Abstract
BackgroundFrequent attenders (FAs) in primary care receive considerable resources with uncertain benefit. Only some FAs attend persistently. Modestly successful models have been built to predict persistent attendance. Nevertheless, an association between relational continuity of care and persistent frequent attendance remains unclear, and could be important considering both the UK government and Royal College of General Practitioner’s (RCGP) aim of improving continuity.AimTo identify predictive measures (including continuity) for persistent frequent attendance that may be modified in future interventions.Design & settingThis is a retrospective cohort study sampling 35 926 adult patients registered in seven Bristol practices.MethodThe top 3% (1227) of patients by frequency of GP consultations over 6 months were classed as FAs. Individual relational continuity was measured over the same period using the Usual Provider Continuity (UPC) index. Attendance change was calculated for the following 6 months. Multivariable logistic regression analysis was used to determine variables that predicted attendance change.ResultsFAs were on average 8.41 years older (difference 95% confidence interval [CI] = 7.33 to 9.50, P<0.001) and more likely to be female (65.36% versus 57.88%) than non-FAs. In total, 79.30% of FAs decreased attendance over the subsequent 6 months. No association was found between continuity and subsequent attendance. Increasing age was associated with maintained frequent attendance.ConclusionContinuity does not predict change in frequent attendance. In addition to improving continuity, recent government policy is focused on increasing primary care access. If both aims are achieved it will be interesting to observe any effect on frequent attendance.
Highlights
This study has found that continuity of care within this sample of Frequent attenders (FAs) did not predict subsequent change in attendance
The aim of this study was to present the characteristics of primary care FAs identified over a 6-m onth period and to identify predictive measures for ongoing persistent frequent attendance
These predictors could potentially be modified in future interventions. This retrospective cohort study was based on anonymised practice record data from seven practices, which were recruited via the Clinical Research Network: West of England for a feasibility trial of a primary care intervention to improve the care of frequent attenders.[17]
Summary
Frequent attenders (FAs) in primary care receive considerable resources with uncertain benefit. An association between relational continuity of care and persistent frequent attendance remains unclear, and could be important considering both the UK government and Royal College of General Practitioner’s (RCGP) aim of improving continuity. Aim: To identify predictive measures (including continuity) for persistent frequent attendance that may be modified in future interventions. Conclusion: Continuity does not predict change in frequent attendance. In addition to improving continuity, recent government policy is focused on increasing primary care access. If both aims are achieved it will be interesting to observe any effect on frequent attendance
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