title: Infrequent attendance in general practice after a major disaster: a problem? A longitudinal study using medical records and self-reported distress and functioning.
abstract: OBJECTIVE
  To assess the characteristics and implications for care of infrequent attendance in general practice in the aftermath of disaster.
  
  
  METHODS
  A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires administered 3 weeks and 18 months post-disaster. The disaster (explosion of a firework depot in Enschede, The Netherlands) caused 23 deaths, about 1000 people injured and 1200 people who had to relocate. Sample included survivors (N = 922) who participated in two surveys and whose data could be linked to EMRs of GPs. A comparison of reported morbidity in 'infrequent' (a maximum of three times in men and four times in women in the first two post-disaster years) and 'more frequent attenders' (frequency determined post-disaster) in general practice examined in relation to health status (measured by diagnoses in EMRs, symptom checklist and quality of life instrument) was the
  
  
  METHODS
  
  
  
  RESULTS
  Infrequent attenders reported approximately three times as few contacts as more frequent attenders in the pre-disaster year (P < 0.001). Multivariate logistic regression analyses revealed that infrequent attenders were likely to be younger, less depressed, have better subjective health and physical functioning and exhibited more hostile behaviour (measured by questionnaire). Infrequent attenders were less often personally bereaved by the disaster, but more often relocated, and had a lower prevalence of psychological problems pre- and post-disaster although this increased stronger (by 10-fold).
  
  
  CONCLUSIONS
  Both groups showed the same type of psychological problems post-disaster, but differed in the frequency of contacting the GP.
authors.affiliation: Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands. g.donker@nivel.nl
authors.forename: Gé A
authors.initials: GA
authors.lastname: Donker
authors.forename: Peter G
authors.initials: PG
authors.lastname: van der Velden
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Kerssens
authors.forename: C Joris
authors.initials: CJ
authors.lastname: Yzermans
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D004190:Disasters; D005194:Family Practice; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016347:Medical Records Systems, Computerized; D008603:Mental Health; D008875:Middle Aged; D009426:Netherlands; D010349:Patient Compliance; D012650:Self Disclosure; D013313:Stress Disorders, Post-Traumatic; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000523:psychology