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I read about your interesting plans to study the prevalence of common mental health disorders in adults who are high or costly users of healthcare services in BMJ Open.
Please allow me to share with you some thoughts about your plans produced by our own research.
- We studied the prevalence of (physical, mental and social) problems in the Netherlands (as defined by the GP on the Problem list; ICPC) in (persisting) frequent attenders 1 and whether we could predict, with these GP data, which frequent attender would persist in this behaviour.2
- We found that high users and costly users are two different groups. Frequent users of primary care3 have higher average/median costs (also and especially in sec care), but high costs are mostly generated in sec care.4
- We also found that costs are more substantial in persisting frequent users. Perhaps you can consider to differentiate between temporarily and persisting frequent users.
- Costs are very high in a few outliers. Do you exclude these patients from your research?? Median costs? Average costs?
- We also found that anxiety, and especially panic disorder, is associated with persistence of frequent attendance in primary care.5
Much success with your plans!
Frans Smits, GP PhD
1 Smits FT, Brouwer HJ, Ter Riet G, Van Weert HCP. Epidemiology of frequent attenders: A 3-year historic cohort study comparing attendance, morbidity and pr...
1 Smits FT, Brouwer HJ, Ter Riet G, Van Weert HCP. Epidemiology of frequent attenders: A 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders. BMC Public Health 2009; 9. DOI:10.1186/1471-2458-9-36.
2 Smits FTM, Brouwer HJ, van Weert HCP, Schene AH, ter Riet G. Predictability of persistent frequent attendance: A historic 3-year cohort study. Br J Gen Pract 2009; 59. DOI:10.3399/bigp09X395120.
3 Smits FTM, Mohrs JJ, Beem EE, Bindels PJE, Van Weert HCPM. Defining frequent attendance in general practice. BMC Fam Pract 2008; 9. DOI:10.1186/1471-2296-9-21.
4 Smits FT, Brouwer HJ, Zwinderman AH, et al. Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: A record linkage study between patient data and reimbursements data. DOI:10.1186/1471-2296-14-138.
5 Smits FT, Brouwer HJ, Zwinderman AH, et al. Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: A prospective cohort study. J Psychosom Res 2014; 77: 492–503.