Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study
Introduction
A small group of patients, the so-called frequent attenders (FAs), account for 21–67% of all consultations in daytime general practice (Browne, Humphrey, Pallister, Browne, & Shetzer, 1982; Courtenay, Curwen, Dawe, Robinson, & Stern, 1975; Gill & Sharpe, 1999; Heywood, Blackie, Cameron, & Dowell, 1998; Karlsson, Lehtinen, & Joukamaa, 1994; Wamoscher, 1966) and receive five times more prescriptions and referrals than other patients (Heywood et al., 1998; Robinson & Granfield, 1986; Svab & Zaletel Kragelj, 1993). Knowledge of which factors are prompting patients to seek primary care is sparse, most existing studies are small and only few are populations-based and therefore potentially fraught with bias and poor precision. FA studies have used different definitions of FAs, designs and measures of determinants (Gill & Sharpe, 1999) and many have failed to distinguish between age and gender groups although it is possible that subgroups have different characteristics and needs. The quantitative and qualitative shortcomings of existing FA data could be remedied through large-scale population-based studies that incorporate valid general health measures and registry data in a stratified design.
Two persons having much the same clinical symptoms may attend quite differently (Mechanic & Volkart, 1961). A prospective descriptive study found that adults overall consulted a general practitioner (GP) 6% of the days they were having a symptom (Roghmann & Haggerty, 1972), whereas another study found that women only consulted a GP on less than 3% of such days (Banks, Beresford, Morrell, Waller, & Watkins, 1975). These observations have led to the hypothesis that differences in attendance may be rooted not only in differences in health, but also in differences in health perception and evaluation (Campbell & Roland, 1996; Hibbard & Pope, 1983; Hunt, Ford, Harkins, & Wyke, 1999; Mechanic & Volkart, 1961) and in social and health services factors (Hulka & Wheat, 1985; van de Kar, Knottnerus, Meertens, Dubois, & Kok, 1992; Wolinsky, 1978). The ‘Behavioural Model of Health Services Use’, initially developed and described by Andersen and Newman (Andersen & Newman, 1973; Andersen, 1995; Krasnik, 1996), takes many of these aspects into consideration. The model triangulates societal, health services system and individual determinants of health services utilization (Andersen & Newman, 1973). FA behaviour is a strain on general practice resources and any effort to improve intervention towards this group must be based on knowledge of the intricate interplay between all factors inducing patients to seek medical care. The Andersen-Newman model provides such a comprehensive approach and was therefore adapted to the particular needs of the present study.
The aim of this study was to examine factors associated with frequent attendance in general practice with special focus on physical, mental and social conditions.
Section snippets
The organisation of Danish general practice
The Danish GPs work as independent contractors to the National Health Service (NHS) and are partly remunerated per capita listed and partly on a fee-for-service basis (40/60%). The GPs act as gatekeepers and more than 98% of the inhabitants are registered with a GP and receive free medical care (de Fine Olivarius, Hollnagel, Krasnik, Pedersen, & Thorsen, 1997). Individuals have to consult the GP with whom they are registered. For reasons of accounting the NHS receives electronic information on
Results
Descriptive data are shown in Table 2.
Discussion
We found that FAs reported a lower physical and mental health and exhibited poorer social functioning than non-FAs. The present cross-sectional design did not, however, allow determination of the temporal relationship between these variables. Our findings are consistent with other studies where one or more physical diagnoses were held by 43% (record) (Courtenay et al., 1975), 46% (GP) (Heywood et al., 1998), 61% (record) (Báez et al., 1998) and 96% (GP/record/hospital) (Karlsson et al., 1994)
Acknowledgements
We thank Associate Professor, Morten Frydenberg, M.Sc. Ph.D., Department of Biostatistics, University of Aarhus, for the help with the statistics. We thank Mr. Jørgen N. Nielsen, the National Health Insurance, Aarhus County, for help with the data collection. We wish to thank Jakob Bue Bjørner for providing norm data. The study was supported by grants from The Municipal VAT Fund, The Lundbeck Pharma Research Fund for General Practice, The Insurance and Pension Research Fund and the Nycomed
References (63)
- et al.
Tests of data quality, scaling assumptions, and reliability of the Danish SF-36
Journal of Clinical Epidemiology
(1998) - et al.
Differential item functioning in the Danish translation of the SF-36
Journal of Clinical Epidemiology
(1998) - et al.
The Danish SF-36 Health SurveyTranslation and preliminary validity studies
Journal of Clinical Epidemiology
(1998) Sex differences in general practice attendance and help seeking for minor illness
Journal of Psychosomatic Research
(1990)- et al.
Socio-economic status and the utilisation of physicians’ servicesResults from the Canadian national population health survey
Social Science and Medicine
(2000) - et al.
Screening for somatization and hypochondriasis in primary care and neurological inpatients A seven-item scale for hypochondriasis and somatization
Journal of Psychosomatic Research
(1999) - et al.
Frequent consulters in general practiceA systematic review of studies of prevalence, associations and outcome
Journal of Psychosomatic Research
(1999) - et al.
Gender roles, illness orientation and use of medical services
Social Science and Medicine
(1983) - et al.
A comparative study of frequent and infrequent attenders at a general practice
International Journal of Nursing Studies
(1974) - et al.
Alexithymia, hypochondriacal beliefs, and psychological distress among frequent attenders in primary health care
Comprehensive Psychiatry
(1999)
Psychiatric morbidity among frequent attender patients in primary care
General Hospital Psychiatry
The frequent consulter in primary medical care
Journal of Psychosomatic Research
A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients
Journal of Psychosomatic Research
Revisiting the behavioral model and access to medical careDoes it matter?
Journal of Health and Social Behavior
Societal and individual determinants of medical care utilization in the United States
The Milbank Memorial Fund quarterly. Health and Society
Patients frequently consulting general practitioners at a primary health care centre in Sweden–a comparative study
Scandinavian Journal of Social Medicine
Factors influencing demand for primary medical care in women aged 20–44 yearsA preliminary report
International Journal of Epidemiology
Understanding patient-initiated frequent attendance in primary careA case-control study
British Journal of General Practice
Psychosocial and health belief variables associated with frequent attendance in primary care
Psychological Medicine
The epidemiologic evidence for a relationship between social support and health
American Journal of Epidemiology
Prevalence and characteristics of frequent attenders in a prepaid Canadian family practice
Journal of Family Practice
Why do people consult the doctor?
Family Practice
Descriptive tools and analysis
Statistical models in epidemiology
The characteristics of high and low attenders at two general practices
Social Psychiatry and Psychiatric Epidemiology
Frequent attendance in a family practice
Journal of Royal College of General Practitioners
The Danish National Health Service Register
Danish Medical Bulletin
GP frequent attendance in Liverpool and Granada the impact of depressive symptoms
British Journal of General Practice
Psychiatric morbidity in primary public health care: A nordic multicentre investigation Part IMethod and prevalence of psychiatric morbidity
Acta Psychiatrica Scandinavica
Is lower income associated with greater biopsychosocial morbidity? Implications for physicians working with underserved patients
Journal of Family Practice
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