Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives

Sharabani, R., Kagan, I., & Cojocaru, S. Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives. Journal of Clinical Nursing, 32(19-20), 7135-7146.  https://doi.org/10.1111/jocn.16772

Abstract

Aims and Objective

To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced.

Background

Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40–50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients.

Design

Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2).

Methods

Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross-sectional survey.

Results

FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs’ personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it.

Conclusions

The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon.

How to cite:

Sharabani, R., Kagan, I., & Cojocaru, S. Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives. Journal of Clinical Nursing, 32(19-20), 7135-7146.  https://doi.org/10.1111/jocn.16772

References:

Bello, P. (2017). Effective communication in nursing practice: A literature review. BSc Nursing Thesis. Retrieved from: https://core.ac.uk/download/pdf/84798372.pdf

Bellón, J. Á., & Fernández-Asensio, M. E. (2002). Emotional profile of physicians who interview frequent attenders. Patient Education and Counseling48(1), 33–41. https://doi.org/10.1016/S0738-3991(02)00097-6

Bergh, H., Baigi, A., Fridlund, B., & Marklund, B. (2006). Life events, social support and sense of coherence among frequent attenders in primary health care. Public Health120(3), 229–236. https://doi.org/10.1016/j.puhe.2005.08.020

Bergh, H., Baigi, A., Mansson, J., Mattsson, B., & Marklund, B. (2007). Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years. Public Health121(1), 25–33. https://doi.org/10.1016/j.puhe.2006.08.018

Bergh, H., Baigi, A., & Marklund, B. (2005). Consultations for injuries by frequent attenders are found to be medically appropriate from general practitioners’ perspective. Scandinavian Journal of Public Health33(3), 228–232. https://doi.org/10.1080/14034940510005761

Bergh, H., & Marklund, B. (2003). Characteristics of frequent attenders in different age and sex groups in primary health care. Scandinavian Journal of Primary Health Care21(3), 171–177. https://doi.org/10.1080/02813430310001149

Braun-Lewensohn, O., Sagy, S., & Roth, G. (2010). Coping strategies among adolescents: Israeli Jews and Arabs facing missile attacks. Anxiety, Stress, and Coping23(1), 35–51. https://doi.org/10.1080/10615800802647601

Brezzi, M., Dijkstra, L., & Ruiz, V. (2011). OECD Extended Regional Typology. https://doi.org/10.1787/5kg6z83tw7f4-en

Carelli, F., Petrazzuoli, F., Daddio, F., & Sauro, A. (2003). Frequent attenders: The practitioner’s everyday life hell. British Medical Journal325, 323.

Carney, T. A., Guy, S., & Jeffrey, G. (2001). Frequent attenders in general practice: a retrospective 20-year follow-up study. British Journal of General Practice51(468), 567–569. https://www.ncbi.nlm.nih.gov/pubmed/11462318

Clarfield, A. M., Manor, O., Nun, G. B., Shvarts, S., Azzam, Z. S., Afek, A., Basis, F., & Israeli, A. (2017). Health and health care in Israel: An introduction. Lancet389(10088), 2503–2513. https://doi.org/10.1016/s0140-6736(17)30636-0

Committee for Strengthening the Public Health System Report. (2014). Retrieved from Jerusalem

Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed methods approaches ( 4th ed.). Sage.

