Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel

Hammerman, Oded; Halpérin, Daniel; Tsalihin, Daniel; Greenberg, Dan; Kushnir, Talma; Ezra, Yacov

doi:10.1080/13814788.2021.1985997

Cited by 4 publications

(3 citation statements)

References 28 publications

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“…Frequent attenders (FAs) are a unique patient group characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP) (Hodgson et al, 2005). FAs are defined in the literature by the number of physician visits per year (usually 6–12) (Scaife et al, 2000) or by the top percentage (usually 3–10%) of attenders during a single year (Hammerman et al, 2021; Neal et al, 1998; Pymont & Butterworth, 2015; Reho et al, 2018; Vedsted & Christensen, 2005). Several studies have shown that about 10–30% of FAs continue to seek frequent consultation for more than one year (Carney et al, 2001; Smits, Brouwer, van Weert, et al, 2009), and they are often defined as persistent FAs (Smits et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

“…FAs often have complex health problems (Bergh et al, 2007; Reho et al, 2019) that manifest in a greater rate of diagnoses and chronic diseases compared to other health consumers (Vedsted & Christensen, 2005), as well as psychiatric and psychological symptomatology, impairment in activities of daily living (Pymont & Butterworth, 2015), worse self‐rated health, lower physical functioning and physical illnesses (Hajek et al, 2021), lower quality of life (Kivela et al, 2018) and lower ability to cope with life events (Bergh et al, 2006). Hammerman et al (2021) have found that almost 50% of FAs have medically unexplained symptoms. Socioeconomic deprivation has also been suggested as a characteristic of FAs (Scaife et al, 2000) as well as lower age and unemployment (Hajek et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…Although FAs constitute about 10% of all primary clinic attendees, they are responsible for approximately 40–50% of clinic visits (Kontopantelis et al, 2021; Neal et al, 1998; Patel et al, 2015; Smits, Brouwer, ter Riet, & van Weert, 2009). FAs affect the efficiency, accessibility and quality of health services provided to other patients, prolong wait times, shorten the time devoted to each patient, cause unnecessary referrals and prescriptions and increase the cost of care and the burden on PCPs (Groode et al, 2008; Hammerman et al, 2021; Neal et al, 1998; Smits, Brouwer, ter Riet, & van Weert, 2009).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Frequent attenders in primary health care: a mixed‐methods study of patient and staff perspectives

Sharabani

Kagan

Cojocaru

2023

Journal of Clinical Nursing

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Aims and ObjectiveTo understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced.BackgroundFrequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40–50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients.DesignMixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2).MethodsEighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross‐sectional survey.ResultsFAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it.ConclusionsThe accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon.Relevance to Clinical PracticeThe frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support.Patient or Public ContributionThere was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

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