Frequent attendance in primary care: Comparison and implications of different definitions

Juan V. Luciano, Ana Fernández, Alejandra Pinto-Meza, Leila Luján, Juan A. Bellón, Javier Garcia-Campayo, María T. Peñarrubia, Rita Fernández, Marta Sanavia, Maria E. Blanco, Josep M. Haro, Diego J. Palao, Antoni Serrano-Blanco

Research output: Contribution to journalArticleResearchpeer-review

43 Citations (Scopus)

Abstract

Background: The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. Aim: To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. Design of study: One-phase cross-sectional study. Setting: Seventy-seven primary care centres in Catalonia, Spain. Method: A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. Results: The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. Conclusion: The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).

Original languageEnglish
Pages (from-to)95-100
Number of pages6
JournalBritish Journal of General Practice
Volume60
Issue number571
DOIs
Publication statusPublished - Feb 2010

Keywords

  • Chronic illness
  • Frequent attendance
  • Health services
  • Mental disorders
  • Primary health care
  • Utilisation

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