Filc, D., Rasooly, A., & Davidovitch, N. (2020). From public vs. private to public/private mix in healthcare: Lessons from the Israeli and the Spanish cases. Israel Journal of Health Policy Research9(1), 31. https://doi.org/10.1186/s13584-020-00391-4

Groode, J., Cohen, A. D., Vardy, D. A., & Dreiher, J. (2008). Factors associated with frequent attendance in a Bedouin primary care setting. Harefuah147(12), 966-970, 1030. https://www.ncbi.nlm.nih.gov/pubmed/19260591

Hajek, A., Kretzler, B., & König, H.-H. (2021). Determinants of frequent attendance in primary care. A systematic review of longitudinal studies. Frontiers in Medicine8, 595674. https://www.frontiersin.org/articles/10.3389/fmed.2021.595674

Hammerman, O., Halperin, D., Tsalihin, D., Greenberg, D., Kushnir, T., & Ezra, Y. (2021). Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel. European Journal of General Practice27(1), 294–302. https://doi.org/10.1080/13814788.2021.1985997

Heywood, P. L., Blackie, G. C., Cameron, I. H., & Dowell, A. C. (1998). An assessment of the attributes of frequent attenders to general practice. Family Practice15(3), 198–204. https://doi.org/10.1093/fampra/15.3.198

Hodgson, P., Smith, P., Brown, T., & Dowrick, C. (2005). Stories from frequent attenders: a qualitative study in primary care. Annals of Family Medicine3(4), 318–323. https://doi.org/10.1370/afm.311

Huhtakangas, M., Tuomikoski, A.-M., Kyngäs, H., & Kanste, O. (2021). Frequent attenders’ experiences of encounters with healthcare personnel: A systematic review of qualitative studies. Nursing & Health Sciences23(1), 53–68. https://doi.org/10.1111/nhs.12784

Jacob, R., Wong, M. L., Hayhurst, C., Watson, P., & Morrison, C. (2016). Designing services for frequent attenders to the emergency department: a characterisation of this population to inform service design. Clinical Medicine (London)16(4), 325–329. https://doi.org/10.7861/clinmedicine.16-4-325

Kivela, K., Elo, S., & Kaariainen, M. (2018). Frequent attenders in primary health care: A concept analysis. International Journal of Nursing Studies86, 115–124. https://doi.org/10.1016/j.ijnurstu.2018.06.003

Kontopantelis, E., Panagioti, M., Farragher, T., Munford, L. A., Parisi, R., Planner, C., Spooner, S., Tse, A., Ashcroft, D. M., & Esmail, A. (2021). Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices. BMJ Open11(12), e054666. https://doi.org/10.1136/bmjopen-2021-054666

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing20(1), 158. https://doi.org/10.1186/s12912-021-00684-2

Lin, E. H. B., Katon, W., Von Korff, M., Bush, T., Lipscomb, P., Russo, J., & Wagner, E. (1991). Frustrating patients. Journal of General Internal Medicine6(3), 241–246. https://doi.org/10.1007/BF02598969

McCabe, C. (2004). Nurse–patient communication: An exploration of patients’ experiences. Journal of Clinical Nursing13(1), 41–49. https://doi.org/10.1111/j.1365-2702.2004.00817.x

Neal, R. D., Heywood, P. L., Morley, S., Clayden, A. D., & Dowell, A. C. (1998). Frequency of patients’ consulting in general practice and workload generated by frequent attenders: Comparisons between practices. British Journal of General Practice48(426), 895–898. https://www.ncbi.nlm.nih.gov/pubmed/9604412

Nyman, J., & Jäppinen, P. H. (2015). Heavy users of health station outpatient care. Journal of Social Medicine52(1), 4–19.

Patel, S., Kai, J., Atha, C., Avery, A., Guo, B., James, M., Malins, S., Sampson, C., Stubley, M., & Morriss, R. (2015). Clinical characteristics of persistent frequent attenders in primary care: Case-control study. Family Practice32(6), 624–630. https://doi.org/10.1093/fampra/cmv076

Pino-Moya, E., Ortega-Moreno, M., Gómez-Salgado, J., & Ruiz-Frutos, C. (2018). Determining factors for the increase in self-referrals to the emergency department of a rural hospital in Huelva (Spain). PLoS One13(11), e0207199. https://doi.org/10.1371/journal.pone.0207199

Polit, D. F., & Beck, C. T. (2017). Nursing Research: Generating and Assessing Evidence for Nursing Practice ( 10th ed.), Philadelphia: Wolters Kluwer Health.

