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Frequent attenders in general practice: an attempt to reduce attendance
1Institute of General Practice and Primary Care, Northern General Hospital, Herries Rd, Sheffield S5 7AU, UK.
Insights
Providing general practitioners (GPs) with patient record summaries did not reduce consultation rates for frequent attenders. This intervention failed to impact the frequency of visits for patients with multiple health issues.
Area of Science:
- General Practice
- Health Services Research
- Patient Management
Background:
- Frequent attenders in general practice often present with complex, multifaceted health issues.
- Effective management of frequent attenders relies on accessible and comprehensive patient clinical records.
- Previous studies have not adequately assessed the impact of record summaries on consultation frequency.
Purpose of the Study:
- To evaluate the effect of providing detailed, accessible patient problem summaries on general practitioner (GP) consultation rates.
- To determine if summarizing physical, social, and psychological data influences patient attendance frequency.
Main Methods:
- A prospective controlled study involving 104 frequent attenders (≥11 consultations/year) at a UK general practice.
- Patients were divided into intervention (prominent summaries in notes) and control (no summaries) groups.
- Consultation rates were monitored for 5 months following the introduction of summaries.
Main Results:
- The intervention of providing summarized patient records did not significantly reduce consultation rates among frequent attenders.
- Even when GPs evidenced consulting the summaries, patient attendance frequency remained unchanged compared to those whose summaries were not consulted.
Conclusions:
- Prominently displayed patient history summaries for GPs do not decrease consultation frequency for frequent attenders.
- The complexity of frequent attenders' multiple problems may necessitate approaches beyond simple record summarization to manage attendance rates.
Background:
'Frequent attenders' in general practice are known to include patients with a variety of problems. Most studies of frequent attenders have not assessed the impact of providing GPs with detailed summaries of the clinical records of these patients on consultation rates. Good medical records are associated with good care. If it is not relatively easy or quick for GPs to ascertain which chronic illness or psychosocial problems the patient has from the records, it will be difficult to manage the patient proactively.
Objective:
The aim of this study was to investigate the impact on the consultation rate of providing a detailed and accessible summary of patients' problems including physical, social and psychological data based on information already recorded in the patients' records.
Method:
A prospective controlled study was made of frequent attenders at one UK general practice comprising four full-time GPs. A total of 104 frequent attenders were identified by examining the lists of patients attending the surgery and by including the names of patients identified by GPs from memory. The final study groups were patients who consulted a GP 11 times or more in a year. The sample was divided into two groups. In both groups, the clinical notes were summarized for data relating to physical, social and psychological problems. In the intervention group, summaries were displayed prominently in the notes which were marked with a distinctive label. GPs were asked to read and initial the available summaries in these notes. In the control group, summaries were not included in the notes and the notes were not highlighted in any way. The consultation rate of these 104 patients was recorded for 5 months after the availability of the summaries in the notes.
Results:
Summarizing the notes in the style described in this study failed to reduce the consultation rate of the identified frequent attenders (Kruskal-Wallis H = 2.75, P = 0.1) Furthermore, in the intervention group, patients for whom there was evidence that the summaries had been consulted by their GP (24; 46%) continued to attend as frequently as those whose summaries were not endorsed as consulted (mean attendance 4.8 consultations compared with 4.2 in 5 months).
Conclusion:
Frequent attenders often have multiple problems, but prominently displayed summaries of their history for use by GPs during consultations do not reduce the frequency of consultations.