Predictability of persistent frequent attendance: a historic 3-year cohort study

Abstract

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.

Clinical characteristics of persistent frequent attenders in primary care: case–control study

“…There was a very low recruitment rate in the pilot practice (only 11%), but recruitment improved for the remaining four practices (24%) as practices became more able to identify appointments due to routine monitoring and health checks. Although only a low proportion of FAs and NAs responded to the study, there is enough similarity with anonymised record based studies involving other varied practice samples [6,7,9,10,24] to believe that our results are representative of FAs in general.…”

“…[5] However, recent prospective research in Europe shows only one in seven frequently attending patients continue to attend primary care so frequently over the next two years. [6,7] Therefore psychological interventions might be best focussed on persistent frequent attenders (FAs) in primary care.…”

“…[6][7][8][9][10], there are no case control studies employing a full standardised psychiatric interview with a standardised assessment of long-term conditions and health status. Such data might guide service planning, for example, of relevant therapist expertise or commissioning of care more tailored to patient need.…”

Frequent attendance in family practice and common mental disorders in an open access health care system

“…The threshold for FA (number of visits or percentage with highest attendance rates) and the time range varies considerably between studies [2,[4][5][6][7], leading to wide variations in rates, ranging from 2.7% of patients in a UK family practice [2] to 59.6% in Italy [8]. FA is higher in women [2,3,9] and in higher age groups [2,3], leading to a consensus definition of FA as the 10% age-and sex-stratified most frequent attenders (FAs) [4,7,10].…”

Persistent frequent attenders

“…4 Therefore, we stated in a paper in this Journal that for GPs persistent frequent attending is of more importance and clinical usefulness than short-term frequent attending. 5 Unfortunately, the authors did not raise this issue in their paper. influence of the mass media.…”