An assessment of the attributes of frequent attenders to general practice

Although it is thought that frequent attendance to general practice is associated with high use of health services, there is little information on the health of these patients, their use of health services or their perceptions of their service use.

We aimed to define and identify the frequent attenders aged between 20 and 65 years in a general practice population and to characterize their attributes and use of services.

We carried out a retrospective analysis of case-notes to identify a study population for interview and to be administrated the Patient Satisfaction Questionnaire, General Health Questionnaire (GHQ-28) and Nottingham Health Profile (NHP). The study was set in a UK teaching general practice of 12 400 patients. The subjects were 132 patients who attended 12 or more times in the study year and 102 age- and sex-matched control patients of normal consulting frequency.

The mean frequency of attendance of very frequent attenders (VFAs) at 15 times per year was five times that of control patients. A total of 86% of very frequent attenders (VFAs) are female; 60% are married, compared with 78% of controls. Only half of VFAs thought they consulted more often than average, although 82% of 55 patients who consulted more than 24 times in 2 years recognized that they consulted more often than average. Ninety-four per cent of VFAs and 39% of controls had a chronic health problem. VFAs received prescriptions from more therapeutic groups than controls and overall received five times as many prescriptions. The rate of referral to hospital specialists was five times greater for VFAs than for controls. There were no differences on the Patient Satisfaction Questionnaire; 52% of VFAs and 29% of controls were depressed on GHQ-28; and VFAs showed distress on all modalities of well-being on NHP.

This population of VFAs has high levels of physical and psychological ill health. They consult five times as often as the norm, receive five times as many prescriptions and are referred to hospitals five times as often. It remains unanswered whether this represents good general practice containment of the problem or is a poor use of the resources. Given the high levels of depression and low levels of well-being, perhaps strategies should be adopted to tackle these first. If the average consulting rate of VFAs could be reduced by one consultation per year, it would represent an overall reduction of 1% in the GP's practice workload for this age group.