Repeat attenders at National Health Service walk-in centres – a descriptive study using routine data

Abstract

Whilst numerous studies have examined repeat attendance at general practices or emergency departments, little is known about repeat attenders at walk-in centres. The aim of this study was to examine age, gender, socio-economic status, distance from walk-in centre, day and time of attendance in relation to repeat attendance at walk-in centres. Descriptive study using routine data from four walk-in centres in England, two of which were located in London and were accessible to local and commuter populations. Data for 2 years (2003-2004) were examined. Age, gender, day and time of attendance were obtained from administrative records. Distance was calculated from the census output area of residence to walk-in centre attended. The Index of Multiple Deprivation (Income Domain) was used as an indicator of socio-economic deprivation at the small-area level. Thirty-nine percent of 272,701 attendances by 166,486 patients were repeat attendances. Seventy percent of patients attended once, 27.9% attended two to five times, and 2.2% attended on over five occasions over the 2-year study period. Patients attending the two London walk-in centres lived closer than those attending the two walk-in centres outside London (percentage living 6 km or more from walk-in centre: 9% and 12% compared with 18% and 22%). The London walk-in centres had a higher percentage of single attenders (74.1% and 78%) compared with the other two walk-in centres (63.3% and 64.7%). Repeat attenders lived closer to walk-in centres than single attenders. Adjusted odds ratios for patients living within 3 km of the walk-in centre relative to patients living 6 km or more from the walk-in centre ranged from 1.59 [95% confidence interval (CI) 1.42-1.78] to 3.34 (95% CI 3.12-3.57) for patients attending two to five times, and from 2.37 (95% CI 1.36-4.11) to 14.99 (95% CI 11.30-19.88) for patients with over five attendances. There was substantial variation with significant contrasting patterns in odds ratios across walk-in centres in relation to the other variables. Repeat attenders were older than single attenders at three of the four walk-in centres. Repeat attenders tended to be more likely to be male at two walk-in centres, and less likely to be male at the other two walk-in centres. Socio-economic deprivation tended to be associated with repeat attendance at one of the walk-in centres. There were also significant and contrasting patterns in relation to day and, to a lesser extent, time of attendance. Users living near walk-in centres are more likely to be repeat attenders. Age, gender, socio-economic deprivation, day and time of attendance had significantly higher or lower odds ratios for repeat attendance at different walk-in centres, suggesting that organizational and other factors may determine patterns of repeat attendance.