A framework for understanding visits by frequent attenders in family practice

J Fam Pract. 2001 Oct;50(10):847-52.


Objective: Our purpose was to develop a typology of outpatient visits between family physicians and adult "frequent attender" patients.

Study design: This was a cross-sectional observational study using qualitative analysis of family physician visits. Three family physician researchers reviewed detailed field notes for each patient based on direct observation of a single office visit to determine major themes and characteristics of physician-patient encounters.

Population: Non-pregnant adults in the top 5% for visit frequency, and age-and sex-mated non-frequent attenders were identified from among 1194 adult patients in 18 Midwestern family practice offices as part of The Prevention and Competing Demands in Primary Care Study.

Results: Visits by 62 patients who had made at least 25 visits in the previous 2 years were selected (frequent attender visits). Three major dimensions emerged to distinguish different encounter types: (1) biomedical complexity, (2) psychosocial complexity, and (3) the degree of dissonance between the patient and the physician. These 3 dimensions were used in a descriptive framework to characterize visit types as: simple medical, ritual visit, complicated medical, the tango, simple frustration, psychosocial disconnect, medical disharmony, and the heartsink visit.

Conclusions: The discovery of a wide variation of encounter types among adult frequent attenders and the resulting descriptive framework laid a foundation for defining the appropriateness of outpatient health care utilization, for designing interventions to reduce inappropriate utilization, and for educating physicians regarding effective management of frequent attender patients.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ambulatory Care / classification
  • Ambulatory Care / statistics & numerical data
  • Cross-Sectional Studies
  • Family Practice / classification
  • Family Practice / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Midwestern United States
  • Observation
  • Office Visits / statistics & numerical data*
  • Outpatients / classification*
  • Outpatients / psychology
  • Patient Satisfaction
  • Physician-Patient Relations*