title: Frequent consulting and multiple morbidity: a qualitative comparison of 'high' and 'low' consulters of GPs.
abstract: BACKGROUND
  Frequent consulting is associated with multiple and complex social and health conditions. It is not known how the impact of multiple conditions, the ability to self-manage and patient perception of the GP consultation combines to influence consulting frequency.
  
  
  OBJECTIVE
  To investigate reasons for frequent consultation among people with multiple morbidity but contrasting consulting rates.
  
  
  METHODS
  Qualitative study with in-depth interviews in the west of Scotland. Participants were 23 men and women aged about 50 years with four or more chronic illnesses; 11 reported consulting seven or more times in the last year [the frequent consulters (FCs)] and 12, three or fewer times [the less frequent consulters (LFCs)]. The main outcome measures were the participants' accounts of their symptoms, self-management strategies and reasons for consulting a GP.
  
  
  RESULTS
  All participants used multiple self-management strategies. FCs described: more disruptive symptoms, which were resistant to self-management strategies; less access to fewer treatments and resources and more medical monitoring, for unstable conditions and drug regimens. The LFCs reported: less severe and more containable symptoms; accessing more efficacious self-management strategies and infrequent GP monitoring for stable conditions and routine drug regimens. All participants conveyed consulting as a 'last resort'. However, the GP was seen as 'ally', for the FCs, and as 'innocent bystander', for the LFCs.
  
  
  CONCLUSIONS
  This qualitative investigation into the combined significance of multiple morbidities and self-management on the GP consultation suggests that current models of self-management might have limited potential to reduce utilization rates among this vulnerable group. Severity of symptoms, stability of condition and complexity of drug regimens combine to influence the availability of effective resources and influence frequency of GP consultations.
authors.affiliation: The W. Maurice Young Centre for Applied Ethics, University of British Columbia, Vancouver, British Columbia V6T1Z2, Canada. atownsen@interchange.ubc.ca
authors.forename: Anne
authors.initials: A
authors.lastname: Townsend
authors.forename: Sally
authors.initials: S
authors.lastname: Wyke
authors.forename: Kate
authors.initials: K
authors.lastname: Hunt
mesh_terms: D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D010821:Physicians, Family; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012606:Scotland; D012648:Self Care