Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention
Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Published: |
BioMed Central
2012
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| Online Access: | https://eprints.nottingham.ac.uk/2632/ |
| _version_ | 1848790835062112256 |
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| author | Morriss, Richard K. Kai, Joe Atha, Christopher Avery, Anthony Bayes, Sara Franklin, Matthew George, Tracey James, Marilyn Malins, Samuel McDonald, Ruth Patel, Shireen Stubley, Michelle Yang, Min |
| author_facet | Morriss, Richard K. Kai, Joe Atha, Christopher Avery, Anthony Bayes, Sara Franklin, Matthew George, Tracey James, Marilyn Malins, Samuel McDonald, Ruth Patel, Shireen Stubley, Michelle Yang, Min |
| author_sort | Morriss, Richard K. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background:
The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context.
Methods/design:
A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined.
Discussion:
The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. |
| first_indexed | 2025-11-14T18:18:55Z |
| format | Article |
| id | nottingham-2632 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T18:18:55Z |
| publishDate | 2012 |
| publisher | BioMed Central |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-26322020-05-04T16:33:15Z https://eprints.nottingham.ac.uk/2632/ Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention Morriss, Richard K. Kai, Joe Atha, Christopher Avery, Anthony Bayes, Sara Franklin, Matthew George, Tracey James, Marilyn Malins, Samuel McDonald, Ruth Patel, Shireen Stubley, Michelle Yang, Min Background: The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context. Methods/design: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6–22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined. Discussion: The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention. BioMed Central 2012-05-20 Article PeerReviewed Morriss, Richard K., Kai, Joe, Atha, Christopher, Avery, Anthony, Bayes, Sara, Franklin, Matthew, George, Tracey, James, Marilyn, Malins, Samuel, McDonald, Ruth, Patel, Shireen, Stubley, Michelle and Yang, Min (2012) Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Family Practice, 13 (39). ISSN 1471-2296 http://www.biomedcentral.com/1471-2296/13/39 doi:10.1186/1471-2296-13-39 doi:10.1186/1471-2296-13-39 |
| spellingShingle | Morriss, Richard K. Kai, Joe Atha, Christopher Avery, Anthony Bayes, Sara Franklin, Matthew George, Tracey James, Marilyn Malins, Samuel McDonald, Ruth Patel, Shireen Stubley, Michelle Yang, Min Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title | Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title_full | Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title_fullStr | Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title_full_unstemmed | Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title_short | Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| title_sort | persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention |
| url | https://eprints.nottingham.ac.uk/2632/ https://eprints.nottingham.ac.uk/2632/ https://eprints.nottingham.ac.uk/2632/ |