journal of Psychiatry, 176, 273–80.Google Scholar
Jiwa, M. (2000). Frequent attenders in general practice: an attempt to reduce attendance. Family Practice, 17, 248–51.Google Scholar
Joukamaa, M., Karlsson, H., Sohlman, B., et al. (1996). Alexithymia and psychological distress among frequent attendance patients in health care. Psychotherapy & Psychosomatics, 65, 199–202.Google Scholar
Jyvasjarvi, S., Joukamaa, M., Vaisanen, E., et al. (1999). Alexithymia, hypochondriacal beliefs and psychological distress among frequent attenders in primary health care. Comprehensive Psychiatry, 40, 292–8.Google Scholar
Jyvasjarvi, S., Joukamaa, M., Vaeisaenen, E., et al. (2001). Somatizing frequent attenders in primary health care. Journal of Psychosomatic Research, 50, 185–92.Google Scholar
Kapur, N., Macfarlane, G. J. and Creed, F. (2001). Frequent attenders in general practice. British Journal of General Practice, 51, 756–7.Google Scholar
Kapur, N., Hunt, I. and Macfarlane, G., et al. (2004a). Childhood experience and healthcare use in adulthood. Nested case-control study. British Journal of Psychiatry, 185, 134–9.Google Scholar
Kapur, N., Hunt, I., Lunt, M., et al. (2004b). Psychosocial and illness-related predictors of consultation rates in primary care – a cohort study. Psychological Medicine, 34, 719–28.Google Scholar
Karlsson, H., Lehtinen, V. and Joukamaa, M. (1994). Frequent attenders of Finnish public primary care: socio-demographic characteristics and physical morbidity. Family Practice, 11, 424–30.Google Scholar
Karlsson, H., Joukamaa, M., Lahti, I., et al. (1997). Frequent attender profiles: different clinical subgroups among frequent attender patients in primary care. Journal of Psychosomatic Research, 42, 57–66.Google Scholar
Katon, W., Korff, M., Lin, E., et al. (1992). A randomized trial of psychiatric consultation with distressed high utilizers. (See comments.)General Hospital Psychiatry, 14, 86–98.Google Scholar
Kessler, R. C., Davis, C. G. and Kendler, K. S. (1997). Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychological Medicine, 27, 1101–19.Google Scholar
Little, P., Somerville, J., Williamson, I., et al. (2001). Psychosocial, lifestyle and health status variables in predicting high attendance among adults. British Journal of General Practice, 51, 987–94.Google Scholar
McFarland, B. H., Freeborn, D. K., Mullooly, J. P., et al. (1985). Utilization patterns among long term enrollees in a pre-paid group practice health maintenance organization. Medical Care, 1221–33.Google Scholar
Mehl-Madrona, L. E. (1998). Frequent users of rural primary care: comparisons with randomly selected users. Journal of the American Board of Family Practice, 11, 105–15.Google Scholar
Morris, J. K., Cook, D. G., Walker, M., et al. (1992). Non-consulters and high consulters in general practice: cardio-respiratory health and risk factors. Journal of Public Health Medicine, 14, 131–7.Google Scholar
Morriss, R., Gask, L., Ronalds, C., et al. (1998). Cost-effectiveness of a new treatment for somatized mental disorder taught to GPs. Family Practice, 15, 119–25.Google Scholar
Neal, R. D., Heywood, P. L., Morley, S., et al. (1998). Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices. British Journal of General Practice, 48, 895–8.Google Scholar
Neal, R. D., Heywood, P. L. and Morley, S. (2000a). Frequent attenders' consulting patterns with general practitioners. British Journal of General Practice, 50, 972–6.Google Scholar
Neal, R. D., Heywood, P. L. and Morley, S. (2000b). Freight trains and supernovas: the use of a sorting task to determine patterns within long-term frequent attendance to general practitioners. Primary Health Care Research and Development, 1, 39–50.Google Scholar
Neal, R. D., Heywood, P. L. and Morley, S. (2000c). ‘I always seem to be there’ – a qualitative study of frequent attenders. British Journal of General Practice, 50, 716–23.Google Scholar
Newman, M. G., Clayton, L., Zuellig, A., et al. (2000). The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization. Psychological Medicine, 30, 1063–77.Google Scholar
Nighswander, T. S. (1984). High utilizers of ambulatory care services: 6 year follow up at Alaska Native Medical centre. Public Health Reports, 99, 400–4.Google Scholar
O'Dowd, T. C. (1992). Five years of heartsink patients in general practice. British Medical Journal, 297, 528–32.Google Scholar
Pennebaker, J. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162–6.Google Scholar
Pescosolido, B. and Boyer, C. (1996). From the community into the treatment system – how people use health services. In The Sociology of Mental Illness, ed. Horwitz, A. and Scheid, T.. New York: Oxford University Press.
Robinson, J. O. and Granfield, A. J. (1986). The frequent consulter in primary medical care. Journal of Psychosomatic Research, 30, 589–600.Google Scholar
Ronalds, C., Kapur, N., Stone, K., et al. (2002). Determinants of consultation rate in patients with anxiety and depressive disorders in primary care. Family Practice, 19, 23–8.Google Scholar
Schilte, A. F., Portegijs, P. J., Blankenstein, A. H., et al. (2001). Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care. British Medical Journal, 323, 86.Google Scholar
Sensky, T., MacLeod, A. K. and Rigby, M. F. (1996). Causal attributions about common somatic sensations among frequent general practice attenders. Psychological Medicine, 26, 641–6.Google Scholar
Simon, G. E., Manning, W. G., Katzelnick, D. J., et al. (2001). Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Archives of General Psychiatry, 58, 181–7.Google Scholar
Smyth, J. M. (1998). Written emotional expression: effect sizes, outcome types and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–84.Google Scholar
Svab, I. and Zaletel-Kragelj, L. (1993). Frequent attenders in general practice: a study from Slovenia. Scandinavian Journal of Primary Health Care, 11, 38–43.Google Scholar
Vedsted, P. and Olesen, F. (1999a). Frequent attenders in out-of-hours general practice care: attendance prognosis. Family Practice, 16, 283–8.Google Scholar
Vedsted, P. and Olesen, F. (1999b). Effect of a reorganized after-hours family practice service on frequent attenders. Family Medicine, 31, 270–5.Google Scholar
Walker, E. A., Unutzer, J., Rutter, C., et al. (1999a). Costs of health care use by women HMO members with a history of childhood abuse and neglect. Archives of General Psychiatry, 56, 609–13.Google Scholar
Walker, E. A., Gelfand, A., Katon, W. J., et al. (1999b). Adult health status of women with histories of childhood abuse and neglect. American Journal of Medicine, 107, 332–9.Google Scholar
Ward, A. M., Underwood, P., Fatovich, B., et al. (1994). Stability of attendance in general practice. Family Practice, 11, 431–7.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×