Clinical characteristics of persistent frequent attenders in primary care: case-control study

Fam Pract. 2015 Dec;32(6):624-30. doi: 10.1093/fampra/cmv076. Epub 2015 Oct 8.


Background: Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status.

Objective: To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice.

Methods: Case-control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years.

Results: Compared to NAs, FAs were more likely to report a lower quality of life (P < 0.001), be unmarried (P = 0.03) and have no educational qualifications (P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety (P < 0.001), morbid obesity (P = 0.02), pain (P < 0.001) and long-term pathological and ill-defined physical conditions (P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001).

Conclusions: Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity.

Keywords: Frequent attendance; health anxiety; medically unexplained symptoms; primary care; quality of life..

Publication types

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

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Female
  • Health Services Misuse* / statistics & numerical data
  • Health Status
  • Humans
  • Male
  • Mental Disorders*
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Primary Health Care*
  • Psychiatric Status Rating Scales
  • Quality of Life / psychology
  • Young Adult