DOI: 10.5061/dryad.0s0n6
title: Data from: Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care

description: Objectives: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs. Design: Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients’ problem lists were defined as chronic ECs (CECs), other episodes as TECs. Setting: 1 Dutch urban primary healthcare centre served by 5 GPs. Participants: All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009. Outcome measures: Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs. Results: The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52–54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs). Conclusions: FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs.
description: bmjopen-2016-012563_FTSmits.sav_v2We used the data of 5,712 patients at least 18 years of age, enlisted in 2007-2009 in 5 GP practices in one primary healthcare centre in Amsterdam, the Netherlands. These practices participated in the GP-based continuous morbidity registration network of the Department of General Practice at the Academic Medical Center of the University of Amsterdam. In this GP network, electronic medical record data are extracted for research purposes. We used only face-to-face consultations with the GP (consultations in the surgery and house-calls). Patients under the age of 18 years were excluded, because their consultations often involved the parents as well as the patient. Because only a proportional threshold definition selects the exceptional users within each sex and age group and allows more meaningful comparisons between practices, periods and countries, we defined FAs as the age and sex-adjusted (18-30 years; 31-45 years; 46-60 years; 61 years+) top 10 centile attenders within a time frame of one year (1-year frequent attenders).3;8 FAs were determined for each of the years 2007, 2008 and 2009. One-year frequent attenders (1yFAs) attended frequently in one of those years. We defined 1-, 2-, and 3-year frequent attenders (1-, 2- and 3yFAs) as those patients who were frequent attender in one, two or three of those years, respectively. All other enlisted patients were non-FAs.