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Characteristics of Frequent Attenders At a Community Health Center

From the Office of Community Programs (SBC), University of Massachusetts Medical School, Worcester, MA
Department of Family Medicine and Community Health (JAS, MM, SBC), University of Massachusetts Medical School, Worcester, MA
Department of Statistics, Worcester Polytechnic Institute, Worcester, MA (AU, YB)
Family Health Center of Worcester, Worcester, MA (MC)

Correspondence: Corresponding author: Judith A. Savageau, MPH, Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655 (E-mail: judith.savageau{at}umassmed.edu)

Background: As high utilizers of health care resources, frequent attenders to medical practices pose a significant issue for primary health care. Studies documenting content of visits and characteristics of frequent attenders have paid limited attention to community health center populations. This study profiles these high utilizers comparing them to non-frequent attenders.

Methods: Through medical record abstraction, retrospective and longitudinal patient data were obtained for a 30-month time period for 382 established patients.

Results: Older patients 45 to 64 years (OR = 1.85; 95% CI: 0.92, 3.70) and Medicaid recipients (OR = 3.22; 95% CI: 1.54, 6.72) were more likely to be frequent attenders. Patients residing furthest away from the CHC were also the most frequent of attenders (OR = 3.68; 95% CI: 1.22, 11.13), as were those with a diagnosis of diabetes (OR = 5.03; 95% CI: 2.17, 11.70) or depression (OR = 1.85; 95% CI: 0.96, 3.56). Patients who used the Emergency Department more (OR = 1.54; 95% CI: 1.23,1.91) had the highest number of visits, although those patients who missed more appointments as a proportion of the number of scheduled appointments were less likely to be frequent attenders (OR = 0.49; 95% CI: 0.36, 0.66).

Conclusions: Through developing interventions such as customized social report cards and applying elements of the Chronic Care Model, these results can help administrators and policy makers ensure that frequent attenders are cared for adequately and that safety net providers’ resources are appropriate to the tasks demanded of them.

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