Psychosocial and health belief variables associated with frequent attendance in primary care.
BACKGROUND
The reasons for high use of primary care, and in particular the role of psychosocial factors, remain unclear.


METHODS
We identified and interviewed 236 frequent attenders and 420 normal users, matched by age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health beliefs (health belief model, locus of health control and medical care expectations). We also measured a set of individual, social and illness variables.


RESULTS
Multiple logistic regression analyses showed that mental health was the main factor associated with frequent attender status (odds ratio = 3.1; 2.4-3.9). The association was stronger than that between frequent attender status and perceived illness, and between the former and reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease were also significantly but more weakly associated with frequent attender status. Affective support was more strongly associated with FA status than was confidant support, but both associations disappeared when mental health and family function were controlled for.


CONCLUSIONS
Our findings document the association of psychosocial factors and primary health care use. We suggest that the effective management of mental health problems from a family-based approach may reduce primary health care high use.
Bellón
J A
JA
Zaidín-Sur Health Centre, Medical School of Family and Community Medicine, Department of Preventive Medicine and Biostatistics, University of Granada, Spain.
Delgado
A
A
Luna
J D
JD
Lardelli
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005195:Family Relations; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D007389:Internal-External Control; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D008875:Middle Aged; D010555:Personality Inventory; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012803:Sick Role; D012944:Social Support; D013030:Spain