Social capital and frequent attenders in general practice: a register-based cohort study

Alexander A Pasgaard,Maiken H Mæhlisen,Christian Torp-Pedersen,Charlotte Overgaard,Henrik Bøggild,Linda Ejlskov

doi:10.1186/s12889-018-5230-2

Alexander A Pasgaard, Maiken H Mæhlisen + Show 4 more

Open Access

https://doi.org/10.1186/s12889-018-5230-2

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Abstract

BackgroundFrequent attendance to primary care constitutes a large use of resources for the health care system. The association between frequent attendance and illness-related factors has been examined in several studies, but little is known about the association between frequent attendance and individual social capital. The aim of this study is to explore this association.MethodsThe analysis is conducted on responders to the North Denmark Region Health Profile 2010 (n = 23,384), individually linked with information from administrative registers. Social capital is operationalized at the individual level, and includes cognitive (interpersonal trust and norms of reciprocity) as well as structural (social network and civic engagement) dimensions. Frequent attendance is defined as the upper-quartile of the total number of measured consultations with a general practitioner over a period of 148 weeks.ResultsUsing multiple logistic regression, we found that frequent attendance was associated with a lower score in interpersonal trust [OR 0.86 (0.79–0.94)] and social network [OR 0.88 (0.79–0.98)] for women, when adjusted for age, education, income and SF12 health scores. Norms of reciprocity and civic engagement were not significantly associated with frequent attendance for women [OR 1.05 (0.99–1.11) and OR 1.01 (0.92–1.11) respectively]. None of the associations were statistically significant for men.ConclusionThis study suggests that for women, some aspects of social capital are associated with frequent attendance in general practice, and the statistically significant dimensions belonged to both cognitive and structural aspects of social capital. This association was not seen for men. This indicates a multifaceted and heterogeneous relationship between social capital and frequent attendance among genders.

Highlights

Frequent attendance to primary care constitutes a large use of resources for the health care system
Social capital and frequent attenders in general practice Social capital has been associated with a diverse range of health outcomes over the last 20 years, with many studies focusing on all-cause mortality [1,2,3]
This paper has examined the relationship between four dimensions of social capital representing structural and cognitive aspects and frequent attendance in general practice in a Danish health care setting

Summary

Introduction

Frequent attendance to primary care constitutes a large use of resources for the health care system. Social capital and frequent attenders in general practice Social capital has been associated with a diverse range of health outcomes over the last 20 years, with many studies focusing on all-cause mortality [1,2,3]. A review of the association between health care utilization and social capital found little consistency in the findings of the investigated studies, which suggest that this might be due to the lack of a theoretical framework in the approach to working with social capital. Attendance not associated to health constitutes a potential misuse of general practice resources, and we hypothesize that social capital might provide fundamental supportive resources that mitigate both health and non-healthrelated use of the general practice, lowering the risk of becoming a frequent attender

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