Objective. To analyse the prevalence of GAD and other anxiety disorders, as well as sensitivity and specificity of GAD-7 among high utilizers of health care. Setting. Four municipal health centres in Northern Finland. Subjects. A psychiatric interview was conducted for 150 high utilizers of health care. Main outcome measures. Prevalence of GAD as well as sensitivity and specificity of GAD-7. Results. The prevalence of GAD was 4% in this study group of Finnish high utilizers of health care. The sensitivity of GAD-7 was 100.0% (95% CI 54.1–100.0) and the specificity of GAD-7 was 82.6% (95% CI 75.4–88.4) with a cut-off point of 7 or more. Conclusion. GAD is rather common among high utilizers of primary care, although the prevalence of 4% is lower than that previously reported. GAD-7 is a valid and useful tool for detecting GAD among primary health care patients.

ObjectivesThe aim of the study was to describe adherence to health regimens and the factors associated with it among adult frequent attenders (FAs).DesignThis was a cross-sectional study. The study sample consisted of 462 healthcare FAs in 7 municipal health centres in northern Finland. An FA is a person who has had 8 or more outpatient visits to a GP (in a health centre) or 4 or more outpatient visits to a university hospital during 1 year. The main outcome was self-reported adherence to health regimens.ResultsOf the FAs, 82% adhered well to their health regimens. Carrying out self-care, medical care and feeling responsible for self-care were the most significant predictors to good adherence in all models. No significant differences in adherence were found in male and female subjects, age groups or educational levels. Support from healthcare providers and support from relatives were not significant predictors of good adherence.ConclusionFAs in Finland adhere well to health regimens and exceptionally well to medication. Variables that predict the best adherence of FAs to health regimens are carrying out self-care, receiving medical care and feeling responsible for self-care.

Background and objective: Frequent attender is the largest group to whom health care resources are allocated. Therefore potential interventions should be targeted at this group. Nurse-based case management considers frequent attenders' (FAs') needs for care as a whole and thus may reduce the use of other health services operators' resources. The objective of this study is to evaluate the effects of nurse-led case management on adherence to health regimens, depression, somatization and hypochondriasis in FAs. Methods: The study is a quasi-experimental intervention trial, carried out as a prospective 2-year follow-up design with an intervention group (n = 285) and a control group (n = 435). The hypothesis was that nurse-led case management based intervention would have a positive impact on FAs' adherence to health regimens, somatization, hypochondriasis, and depression. The intervention patients received nurse-led case management which included an evaluation of patient needs and resources, an individualized care plan, the coordination of multidisciplinary services, and support for self-management. The control patients received the usual care, which means patient support and education during visits to the health center. The data were collected from at least 18 years of age frequent attenders by self-reported instruments: the Adherence of Chronic Disease Inventory, the Whiteley Index, the Symptom Checklist-90-R and Beck Depression Inventory, and one-and two-year follow-ups between October 2008 and May 2011. Results: The intervention had an uplifting effect on the FAs' mood, and there was a statistically significant difference between the intervention patients and the control patients (p = .03). Intervention reduced somatization with FAs, and it improved FAs' adherence to health regimens, but there was not a statistically significant difference between groups. Hypochondriasis increased in the intervention group compared to the control group after intervention (p = .01). Conclusions: Nurse-led case management has a positive effect on FAs' depression symptoms, somatization, and adherence to health regimens. The results will be useful in developing effective nurse-led interventions and support methods for FAs with complex long-term health conditions. Hypochondriasis increased in the intervention group although the purpose was for the community matron to discuss with FAs and reduce their concerns.

Background and objective: When FAs with chronic disease and various needs are able to keep up their psychological and physical wellbeing, perform daily activities and maintain control of their life, they are able to live an active life and take care of themselves longer, and this has an impact on their quality of life. The role of community matron is to assess an individual's problems and needs for health services and improve the self-care of FAs by providing a needs-based education. The goal of this study is to evaluate the effectiveness of nurse-led intervention on the quality of life, sense of coherence and daily activities of frequent attenders (FAs).Methods: This study is an intervention trial, with a two-year follow-up, including intervention and control groups. The intervention group received nurse-led intervention that included the assessment of FAs care needs, an individualized care plan, support for self-management and service coordination. The FAs in the control group received traditional care, including patient education and support. Self-reported instruments were used to collect data from adult frequent attenders, including the Frenchay Activities Index (FAI), Sense of Coherence (SOC) and 15D, to assess the health-related quality of life (HRQoL). Follow-ups measurements were taken after one year and after two years between 2008 and 2011.Results: The study shows a significant correlation between sense of coherence and quality of life (p < .0005) and quality of life and amount of daily activities performed (p < .0005) in both groups. The intervention group had statistically significantly better sense of coherence at every stage of the study. The activities of daily living statistically significantly weakened in the intervention group (p = .001) from baseline to two years despite intervention, whereas in the control group it remained unchanged. In the control group, a statistically significant correlation was found between sense of coherence and FAs feeling satisfaction with their current life (p = .019). The HRQoL did not differ between the groups during the study. Conclusions:These results indicate a correlation between sense of coherence and quality of life and also between quality of life and amount of daily activities among FAs. Intervention did not improve the quality of life of FAs or their daily functioning. More research is needed to demonstrate the effects of community matron model on FAs care, the role of ehealth needs to be strongly involved.