High service users: does the clinical psychologist have a role?

To assess the impact of psychological intervention on high users of the GP service.

A sample of high-attenders was offered the opportunity to attend an interview with a clinical psychologist. A three-year (one year before and two years after psychological intervention) survey of patient records was carried out to determine the pattern of patient attendances. In addition, GP and patient satisfaction questionnaires were utilised to rate the psychological service.

A GP surgery situated in the coastal region of Scotland.

All adult patients, who had consulted over 12 times in the 12 months prior to the beginning of the study except those who had ongoing medical problems that the GP felt were being dealt with adequately, were invited to a psychological interview. In all, 174 invitations were sent, and 101 agreed to psychological intervention.

After three months both the GPs and patients positively rated the input of the psychologist. There were short-term benefits from the psychological intervention in terms of attendance rates, which were not in evidence in the long term. For the participating group there was a significant decrease in attendance rate three months after psychological intervention compared to the non-participating group (P < 0.001). However, at 12 and 24 months after intervention both groups reduced attendance at a similar rate.

Psychologist intervention had a short, but not long term, benefit, in reducing attendance rates. However, both GPs and patients found the provision of a report from the psychologist useful.