Abstract
BackgroundDespite only constituting a small percentage of the population, frequent attenders place a tremendous burden on the healthcare system in Germany. Whilst there are some cross-sectional studies that examine the correlates of frequent attendance among older adults, there are only a few longitudinal studies that analyze the factors that lead to frequent attendance among middle-aged or older adults. Thus, the aim of this study was to investigate the factors leading to frequent attendance in the outpatient sector longitudinally.MethodsData was drawn from three waves of a large, population-based sample of community-dwelling individuals aged 40 and above in Germany (n = 1049 in fixed effects regression). Individuals were classified as frequent attenders (GP visits) if they had, on average, visited a GP every second month in the previous 12 months. The same logic was applied for specialist visits.ResultsConditional FE logistic regressions showed that the onset of frequent attendance (GP visits) was negatively associated with age [OR: 0.91, 95% CI: 0.87–0.95], a change in employment status from employed to unemployed [OR: 2.26, 1.17–4.39], decreases in physical functioning [OR: 0.98, 0.97–0.99], worsening self-rated health [OR: 1.40, 1.11–1.78], and increases in physical illnesses [OR: 1.18, 1.06–1.32]. Similarly, the onset of frequent attendance (specialist visits) was associated with age [OR: 0.95, 0.92–0.98], decreases in physical functioning [OR: 0.99, 0.98–1.00], worsening self-rated health [OR: 1.50, 1.25–1.79], and increases in physical illnesses [OR: 1.24, 1.13–1.35].ConclusionsNeed factors in particular were associated with the onset of frequent attendance. This relation did not vary by gender nor education, which may indicate that individuals only start to use health services more frequently when their needs increase.
Highlights
Despite only constituting a small percentage of the population, frequent attenders place a tremendous burden on the healthcare system in Germany
Sample characteristics and bivariate associations Sample characteristics for the observations included in fixed effects (FE) regression analysis are displayed in Table 1 and separated by status
What does this study add to the current knowledge? Using a sample that is generalizable to the non-institutionalized population in the second half of life in Germany, our findings extend previous knowledge about the correlates of frequent attendance that is based on cross-sectional studies
Summary
Despite only constituting a small percentage of the population, frequent attenders place a tremendous burden on the healthcare system in Germany. The aim of this study was to investigate the factors leading to frequent attendance in the outpatient sector longitudinally. It has been shown that the most frequent 1% of attenders accounted for 6% of all GP consultations (Leeds, four general practices; 44,146 patients and 470,712 consultations; year 1991 to 1995) [2]. These so-called frequent attenders place a tremendous burden on the health care system [3], underpinning the significance of characterizing this group in detail. A recent systematic review identified some studies investigating the correlates of frequent attendance in late life [4]. The association between physical illnesses and frequent attendance was found in six out of ten reviewed studies at the primary care level [4]
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