Table 1

Characteristics of included studies and appraisal score (by alphabetical order)

Author and appraisal scrore	Year	Country	Setting	Design	Data collection tool(s)	Sample population			Frequent users definition	Aim
Author and appraisal scrore	Year	Country	Setting	Design	Data collection tool(s)	No of participants	Age range	% Men	Frequent users definition	Aim
Digel Vandyk et al30	2018	Canada	Emergency Department (ED)	Qualitative study design/Interpretative Description/Thematic Analysis	Semistructured interviews	10	22–66 years	40	Twelve or more visits to the ED for mental health reasons within a 1-year frame	Explore the experience of persons who frequently present to the ED for mental health reasons.
Dwamena et al29	2009	USA	Primary care	Qualitative study design/grounded theory	In-depth semistructured interviews	19	31–65 years	16	Eight or more visit a year for two consecutive years (see study protocol)41	Describe and analyse perceptions and lived experiences of high utilising primary care patients with medically unexplained symptoms.
Hodgson et al26	2005	UK	Primary care	Qualitative study design/thematic analysis	In-depth, semistructured interviews	30	24–81 years	60	At least double the average number of visits in 12 months and an assessment that the visits did not have important clinical outcomes.	Explore frequent users’ points of view on their healthcare usage, expectations from visits and perceived relationship with their people who presented on multiple occasions.
Malone28	1996	USA	ED	Interpretative phenomenology	Informal interviews with participants and care providers; in-depth, loosely structured interviews with participants; group interviews with care providers; patient observation; medical records review	46	30–60 years	65	Four or more ED visits per year	Describe the context for frequent ED use and what it means to both patients and healthcare providers.
Moss et al33	2014	New Zealand	ED	Qualitative study design/thematic analysis using Tronto’s ethic of care framework	Semistructured interviews	34	17–77 years	32	Six ED visits in 1 year	Understand frequent users’ experience with healthcare providers and how this influences their subsequent choices in healthcare.
Neal et al27	2000	UK	Primary care	Qualitative study design/thematic analysis	Semistructured interviews, 36-item health status questionnaire	28	Mean: 54 years	29	Regular frequent users: at least one primary care visit in each 90 days period, no period of 10 visits in 90 days Burst/Gap Frequent users: at least one burst (ten visits in 90 days) and at least one gap (period without visits over 90 days)	Understand the reason for frequent users’ high rates of primary care visits.
Olofsson et al23	2012	Sweden	ED	Descriptive phenomenology	In-depth interviews with open-ended questions	14	71–90 years	36	Three or more ED visits in the past 12 months	Describe and understand chronically ill elderly patients’ experiences during ED stays.
Olsson and Hansagi24	2001	Sweden	ED	Qualitative study design/thematic analysis	In-depth interviews with open-ended questions	10	23–82 years	50	6–17 visits in the past 12 months	Explore why patients believe they frequently use the ED.
Robinson et al32	2017	Australia	ED	Qualitative study design/thematic analysis	Semistructured interviews, half of which included patients’ carers	19	Not specified	63	Three or more ED visits in 12 months	Explore COPD patients’ experiences in frequently using ED services
Spence et al31	2008	Canada	ED	Qualitative study design/Thematic Analysis	Semistructured interviews with patients and ED staff	52	18–45 years	100	Individuals who present themselves frequently to the ED	Investigate the repeated use of the ED by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group.
Wiklund-Gustin25	2011	Sweden	Primary care	Inductive hermeneutic design	In-depth interviews with open-ended questions	9	25–64 years	44	Five or more primary care visits in the last 12 months	Describe patients’ subjective experiences with the healthcare system as frequent users.
Wiklund-Gustin6	2013	Sweden	Primary care	Qualitative study design using cognitive behavioural therapy framework	In-depth interviews with open-ended questions	9	25–64 years	44	Five or more primary care visits in the last 12 months	Describe frequent attenders’ conception of life and their interaction with the healthcare system from a cognitive perspective.