Psychological and/or educational interventions had a small but statistically significant benefit for anxiety prevention in all populations evaluated. Although more studies with larger samples and active comparators are needed, these findings suggest that anxiety prevention programs should be further developed and implemented.

Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results. AimTo assess the effectiveness of a GP intervention to reduce frequent-attender consultations. Design of studyRandomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention). SettingA health centre in southern Spain. MethodSix GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year postintervention. Baseline measurements were recorded of sociodemographic characteristics, provider-user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used. ResultsA multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI] = 11.39 to 14.94); in the CG1 group was 19.37 (95% CI = 17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI =14.84 to 18.72). ConclusionThe new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders. Keywordsprimary health care: utilisation; randomised controlled trial. INTRODUCTIONPatients who frequently consult their GP generate an enhanced workload for primary care, 1 and the proportion of patients who frequently attend appears to be increasing.2 A systematic review indicated that frequent attenders are highly heterogeneous, and have high rates of physical disease, psychiatric illness, and social difficulty. One group of intervention studies with frequent attenders focused on characteristics associated with frequent attendance, such as psychosocial factors, including depression, 4,5 somatisation, 6 stressful experiences, 7 or widowhood; 8 or physical factors such as chronic bronchitis, 9 or diabetes. 10 A common underlying assumption is that if health problems are improved, the need to consult decreases, although findings to support this have been both negative 4,5 and positive. [6][7][8][9][10] Another group of intervention studies 11-16 used a comprehensive focus with multi-component interventions, although results were inconclusive, and the interventions tended to ...

Institute of Health Carlos III.