Abstract
BackgroundThis study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors.MethodsThis cross-sectional study was conducted in six community health service centers in Shanghai, China, from August to December 2018 based on stratified sampling. On the basis of our preliminary study, FAs were defined as those attending at least four consultations in a month. A self-administered questionnaire was used to collect the clinicodemographic data of the participants. Social support, pain severity, depression, and anxiety were evaluated using the Social Support Revalued Scale, six-point Behavioral Rating Scale, Patient Health Questionnaire–9, and Generalized Anxiety Disorder Scale, respectively.ResultsThis study included 619 patients aged > 60 years. Among these patients, 155 (25%) were FAs to a community health service center, 366 (59.1%) had 1 or 2 chronic diseases, 179 (28.9%) had ≥3 chronic diseases, 313 (50.4%) opted for a family doctor service, and 537 (86.8%) chose a community health service center for the first consultation. The following were identified as independent risk factors for frequent attendance: widowed status, unmarried status, the presence of > 3 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication, the use of both traditional Chinese and Western medicine services, and depression.ConclusionsThis study summarizes the characteristics of older FAs to community health service centers in China and identifies 10 risk factors significantly associated with frequent attendance.
Highlights
This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors
We identified 10 independent risk factors of frequent attendance, including widowed status, unmarried status, the presence of > 3 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication use, the use of both traditional Chinese and Western medicine services, and depression
The results of the stepwise multiple logistic regression analysis performed in our study revealed that an increasing number of chronic diseases, long-term medication use, the use of both traditional Chinese and Western medicine services, and high medical expenses were significantly associated with frequent attendance of older patients aged > 60 years, which is partly consistent with the results of European studies [12, 13, 25]
Summary
This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors. Frequent attendance at community health service centers has resulted in a huge burden on the healthcare system, attracting increasing scientific attention in recent years [1]. The aging population with chronic diseases has become a global concern that demands increased attention [10]. A retrospective study reported that older FAs to the emergency department in Singapore are at higher risk of mortality compared to the overall emergency department population [11]. A systemic review of European studies revealed that severe diseases and the need for treatment primarily drive the frequent attendance of older patients at primary care centers [12]. A population-based longitudinal study in Germany provides evidence that older age, unemployment status, decreasing physical functioning, worsening health, and increasing physical diseases contribute to the onset of frequent attendance in middleaged or older patients [13]
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