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.

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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. AimTo develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records. Design of studyA historic 3-year cohort study. MethodData 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. ResultsOf 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). ConclusionAmong 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.

Background: General practitioners (GPs) or researchers sometimes need to identify frequent attenders (FAs) in order to screen them for unidentified problems and to test specific interventions. We wanted to assess different methods for selecting FAs to identify the most feasible and effective one for use in a general (group) practice.

No study showed convincing evidence that an intervention improves QoL or morbidity of frequent attending primary care patients, although a small effect might be possible in a subgroup of depressed frequent attenders. No evidence was found that it is possible to influence healthcare utilization of FAs.

The strength of the fern test to differentiate between amniotic and nonamniotic fluid in vaginal discharge was determined in 51 term women in labor with ruptured membranes and compared with that in a group of 120 nonlaboring subjects, presenting with nonspecific vaginal fluid loss. Sensitivity and specificity in the laboring group were 98.0 and 88.2%, respectively, in agreement with previous reports. In contrast, in the non-laboring group sensitivity and specificity were only 51.4 and 70.8%, respectively. The result of the fern test predicted the actual state of the membranes correctly in 63% and incorrectly in 29% of these patients. In 16 or 39 subjects with ruptured membranes (approximately 40%), the outcome of the fern test was negative. The modest diagnostic strength of the fern test in the present study compared with previously reported data is at least in part due to differences in study population (laboring versus nonlaboring) and to the fact that observers were deprived of relevant clinical information. It is concluded that the fern test should be granted supportive rather than conclusive value in diagnosing ruptured membranes in nonlaboring women presenting with nonspecific vaginal fluid loss.

BackgroundFrequently attending patients to primary care (FA) are likely to cost more in primary care than their non-frequently attending counterparts. But how much is spent on specialist care of FAs? We describe the healthcare expenditures of frequently attending patients during 1, 2 or 3 years and test the hypothesis that additional costs can be explained by FAs’ combined morbidity and primary care physicians’ characteristics.MethodsRecord linkage study. Pseudonymised clinical data from the medical records of 16 531 patients from 39 general practices were linked to healthcare insurer’s reimbursements data. Main outcome measures were all reimbursed primary and specialist healthcare costs between 2007 and 2009. Multilevel linear regression analysis was used to quantify the effects of the different durations of frequent attendance on three-year total healthcare expenditures in primary and specialist care, while adjusting for age, sex, morbidities and for primary care physicians characteristics. Primary care physicians’ characteristics were collected through administrative data and a questionnaire.ResultsUnadjusted mean 3-year expenditures were 5044 and 15 824 Euros for non-FAs and three-year-FAs, respectively. After adjustment for all other included confounders, costs both in primary and specialist care remained substantially higher and increased with longer duration of frequent attendance. As compared to non-FAs, adjusted mean expenditures were 1723 and 5293 Euros higher for one-year and three-year FAs, respectively.ConclusionsFAs of primary care give rise to substantial costs not only in primary, but also in specialist care that cannot be explained by their multimorbidity. Primary care physicians’ working styles appear not to explain these excess costs. The mechanisms behind this excess expenditure remain to be elucidated.