Pymont, C., & Butterworth, P. (2015). Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare. BMJ Open5(10), e008975. https://doi.org/10.1136/bmjopen-2015-008975

Reho, T., Atkins, S., Talola, N., Sumanen, M., Viljamaa, M., & Uitti, J. (2018). Comparing occasional and persistent frequent attenders in occupational health primary care – a longitudinal study. BMC Public Health18(1), 1291. https://doi.org/10.1186/s12889-018-6217-8

Reho, T. T. M. (2020). Frequent attenders of occupational health primary care and work disability. Tampere University.

Reho, T. T. M., Atkins, S. A., Talola, N., Sumanen, M. P. T., Viljamaa, M., & Uitti, J. (2019). Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland. BMJ Open9(2), e024980. https://doi.org/10.1136/bmjopen-2018-024980

Rosen, B., Waitzberg, R., & Merkur, S. (2015). Israel: Health system review. Health Systems in Transition17(6), 1–212.

Sabar Ben-Yehoshua, N., & Dushnik, L. (2006). Ethical issues in action research. In D. Levy (Ed.), Philosophical and methodological associations between action research and the qualitative research paradigm. Tel Aviv.

Sandvik, H., Hetlevik, O., Blinkenberg, J., & Hunskaar, S. (2021). Continuity in general practice as predictor of mortality, acute hospitalisation, and use of out-of-hours care: a registry-based observational study in Norway. British Journal of General Practice.72, e84–e90. https://doi.org/10.3399/BJGP.2021.0340

Scaife, B., Gill, P. S., Heywood, P. L., & Neal, R. D. (2000). Socio-economic characteristics of adult frequent attenders in general practice: Secondary analysis of data. Family Practice17(4), 298–304. https://doi.org/10.1093/fampra/17.4.298

Shkedi, A. (2003). Words That Try to Touch: Qualitative Research—Theory and Application. Tel-Aviv: Ramot.

Shum, C., Humphreys, A., Wheeler, D., Cochrane, M.-A., Skoda, S., & Clement, S. (2000). Nurse management of patients with minor illnesses in general practice: Multicentre, randomised controlled trial. BMJ320(7241), 1038–1043. https://doi.org/10.1136/bmj.320.7241.1038

Smits, F. T., Brouwer, H. J., ter Riet, G., & van Weert, H. C. (2009). Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders. BMC Public Health9, 36. https://doi.org/10.1186/1471-2458-9-36

Smits, F. T., Brouwer, H. J., van Weert, H. C., Schene, A. H., & ter Riet, G. (2009). Predictability of persistent frequent attendance: a historic 3-year cohort study. British Journal of General Practice59(559), e44–e50. https://doi.org/10.3399/bjgp09X395120

Smits, F. T., Brouwer, H. J., Zwinderman, A. H., Mohrs, J., Schene, A. H., van Weert, H. C., & ter Riet, G. (2014). Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. Journal of Psychosomatic Research77(6), 492–503. https://doi.org/10.1016/j.jpsychores.2014.08.003

Vedsted, P., & Christensen, M. B. (2005). Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health119(2), 118–137. https://doi.org/10.1016/j.puhe.2004.03.007

Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice1(1), 2–4. https://www.ncbi.nlm.nih.gov/pubmed/10345255

Wagner, E. H., Glasgow, R. E., Davis, C., Bonomi, A. E., Provost, L., McCulloch, D., Carver, P., & Sixta, C. (2001). Quality improvement in chronic illness care: a collaborative approach. Joint Commission Journal on Quality Improvement27(2), 63–80. https://doi.org/10.1016/s1070-3241(01)27007-2

Williams, S. J. (2005). Parsons revisited: From the sick role to…? Health (London, England)9(2), 123–144. https://doi.org/10.1177/1363459305050582

Categories: