Exploratory study of frequent attenders in general practice to better understand why patients seek help.

ABSTRACT

BACKGROUND: Frequent attenders (defined as the top 10% of health care users or those making ≥10 visits per year) account for 30-50% of GP consultations. This has significant resource implications. AIM: To understand the characteristics of frequent attenders (≥18-years) at an outer London general practice (list 5,876; deprivation index 5th decile) and reasons for attending. METHOD: A retrospective case note review was conducted using SystmOne of people attending on ≥10 occasions to see a health professional between March 2022 and February 2023. Data were extracted by hand age, gender, reason and type of consultation, diagnoses, referrals, Charlson Comorbidity Index (CCI), mortality at one year. Patient notes for ≥30 contacts were reviewed by a senior GP. RESULTS: 544 people (9.3%) attended ≥10 appointments. Of these, five interacted with a GP ≥50 occasions (Group 1;mean age74.6yrs/female 4 /CCI5.0), eight ≥40 occasions (Group 2; 69.6yrs/6.0/5.5) and 35 ≥30 occasions (Group 3;70yrs/27/4.7). Forty-eight people accounted for 882 appointments, 29% face to face and 71% by telephone. Frequency increased with age and CCI. Patients in group 3 underwent more investigations (6.0/6.0/10.0). There was no difference in mean numbers of clinicians seen (6.4/7.1/7.4) or referrals (5.0/4.0/5.0) between the three groups. Frequent attenders tended to fall into two groups people with chronic diseases, typically associated with anxiety and complex needs, and people with ongoing mental health conditions. Coding was challenging due to complexity. CONCLUSION: Frequent attenders presented due to their medical complexity or mental health disorders rather than medically unexplained symptoms. Most interactions with a GP are understandable.