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Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention.
- Source :
- BMC Family Practice; 2012, Vol. 13 Issue 1, p39-52, 14p, 2 Diagrams
- Publication Year :
- 2012
-
Abstract
- Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems,cognitive processes and social context.Methods/design: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP]over 2 years) with 100 normal attenders (6.22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation,and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined.Discussion: The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. [ABSTRACT FROM AUTHOR]
- Subjects :
- MEDICAL care use
COGNITIVE therapy
HYPOCHONDRIA
CONFIDENCE intervals
EPIDEMIOLOGY
INTERVIEWING
MEDICAL care costs
MEDICAL personnel
PATIENTS
GENERAL practitioners
RESEARCH funding
STATISTICAL sampling
QUALITATIVE research
PILOT projects
JUDGMENT sampling
DATA analysis
MULTIPLE regression analysis
THEMATIC analysis
CASE-control method
DESCRIPTIVE statistics
PREVENTION
THERAPEUTICS
ECONOMICS
Subjects
Details
- Language :
- English
- ISSN :
- 14712296
- Volume :
- 13
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- BMC Family Practice
- Publication Type :
- Academic Journal
- Accession number :
- 78547976
- Full Text :
- https://doi.org/10.1186/1471-2296-13-39