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Predictability of persistent frequent attendance: a historic 3-year cohort study.
Smits, Frans ThM; Brouwer, Henk J; van Weert, Henk C P; Schene, Aart H; ter Riet, Gerben.
Afiliación
  • Smits FT; Network of General Practitioners of the Academic Medical Centre/University of Amsterdam, The Netherlands.
Br J Gen Pract ; 59(559): e44-50, 2009 Feb.
Article en En | MEDLINE | ID: mdl-19192367
ABSTRACT

BACKGROUND:

Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders.

AIM:

To develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records. DESIGN OF STUDY A historic 3-year cohort study.

METHOD:

Data of 28 860 adult patients from 2003 to 2005 were examined. Frequent attenders were patients whose attendance rate ranked in the (age- and sex-adjusted) top 10% during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). Bootstrapped multivariable logistic regression analysis was used to determine which predictors contained information on persistent frequent attendance.

RESULTS:

Of 3045 1-year frequent attenders, 470 (15.4%) became persistent frequent attenders. The prediction rule could update this prior probability to 3.3% (lowest value) or 43.3% (highest value). However, the 10th and 90th centiles of the posterior probability distribution were 7.4% and 26.3% respectively, indicating that the model performs modestly. The area under the receiver operating characteristic curve was 0.67 (95% confidence limits 0.64 and 0.69).

CONCLUSION:

Among 1-year frequent attenders, six out of seven are transient frequent attenders. With the present indicators, the rule developed performs modestly in selecting those more likely to become persistent frequent attenders.
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Citas y Horarios / Aceptación de la Atención de Salud / Medicina Familiar y Comunitaria / Mal Uso de los Servicios de Salud Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Gen Pract Año: 2009 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Citas y Horarios / Aceptación de la Atención de Salud / Medicina Familiar y Comunitaria / Mal Uso de los Servicios de Salud Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Adult / Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Gen Pract Año: 2009 Tipo del documento: Article País de afiliación: Países Bajos