Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare

Abstract

ObjectivesTo describe patterns of frequent attendance in Australian primary care, and identify the prospective risk factors for persistent frequent attendance.Design, setting and participantsThis study draws on data from the Personality and Total Health (PATH) Through Life Project, a representative community cohort study of residents from the Canberra region of Australia. Participants were assessed on 3 occasions over 8 years. The survey assessed respondents’ experience of chronic physical conditions, self-reported health, symptoms of common mental disorders, personality, life events, sociodemographic characteristics and self-reported medication use. A balanced sample was used in analysis, comprising 1734 respondents with 3 waves of data. The survey data for each respondent were individually linked to their administrative health service use data which were used to generate an objective measure of general practitioner (GP) consultations in the 12 months surrounding their interview date.Main outcome measuresRespondents in the (approximate) highest decile of attenders on number of GP consultations over a 12-month period at each time point were defined as frequent attenders (FAs).ResultsBaseline FAs (8.4%) were responsible for 33.4% of baseline consultations, while persistent FAs (3.6%) for 15.5% of all consultations over the 3 occasions. While there was considerable movement between FA status over time, consistency was greater than expected by chance alone. While there were many factors that differentiated non-FAs from FAs in general, persistent frequent attendance was specifically associated with gender, baseline reports of depression, self-reported physical conditions and disability, and medication use.ConclusionsThe degree of persistence in GP consultations was limited. The findings of this study contribute to our understanding of the risk factors that predict subsequent persistent frequent attendance in primary care. However, further detailed investigation of longitudinal patterns of frequent attendance and consideration of time-varying determinants of frequent attendance is required.

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

“…21.0% of patients identified as FAs made no out-of-pocket payment for any of their consultations. Consistent with our previous findings, [2,31] FA status was associated with diabetes, number of life events, low income, lower educational achievement, anxiety, depression, cholesterol, and pain medication use as evidenced in the regression models and preliminary analyses. Some demographics are presented in Table 1 while demographics across payment levels are presented in Supplemental Table 1.…”

“…Hence, there was a 12month observation period for all participants but these could have different starting points. The analysis considers a comprehensive list of relevant GP Medicare item numbers (see [2]) representing all face-to-face Medicare services delivered by a GP. A cut-point was applied to…”

“…In 2014 the Australian Health Minister noted that a small group of patients accounted for a large proportion of overall government funded health services and proposed a need to reconsider the way these patients were managed. [1] The most prolific users of primary health care services (frequent attenders (FAs)), commonly defined as the top 10% of attenders in a year, have been found to account for 33% of GP consultations [2] and generate five times as many prescriptions and hospital contacts as other patients. [3] FA's 3-year expenditures have been found to be higher than non-FAs, even after adjustment for patient and health care provider characteristics.…”

“…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.…”

Persistent frequent attenders in primary care: case-control study comparing chronic diseases of five-year and one-year frequent attenders and features of the typical five-year frequent attenders

“…We could not confirm this finding in this study. Smits et all ( 2009) and Pymont and Butterworth (2015) reported that persistent FAs used analgesic medication more often than one-year FAs, but the indication for pain medication was not specified [6,11]. We found out that pFAs had more back pain, but we did not have information about prescriptions of our study group.…”