Frequent attenders in primary health care. A vulnerable patient group seen from a biopsychosocial perspective

Sammanfattning: Introduction - The small number of the population who make disproportionally greater use of health care are called frequent attenders (FAs). This group, or 3-5% of the population, account for 15- 25% of all visits to general practitioners (GPs). They have, besides more chronic diseases, often a combination of medical, social and psychological problems. Is the high consulting frequency explained by FAs’ comprehension of and way of coping with illness or do they, due to an increased vulnerability, contract diseases more often? No consistent explanation for FAs’ high consulting frequency has yet been found. Aim - The overall aim of this thesis was to describe and explore the phenomenon of frequent attenders in primary health care from a biopsychosocial perspective with special focus on vulnerability. Material and methods – Among 341 frequent attenders and 1 025 controls divided by age and sex, data about consultation rate, diagnoses, prescribed medicine, referrals and certificates of illness, were gathered from the medical records during one year. All consultations concerning injuries were evaluated regarding the medical appropriateness of consulting a doctor or not. A questionnaire battery comprising scales of socio-demographic variables, stressful life events, social support and sense of coherence (SOC) was sent to the participants. The influence of each variable on frequent attendance was then determined. Based on data covering a five-year period from the National Health Insurance register concerning sick leave and disability pension, the influence of each variable on long-term sick leave and disability pension was estimated. Results – FAs’ morbidity in different age and sex groups was similar to that of the controls, but they had a higher consulting frequency for most medical problems. There was no difference concerning medically appropriate consultations for injuries between FAs and controls, although injuries were 7.2 times more common among FAs. SOC had a significant influence on frequent attendance, while stressful life events and social support did not. FAs were found to be a high-risk group for long-term sick leave and disability pension and, here, stressful life events was the only predictive factor. Conclusions – The age- and sex-specific morbidity of FAs is similar to the rest of the population but significantly increased. Although their consulting frequency was very high, FAs’ consultations were medically appropriate A weak SOC, which is supposed to indicate a reduced ability to handle stresses of life, distinguished FAs from controls and supported the finding that stressful life events predicted a bad prognosis regarding long-term sick leave and disability pension. The findings from this thesis all point in the same direction – that FAs are a vulnerable group of patients.