Journal of Public Health Medicine 24:53-57 (2002)
© 2002 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom
Special status consultation for frequent attenders. Who are the candidates?
Peter Vedsted
Morten Bondo Christensen
Henrik Toft Sørensen
Per Fink
Frede Olesen
The Research Unit and Department of General Practice, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. pv{at}alm.au.dk
Department of Clinical Epidemiology, Aalborg and Aarhus Hospitals, Aarhus University, Aarhus, Denmark
The Research Unit for Functional Disorders, Aarhus University Hospital, Aarhus, Denmark
Background The need to optimize frequent attender (FA) care and to economize on scarce resources in primary care has given rise to calls for intervention. However, precise knowledge of the specifics of this need is scarce, as is knowledge of how best to orchestrate intervention vis-à-vis particular FA groups. The aim of the study was to analyse the need for a special FA status consultation and to analyse if such need springs from physical, mental or social factors among FAs.
Method Half of the 270 general practices in the County of Aarhus, Denmark, were randomly allocated to the study group (in total 132 practices; 220 general practitioners (GPs)). From these practices age- and gender-stratified samples of FAs were drawn. FAs were defined as the top 10 per cent attenders in 12 months. Questionnaires were used to elicit FA and GP attitudes to the introduction of a status consultation and to obtain GPs' evaluation of their FAs' physical, mental and social status. The special FA consultation was introduced as a reimbursed half-hour consultation where the FA and the GP could discuss the patient's current and future care status.
Results Over three-quarters of the FAs would accept the offer to have the status consultation, and the GPs would recommend it for one-fourth of their FAs. The expressed need was highly associated with an expected positive effect on health (prevalence ratio (PR) for GPs: 11.7 (8.9–15.5), PR for FAs: 1.6 (1.5–1.8)) and a decrease in attendance (PR for FAs: 1.4 (1.3–1.5)). The GPs quoted physical, mental and social indications for the consultation. The FAs who had high levels of functional symptoms were most likely to accept the consultation.
Conclusions There was an expressed need for an FA status consultation, which may lead to a positive effect on health and attendance. The GPs pointed to physical, mental and social indicators for a special FA consultation.
Keywords: adult, cross-sectional studies, Denmark, family practice, frequent attenders, health services research
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