Frequent attendance, socioeconomic status and burden of ill health. An investigation in the west of Scotland.
OBJECTIVE
To investigate whether associations between frequent attendance in general practice and socioeconomic circumstances remain significant after taking detailed account of underlying ill health, perceived social support and social isolation.


METHODS
Data from a community health survey of 1477 people in their late forties and late sixties living in the West of Scotland were examined for associations between frequent attendance, socioeconomic circumstances, self-reported ill health and social support using logistic regression. The main outcome measure was the probability of being a frequent attender (defined pragmatically after initial review of the distribution as 10+ visits a year) with 95% confidence intervals.


RESULTS
Frequent attendance was significantly associated with: greater numbers of serious conditions reported (adjusted odds ratio 1.47; 99% CI 1.09-1.98); higher levels of anxiety (adjusted OR 1.14; 1.04-1.25); and lower levels of self-assessed health (adjusted OR 0.67; 0.54-0.83). No measures of socioeconomic circumstance or social support remained significantly associated with frequent attendance when the greater burden of ill health in poorer and less well-supported groups was considered.


CONCLUSIONS
The higher levels of frequent attendance likely to be experienced by general practitioners serving populations in adverse social circumstances are likely to be explained by higher levels of health needs, and not solely by a greater readiness to consult for whatever reason. General practitioners working in deprived areas are likely to have to 'run to keep up' in dealing with such comorbidity, and ways of supporting them in the provision of optimum healthcare need to be considered.
Wyke
Sally
S
Scottish School of Primary Care, Edinburgh, UK. sally.wyke@ed.ac.uk
Hunt
Kate
K
Walker
Jeremy
J
Wilson
Philip
P
D000293:Adolescent; D000328:Adult; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012606:Scotland; D012923:Social Class