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  • Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care

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General practice / Family practice
Research
Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care
  1. Frans T Smits1,
  2. Henk J Brouwer1,
  3. Aart H Schene2,
  4. Henk C P M van Weert1,
  5. Gerben ter Riet1
  1. 1Department of General Practice, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
  1. Correspondence to Frans T Smits; f.t.smits{at}amc.uva.nl

Abstract

Objectives Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs.

Design Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients’ problem lists were defined as chronic ECs (CECs), other episodes as TECs.

Setting 1 Dutch urban primary healthcare centre served by 5 GPs.

Participants All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009.

Outcome measures Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs.

Results The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52–54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs).

Conclusions FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs.

  • PRIMARY CARE

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-012563

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    Footnotes

    • Contributors FTS drafted and designed the article, monitored the data collection, coded the missing EC codes, analysed the data, and drafted and revised the paper. He is the guarantor. GtR commented, revised and supervised the paper and did the statistical analyses. HJB monitored the patient data collection, analysed data and drafted, read and revised the paper. AHS, GtR and HCPMvW supervised the project, read and revised the paper. All authors read and approved the final version of this paper.

    • Funding This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw; Alledaagse ziekten) grant number 42011002.

    • Competing interests FTS worked as a GP in Health Centre Reigersbos, Amsterdam, the Netherlands from 1982 to April 2016. Between 2009 and 2014 he was a PhD at the department of General Practice of the University of Amsterdam, the Netherlands on (persistent) Frequent Attenders (PERFACTIO project).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Additional data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.0s0n6.