Frequent attenders in a Finnish health centre: morbidity and reasons for encounter

Jyväsjärvi, Simo; Keinänen‐Kiukaanniemi, Sirkka; Väisänen, Erkki; Larivaara, Pekka; Kivelä, Sirkka‐Liisa

doi:10.1080/028134398750003089

Cited by 50 publications

(16 citation statements)

References 11 publications

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“…There is also a difference between frequent attenders that attend for a diagnosed chronic disease and those suffering from vague symptoms where their general practitioners are unable to diagnose them [6]. Even though the group is not clearly defined, numerous efforts have been made to describe it, using quantitative methods that focus on quality of life [8], social factors [9–11], and comorbidity with psychiatric disease [8, 12–14]. Furthermore, frequent use of health services also appears to be associated with a low sense of coherence and low internal locus of control [15–17].…”

Section: Introductionmentioning

confidence: 99%

Struggling on My Own: A Cognitive Perspective on Frequent Attenders' Conception of Life and Their Interaction with the Healthcare System

Gustin

2013

Psychiatry Journal

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Different studies reveal that a large percentage of people frequently attending healthcare not only suffer from diffuse somatic symptoms but also from psychological distress and difficulties in dealing with everyday life. Even though they are not always diagnosed with psychiatric disease, questions arise about their mental health. The study aims at describing frequent attenders' conceptions of life, and as a result their health, from a cognitive perspective. A qualitative content analysis of in-depth interviews was carried out with nine service users in primary healthcare. The findings reveal that participants experience themselves as inadequate and as being a burden for others, by whom they experience rejection, in different ways. In order to take part in community with others the person develops compensatory strategies that aim at concealing their inadequacies, thus also preventing them from sharing their suffering with others. The consequence is that the persons become even more alienated as they start to relate to others through a façade and furthermore are unable to either improve their health or obtain adequate care. It can be concluded that these patients need to be taken seriously in order to prevent further psychological suffering.

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Section: Introductionmentioning

confidence: 99%

Struggling on My Own: A Cognitive Perspective on Frequent Attenders' Conception of Life and Their Interaction with the Healthcare System

Gustin

2013

Psychiatry Journal

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“…Following previous Finnish studies, frequent attenders were defined as those who had eight or more outpatient visits per year to a GP. [1,3,[5][6][7] Visits to the university hospital were also considered, and patients who had made four or more outpatient visits to the university hospital per year were also defined as FAs. [6][7][8] In order to develop healthcare services, the aim was to study the use of health services as a whole, and that is why we also included specialized care in our study.…”

Section: Settings and Samplementioning

confidence: 99%

“…[4] The need that FAs have for support and information on health care professionals is more than that of the general population. In this study, an FA is defined as a patient who has at least eight visits per year to the GP, according to previous studies in Finland, [1,3,[5][6][7] or at least four visits per year to the university hospital. [6][7][8] The care of FAs should be considered as a comprehensive approach rather than GPs just helping in acute situations.…”

Section: Introductionmentioning

confidence: 99%

The effects of intervention on the quality of life, sense of coherence and daily activities of frequent attenders

Hirsikangas

Kanste²,

Korpelainen³

et al. 2017

JNEP

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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.

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“…According to previous Finnish studies, patients who made at least eight outpatient visits per year to a general practitioner (GP) in the local health center were defined as FAs of medical services. [6][7][8]10] Patients were also defined as FAs if they had made at least four outpatient visits per year to the university hospital. [32] Because the aim was to examine the use of health services as a whole in order to develop health care services, specialized care was selected for inclusion.…”

Section: Settings and Samplementioning

confidence: 99%

“…According to previous studies in Finland, the cut-off point of general practitioner was defined as 8 visits. [6][7][8] In Finland, the number of older people is increasing, and consequently the number of FAs of health services will increase. The population part of people ≥ 65 years of age is expected to increase from the current 19.9% to 26% by the year 2030 and remain broadly unchanged for the following ten years.…”

Section: Introductionmentioning

confidence: 99%

The effects of intervention on frequent attenders' adherence to health regimens, depression, somatization and hypochondriasis

Hirsikangas

Kanste²,

Korpelainen³

et al. 2017

JNEP

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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.

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Frequent attenders in a Finnish health centre: morbidity and reasons for encounter

Cited by 50 publications

References 11 publications

Struggling on My Own: A Cognitive Perspective on Frequent Attenders' Conception of Life and Their Interaction with the Healthcare System

Struggling on My Own: A Cognitive Perspective on Frequent Attenders' Conception of Life and Their Interaction with the Healthcare System

The effects of intervention on the quality of life, sense of coherence and daily activities of frequent attenders

The effects of intervention on frequent attenders' adherence to health regimens, depression, somatization and hypochondriasis

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