title: The use of primary, secondary, community and social care by families who frequently consult their general practitioner.
abstract: There have been very few studies that have examined either the use of other health and social services by patients who frequently consult their general practitioner, or the patterns of service use of frequently attending families. This study has three aims: to quantify the number of contacts to primary, secondary, community and social services of families who frequently attend their general practitioner; to examine the temporal patterns of these contacts and the patterns of use within families; and to determine the nature of these contacts and how they were valued by patients and health professionals. Thirty-five individuals in seven families completed diaries of health service use for 8 weeks; records from primary and community care records were analysed; health professionals and patients provided satisfaction scores for their contacts. The data were compared to standard datasets. The subjects made far more consultations with all health services than predicted, and less than half of these were with the general practitioner. Thirty-two per cent of the contacts with staff based within the health centre were not reported on the diary sheets. Temporal patterns of consulting were apparent within the families. The "index frequent attenders" within each family had most contacts. The differences between professional groups for the nature of the contact were marked, with over two-thirds of general practitioner contacts being for "specific symptoms or problems", and over two-thirds of health visitor contacts being for "weight problems". These findings show that patients who make high use of general practitioners' services also have a large number of contacts for health reasons with a range of other health and social services. These need to be considered as an outcome measure for trials of intervention for frequent attendance. More work is needed to explore why some individuals and their families make high use of health services.
authors.affiliation: Centre for Research in Primary Care, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK. r.d.neal@leeds.ac.uk
authors.forename: R D
authors.initials: RD
authors.lastname: Neal
authors.forename: G
authors.initials: G
authors.lastname: Wickenden
authors.forename: D
authors.initials: D
authors.lastname: Cottrell
authors.forename: J
authors.initials: J
authors.lastname: Mason
authors.forename: J
authors.initials: J
authors.lastname: Rugiano
authors.forename: P
authors.initials: P
authors.lastname: Clarkson
authors.forename: A
authors.initials: A
authors.lastname: Bearpark
mesh_terms: D003153:Community Health Services / Q000706:statistics & numerical data*; D005192:Family Health; D006302:Health Services Research; D006801:Humans; D020380:Needs Assessment; D009819:Office Visits; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012947:Social Work / Q000706:statistics & numerical data*; D006113:United Kingdom