title: Psychosocial and illness related predictors of consultation rates in primary care--a cohort study.
abstract: BACKGROUND
  Despite extensive research, the reasons why patients consult their doctors are unclear. The aim of the current study was to identify the psychosocial and illness related factors that independently predicted primary care consultation over a 5-year period.
  
  
  METHODS
  We carried out a prospective, population-based cohort study with three waves of data collection by postal questionnaire in one general practice in Greater Manchester (UK). Consultation data were sought from primary care records on a random subsample of 800 adult patients. The main outcome measure was the number of consultations (including surgery and home visits) over the 5 years of the study as determined by raters blind to questionnaire responses. Questionnaire measures included the 12-item version of the General Health Questionnaire, the Illness Attitude Scales, a somatic symptom scale, a fatigue scale, a functional assessment of disability.
  
  
  RESULTS
  Consultation data were obtained on 738 patients (92% of selected subjects), who accounted for 12182 consultations. Negative illness attitudes, the presence of physical and psychiatric disorder, health anxiety, changes in psychological distress, reported physical symptoms and demographic factors such as age and sex were independently associated with consultation over a 5-year period. These variables together accounted for a difference of ten consultations per year between groups.
  
  
  CONCLUSIONS
  Consultation in primary care is a complex behaviour with a complex aetiology. Terms such as 'frequent attenders' may be less helpful than recognizing a number of dimensions that operate across the whole spectrum of consultation frequency. Future research should consider the wider context of consultation.
authors.affiliation: Department of Psychiatry and Behavioural Sciences, ARC Epidemiology Unit and Unit for Chronic Disease Epidemiology, University of Manchester. nav.kapur@man.ac.uk
authors.forename: N
authors.initials: N
authors.lastname: Kapur
authors.forename: I
authors.initials: I
authors.lastname: Hunt
authors.forename: M
authors.initials: M
authors.lastname: Lunt
authors.forename: J
authors.initials: J
authors.lastname: McBeth
authors.forename: F
authors.initials: F
authors.lastname: Creed
authors.forename: G
authors.initials: G
authors.lastname: Macfarlane
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D004739:England; D005260:Female; D005544:Forecasting; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D011446:Prospective Studies; D012803:Sick Role; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires