title: A framework for understanding visits by frequent attenders in family practice.
abstract: OBJECTIVE
  Our purpose was to develop a typology of outpatient visits between family physicians and adult "frequent attender" patients.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Family Medicine, University of Cincinnati, PO Box 670582, Cincinnati, OH 45267-0582, USA. Douglas.Smucker@UC.edu
authors.forename: D R
authors.initials: DR
authors.lastname: Smucker
authors.forename: T
authors.initials: T
authors.lastname: Zink
authors.forename: J L
authors.initials: JL
authors.lastname: Susman
authors.forename: B F
authors.initials: BF
authors.lastname: Crabtree
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000145:classification / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000145:classification / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D019370:Observation; D009819:Office Visits / Q000706:statistics & numerical data*; D010045:Outpatients / Q000145:classification* / Q000523:psychology; D017060:Patient Satisfaction; D010817:Physician-Patient Relations