From: Frequent attenders in late life in primary care: a systematic review of European studies
Author and year | FA definition | Included contacts | Excluded contacts | Data sources | Main results |
---|---|---|---|---|---|
Bergh and Marklund, 2003 [37] | 10% most frequent attenders in 12 months/ by sex and age group | face-to-face visits to GP | medical records | Elderly (≥ 65 years): • Most diagnostic groups and medical prescriptions more frequent among FAs than non-FAs for both sexes Most common diseases: • Women: diseases of circulatory and musculoskeletal system, similar for FAs and non-FAs • Men: circulatory & endocrine diagnoses (FAs), circulatory and musculoskeletal problems (non-FAs) | |
Gilleard et al., 1998 [38] | Very High Attenders: 10% most frequent attenders in 12 months (> 15 contacts in 12 months) | face-to-face visits to GP, visits to the practice nurse | home visits, out-of-hour visits | computerized records, interviews, questionnaires | Elderly (≥ 65 years): • 10% FAs responsible for 33% of all visits • Frequent attendance not associated with psychiatric morbidity, self-reported depression, use of hypnotic or antipsychotic medication • Use of antidepressants: 9.5% of FAs received prescriptions for antidepressants compared to 2.8% of low average attenders (chi-square = 13.6, df 3, p < 0.01) |
Menchetti et al., 2006 [39] | > 1 contact to GP per month in 6 months | n/a | n/a | registered data, questionnaires, clinical judgments of GPs | Elderly (≥ 60 years): • Frequent attendance associated with moderate or severe physical illness (aOR = 2.89, 95% CI: 1.63–5.11), depression (aOR = 1.92, 95% CI: 1.10–3.35) and unexplained somatic symptoms (aOR = 1.99, 95% CI: 1.05–3.77) • Depression increased risk of being an FA fivefold and was a risk factor for frequent attendance independent of other clinical predictors |
Rennemark et al., 2009 [40] | 30% most frequent attenders in 12 months (≥3 contacts in 12 months) | n/a | n/a | questionnaires, cognitive tests, medical records | Elderly (≥ 60 years): • Number of GP visits positively correlated with age (0.53, p < 0.001), and comorbidity (0.93, p < 0.001), and negatively correlated with functional ability (−0.18, p < 0.001), education level (−0.12, p < 0.01) and internal locus of control (−0.12, p < 0.01) Results from logistic regression analyses: • Physical comorbidity as main factor determining frequent attendance (OR = 8.17, 95% CI: 5.54–12.04) • Sense of coherence (OR = 1.03, 95% CI: 1.00–1.06) and locus of control (OR = 1.14, 95% CI: 1.02–1.27) significantly related to frequent attendance • Education level and social anchorage not associated with frequent attendance |
Scherer et al., 2008 [46] | > 17 contacts in 9 months | n/a | n/a | questionnaires, telephone interviews | Elderly: • Frequent attendance associated with female sex, living alone, severity of heart failure, psychological distress and quality of life • In multivariate analysis physical problems (OR = 1.1, 95% CI: 1.0–1.1, p < 0.001) and living alone (OR = 2.4, 95% CI: 1.1–5.1) independently related to frequent attendance |
Sheehan et al., 2003 [45] | top third of attenders in 9 months | medical contacts with GP at primary care centre or at home | consultations with practice nurse | patient interview, GP records, GP assessment of patients tendency to somatise | Elderly (≥ 65 years): • Frequent attendance related to depression (OR = 2.24, 95% CI: 1.11–4.50, p < 0.05), high rates of physical disorder (OR = 1.78, 95% CI:1.16–2.71, p < 0.05), somatic symptom reporting (OR = 1.83, 95% CI:1.13–2.97, p < 0.05), and low social support (OR = 1.73, 95% CI:1.01–2.94, p < 0.05) • In multivariate regression only low social support and somatic symptoms significantly related to frequent attendance |
Svab and Zaletel-Kragelj, 1993 [43] | 25% most frequent attenders in 12 months/ by age group | face-to-face visits with GP, contacts for administrative purposes | telephone contacts | medical records and registered data | Elderly (>65): • Probability for superficial (administrative) contacts larger for FAs compared to non-FAs (median percentage of superficial contacts among all contacts: FAs = 27.1%/non-FAs = 0.5%, p = 0.05) • Non-significant trend: larger probability of referral to specialists for FAs compared to non-FAs (median index-value for referral to a specialist: FAs = 8.0/non-FAs = 0.4). |
van den Bussche et al., 2016 [44] | A: ≥ 50 contacts with physician practices in 12 months B: contacts with ≥10 different practices in 12 months C: contacts with ≥3 different practices of the same medical specialty in 12 months | visits to the practice, home, nursing home visits, telephone contacts, contacts with practice staff | appointments by phone and administrative contacts | insurance claims data/ registered data | Elderly (≥65): • Type A attendance associated with higher age, dependency on nursing care, multi-morbidity, and high impact somatic diseases • Types B and C attendance associated with younger age, less dependency on nursing care, and presence of mental diseases • Number of chronic conditions reduced the risk of being Type C FA |
Vedsted et al., 2001 [42] | daytime: 10% most frequent attenders (≥ 12 contacts) in 12 months/ by sex and age group out-of-hours: 10% most frequent attenders (≥ 4 contacts) in 12 months | daytime: face-to-face visits with GP out-of-hours: telephone advice, surgery consultations, home visits | telephone contacts during daytime and administrative and routine consultations | electronic records | Elderly (≥ 65 years): • Frequent attendance during daytime strongly related to the risk of being an out-of-hours FA: OR and 95% CI of daytime users to be an FA in out-of-hours service compared to non-attenders: men with 10% most daytime contacts: OR = 72.5 (CI: 48.7–107.9) women with 10% most daytime contacts: OR = 40.7 (CI: 28.2–58.8) |
Vedsted et al., 2004 [41] | 10% most frequent attenders (≥ 12 contacts) in 12 months/ by sex and age group | face-to-face visits to GP, home visits during daytime | telephone contacts, administrative and routine consultations (e.g. driver’s licenses) | electronic records | Elderly (≥ 65 years): • Prevalence ratio for using one or more drugs only slightly higher among FAs compared to the 50%-group with the fewest contacts • Prevalence for polypharmacy (drugs from 5 or more drug groups) 6.7 times (men) and 4.2 times (women) higher among FAs compared to the 50%-group with the fewest contacts |