Frequent attenders in general practice and immigrant status in Norway: A nationwide cross-sectional study

Abstract

Objective. To compare the likelihood of being a frequent attender (FA) to general practice among native Norwegians and immigrants, and to study socioeconomic and morbidity factors associated with being a FA for natives and immigrants. Design, setting and subjects. Linked register data for all inhabitants in Norway with at least one visit to the general practitioner (GP) in 2008 (2 967 933 persons). Immigrants were grouped according to their country of origin into low- (LIC), middle- (MIC), and high-income countries (HIC). FAs were defined as patients whose attendance rate ranked in the top 10% (cut-off point > 7 visits). Main outcome measures. FAs were compared with other GP users by means of multivariate binary logistic analyses adjusting for socioeconomic and morbidity factors. Results. Among GP users during the daytime, immigrants had a higher likelihood of being a FA compared with natives (OR (95% CI): 1.13 (1.09–1.17) and 1.15 (1.12–1.18) for HIC, 1.84 (1.78–1.89) and 1.66 (1.63–1.70) for MIC, and 1.77 (1.67–1.89) and 1.65 (1.57–1.74) for LIC for men and women respectively). Pregnancy, middle income earned in Norway, and having cardiologic and psychiatric problems were the main factors associated with being a FA. Among immigrants, labour immigrants and the elderly used GPs less often, while refugees were overrepresented among FAs. Psychiatric, gastroenterological, endocrine, and non-specific drug morbidity were relatively more prevalent among immigrant FA compared with natives. Conclusion. Although immigrants account for a small percentage of all FAs, GPs and policy-makers should be aware of differences in socioeconomic and morbidity profiles to provide equality of health care.

Frequent attenders in primary health care: A concept analysis

“…Some suffered from depression, anxiety, and somatoform disorders and needed the support of health care professionals. However, many health problems of frequent attenders were often complex, with chronic diseases, mental disorders, and psychological distress in combination (Dowrick et al, 2000;Neal et al, 2000b;Carney et al, 2001;Jyväsjärvi et al, 2001;Matalon et al, 2002;Kapur et al, 2004;Matalon et al, 2004;Foster et al, 2006;Savegeau et al, 2006;den Boer-Wolters et al, 2009;Robles et al, 2009;Smits et al, 2009;Luciano et al, 2010;Norton et al, 2012;Gomes et al, 2013;Smits et al, 2013;Diaz et al, 2014;Buja et al, 2015;Kaattari et al, 2015;Dinkel et al, 2016;Nyman and Jäppinen, 2015;Patel et al, 2015;Pymont and Butterworth, 2015b;Jørgensen et al,. 2016).…”

“…Individual characteristics of patients who become frequent attenders include: older age, lower level of education, social and economic difficulties, and stressful life events. Socio-demographic data in the literature showed that frequent attenders were older patients with a lower level of education (Carney et al, 2001;Jyväsjärvi et al, 2001;Howe et al, 2002;Matalon et al, 2002;Andersson et al, 2004;Bergh et al, 2006;Menchetti et al, 2006;Savageau et al, 2006;Al-Kandari et al, 2008;Jatic and Jatic, 2008;Smits et al, 2008;Robles et al, 2009;Koskela et al, 2010;Norton et al, 2012;Gomes et al, 2013;Smits et al, 2013;Diaz et al, 2014;Buja et al, 2015;Nyman and Jäppinen, 2015;Smits et al, 2016). The number of consultations usually increased with age starting at age 45 years or older.…”

“…According to the literature, frequent attenders had more social problems than other patient groups (Dowrick et al, 2000;Scaife et al, 2000;Vedsted et al, 2004a;Robles et al, 2009;Smits et al, 2009;Gili et al, 2011;Smits et al 2013). These social problems included: inadequate social support (Smucker et al, 2001;Matalon et al, 2005), social isolation (Scaife et al, 2000), and economic challenges (Scaife et al, 2000;Vedsted et al, 2004a;Vedsted and Olesen, 2005;Jatic and Jatic, 2008;Robles et al, 2009;Diaz et al, 2014;Buja et al, 2015;Dinkel et al, 2016). Furthermore, frequent attenders often also felt lonely and sought companionship from primary health care providers (Jyväsjärvi et al, 2001;Vedsted et al, 2004a;Vedsted and Olesen, 2005).…”

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS)

“…Several studies have analysed frequent attenders and related factors. Age and female sex are commonly reported as determinants of frequent attendance [3,5,[14][15][16][17]. Many studies have reported other strongly associated factors, such as severe or chronic physical disease [16,[18][19][20] and mental health problems [16,18,20].…”

Out-of-pocket costs, primary care frequent attendance and sample selection: Estimates from a longitudinal cohort design

“…We have previously used administrative Medicare data linked to longitudinal survey data to identify the characteristics of Australian primary-care FAs [2] and found that health related risk factors assessed in the survey explained over 50% of FA status and this increased a further 10% to 17% when the time varying nature of the risk factors was considered. [31] This research added to the literature linking FA status to a range of patient characteristics including socioeconomic status, [32] employment status (particularly unemployed), [33] being an immigrant, [3,34] insecure attachment, [35] distress, [36] number of medical issues, [37] and somatising and somatic illness, [38][39][40] but did not examine the role of out-of-pocket expenses on frequent attendance behaviour.…”