Frequent attenders at a primary care clinic: Occasional or regular abusers?

BackgroundFrequent attendance in general practice is known for being associated with certain socio-demographical characteristics (female sex and middle-old age) and with important medical-psychiatric morbidity. Moreover, it has a high impact on workload of GPs. However, we have poor literature about long-term studies on Frequent Attenders (FAs) and persistent FAs.ObjectivesTo re-evaluate a group of patients of FAs after nine years since first assessment; to determine the existence of others FAs and possible differences between persistent and occasional FAs.MethodsConsultation of computerized data on 168 patients between 2001 and 2009; interwiew to the GP and the assistant.SettingA primary health care center in Fiorano Modenese (Modena, Northern Italy).Patients56 persistent FAs, 56 occasional FAs, 56 non FAs.Main outcome results: Twenty-eight of 40 patients (70%) evaluated in 2001 were found to be persistent FAs, most frequently older women. Medical morbidity was frequent among persistent FAs, and intermediate among occasional FAs, while psychiatric morbidity does not show important differences between the two groups; however, depression was present in 46% of persistent FAs and in 41% of occasional FAs, while somatization only in occasional FAs (10%), and not among persistent FAs. Persistent FAs received more prescriptions for all types of drugs, while among the occasional FAs the requests for a psychiatric treatment were higher.ConclusionsThe phenomenon of frequent attendance has a large amount and claims for further studies. Psychiatric morbidity between persistent and occasional FAs might have different expressions, requiring different clinical approaches to be specifically tailored.