Abstract
BackgroundThe aim of the study was to compare occasional and persistent frequent attenders in occupational health (OH) primary care and to identify the diagnoses associated with persisting frequent attendance.MethodsThis is a longitudinal study using electronic medical record data from 2014 to 2016 from an OH service provider. Frequent attenders were defined as patients in the top decile of annual visits to healthcare professionals (frequent attender 10%, FA10). FA10 were categorized to three groups according to the persistence of frequent attendance (1-year-FA, 2 year-FA, and persistent-FA = frequent attenders in all three years). This was used as the dependent variable. We used patient sex, age, employer size, industry and distribution of visits and diagnostic codes to characterize the different frequent attender groups.ResultsIn total, 66,831 patients were included, of which 592 persistent frequent attenders (0.9% of the study population) consulted the OH unit on average 13 times a year. They made altogether 23,797 visits during the study years. The proportion of women and employees of medium and large employers increased among persistent-FAs when compared to the other groups. Multinomial logistic regression accentuated musculoskeletal disorders and to a lesser extent diseases of the respiratory and nervous system and mental disorders. One in five FA becomes a persistent-FA.ConclusionsOur results indicate that in the context of a working population the association of musculoskeletal disorders and persistent frequent attendance is emphasized. Persistent frequent attenders also create a substantial demand on physician resources. When planning interventions aimed at working age frequent attenders, subgroups suffering from musculoskeletal disorders should be identified as they are associated with persisting frequent attendance.
Highlights
The aim of the study was to compare occasional and persistent frequent attenders in occupational health (OH) primary care and to identify the diagnoses associated with persisting frequent attendance
The use of other professionals besides physicians increased as frequent attendance continued. 2yFAs and persistent frequent attenders (pFA) consult with a psychologists, physiotherapists and specialists more often than non-frequent attenders (non-FA) and 1yFAs do
FA status was defined as the top decile of attenders 1-year-FA = Patients that were in the top decile of attenders in one of the study years (2014, 2015 or 2016) 2-year-FA = Patients that were in the top decile in any two study years (2014, 2015 or 2016) pFA = Patients that were in the top decile in all three study years (2014, 2015 and 2016) non-FA = Patients that were never in the top decile were considered as a reference group, non-frequent attenders p value < 0.001 < 0.001 < 0.001
Summary
The aim of the study was to compare occasional and persistent frequent attenders in occupational health (OH) primary care and to identify the diagnoses associated with persisting frequent attendance. Frequent attenders demand a substantial portion of physician’s time and consume a considerable share of health care resources [1,2,3]. Some patients consult their physician repeatedly for a short period and return to an irregular pattern of attendance after some time [3, 4]. Another group of patients, often referred to as persistent frequent attenders, visit health care providers frequently one year after another [3, 5]. Finnish occupational health (OH) primary care is an appropriate environment to study frequent attenders in working population, as it covers 90% of the employees [13] and maintains comprehensive health records
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