Abstract
BackgroundThe 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/designA 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.DiscussionThe 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.
Highlights
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
Cognitive behaviour formulation and treatment (CBT) for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention
Frequent attendance defined as the top 10 per cent of attenders in primary care is discriminative from normal attenders in terms of patient characteristics compared to broader definitions [3]
Summary
In the current global financial climate where most governments are struggling to fund health services, there is a growing interest in the cost, clinical characteristics and interventions for high utilisers of care such as persistent frequent attenders in primary care Previous studies indicate such patients are difficult to manage and will require changes in usual professional practice and organisation of care that may be resisted by patients and professionals alike [32,36,37,42,70]. Understanding of how otherwise inexplicably high rates of consultation have arisen using the narrative context of the patient’s life story [72] may help the clinician to increase their empathy for the patient Such empathy is necessary for strong enough therapeutic relationships to develop between the frequently attending patient, GP and cognitive behaviour therapist that might influence a patient’s behaviour without the need for coercion. Competing interests The authors declare that they have no competing interests
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
