BackgroundFrequent attenders (FAs) use a disproportionately large share of the resources of general practitioners (GPs) working in primary healthcare centres. The aim of this study was to estimate the proportion of FAs among all patients in the primary health care centres of a medium-sized city in Finland, and to examine whether providing GPs with administrative information about their frequent attenders (names and numbers of visits per year) can reduce the number of FAs and the frequency of their visits.MethodsStatistic data on all GP visits (n = 1.8 million) to 11 public healthcare centres in one city were collected from the electronic patient records covering the period from 2001 to 2010. A FA-patient was defined as a person who made10 or more visits to GPs during one year. The baseline situation in 2001 was compared with the situation in 2006 after administrative information had been provided three times to all GPs working in the healthcare centres. Poisson’s regression analysis was used, and FA numbers and consultation rates in the years 2002–2005 were compared with the year 2006; figures for 2006 were also compared with those for the follow-up period 2007–2010.ResultsDuring the years 2001–2006, the proportion of visits of FA-patients fell overall from 9.1 to 8.5%, a decline of 0.6% (p < 0.0001). This reduction was equivalent to an annual work load of two GPs in the study center. The proportion of visits of FA patients increased again in the follow-up period (2007–2010), when administrative information was no longer provided.ConclusionWhen GPs are provided with information on the number and names of their FA-patients, the annual rate of FA visits to GPs drops significantly. The method is simple and repeatable. However, without a control group of GPs who have not received such information, it is impossible to assess if the intervention was the only circumstance affecting the reduction in FA consultation rates.

Introduction: The proportion of patients who are frequent attenders (FAs) varies from few percent to almost 30% of all patients. A small group of patients continued to visit GPs year after year. In previous studies, it has been reported that over 15% of all 1-year FAs were persistent frequent attenders (pFAs). Objectives: This study aimed to identify typical features of pFAs from the textual content in their medical entries, which could help GPs to recognize pFAs easily and facilitated treatment.Methods: A retrospective register study was done, using 10 years of electronic patient records. The data were collected from Finnish primary health care centers and used to analyze chronic symptoms and diagnoses of pFAs and to calculate the inverse document frequency weight (IDF) of words used in the patient records. IDF was used to determine which words, if any, are typical for pFAs. The study group consisted of the 5-year pFAs and control group of 1-year FAs. The main background variables were age, gender, occupation, smoking habits, use of alcohol, and BMI. Results: Out of 4392 frequent attenders, 6.6% were pFAs for 3 years and 1.1% were pFAs for 5 years. Of the pFAs, 65% were female and 35% were male. The study group had significantly more depressive episodes ( P = .004), heart failure ( P = .019), asthma ( P = .032), COPD ( P = .036), epilepsy ( P = .035), and lumbago ( P = .046) compared to the control group. GPs described their 5-year pFAs by words related to lung and breathing issues, but there was no statistical difference to the 1-year FAs’ descriptions. Conclusion: A typical pFA seems to be a woman, aged about 55 years with depressive episodes, asthma or COPD, and lower back pain. Physicians describe pFAs with ordinary words in patient records. It was not possible to differentiate pFAs from 1-year FAs in this way.

Aim: The aim of the study was to find out, if a single cognitive behavior treatment (CBT) session for long-term frequent attenders in primary care affects the attendance frequency and mental well-being of the patients. Methods: Out of 193 long-term frequent attenders, 56 participated and were randomized to receive either a one-session CBT intervention or usual care. The groups were compared to each other regarding change in general practitioner visits and change in depressive symptoms, sense of coherence, somatoform symptoms and hypochondriacal anxiety at six months’ follow-up. Results: The attendance frequency decreased in both groups, but there was no difference between the groups. Changes in mental functioning did not differ between the groups. When patients with no mental health disorder were analyzed separately, the decrease in GP visits was significantly higher in the intervention group than in the control group ( p = .004). Conclusion: A single session of CBT is not useful in reducing GP visits or improving mental well-being of long-term frequent attenders. Frequent attenders without a psychiatric disorder may benefit from this kind of intervention.

Background Persistent frequent attenders have 10 or more face-to-face visits to a general practitioner (GP) within one year and they continue frequent visits for two years or more. It seems that GPs don´t recognize their persistent frequent attenders. These patients can cause frustration for GPs and furthermore patients don`t seem to get the needed help from GPs. We wanted to find out typical features of persistent frequent attenders and thus help GPs to recognize these patients and even to foresee which patients will most probably become persistent attenders in the future. Methods We used the data of 4,392 frequent attenders (FAs) from the primary healthcare centers of the study city in 2001-2006. The five-year FAs formed the study group. Patient record entries of them were scrutinized and the background variables recorded. The background variables were described in terms of means and standard deviations or frequencies and percentages. Chronic diagnoses in the study group were compared to those of the control group. The control group was randomly selected from the group of the one-year frequent attenders in 2001–2006. Conditional logistic regression was used to compare chronic diagnoses between groups. Results Out of 4,392 FAs in 2001- 2006 19.4% were FAs during two years and 1.1% during five years. In the study group, there were 65% women and 35% men and the gender distribution remained equal throughout the whole follow-up period. Their average age was 51.7 year. The study group had 15.3 self-initiated visits to a GP annually and had significantly more depression (p=0.004), epilepsy (p=0.035), heart failure (p=0.019), asthma (p=0.032), chronic obstructive pulmonary disease (COPD, p=0.036) and back pain/lumbago (p=0.046) compared to the control group. Patients in the study group were referred to secondary care, on average, 20.1 times per person. Conclusion We found out that a typical persistent frequent attender was a woman at the age of 55 who had depression, low back pain, heart failure, asthma or COPD. When a GP notices this kind of a patient it might be wisdom to have extra effort with the patient and make a follow-up and treatment plan together.