Successful GP intervention with frequent attenders in primary care: randomised controlled trial.
BACKGROUND
Frequent attenders to GP clinics can place an unnecessary burden on primary care. Interventions to reduce frequent attendance have had mixed results.


OBJECTIVE
To assess the effectiveness of a GP intervention to reduce frequent-attender consultations.


METHODS
Randomised controlled trial with frequent attenders divided into an intervention group and two control groups (one control group was seen by GPs also providing care to patients undergoing the intervention).


METHODS
A health centre in southern Spain.


METHODS
Six GPs and 209 randomly-selected frequent attenders participated. Three GPs were randomly allocated to perform the new intervention: of the 137 frequent attenders registered with these three GPs, 66 were randomly allocated to receive the intervention (IG) and 71 to a usual care control group (CG2). The other three GPs offered usual care to the other 72 frequent attenders (CG1). The main outcome measure was the total number of consultations 1 year post-intervention. Baseline measurements were recorded of sociodemographic characteristics, provider-user interface, chronic illnesses, and psychosocial variables. GPs allocated to the new intervention received 15 hours' training which incorporated biopsychosocial, organisational, and relational approaches. After 1 year of follow-up frequent attenders were contacted. An intention-to-treat analysis was used.


RESULTS
A multilevel model was built with three factors: time, patient, and doctor. After adjusting for covariates, the mean number of visits at 1 year in IG was 13.10 (95% confidence interval [CI]=11.39 to 14.94); in the CG1 group was 19.37 (95% CI=17.31 to 21.55); and in the CG2 group this was 16.72 (95% CI=4.84 to 18.72).


CONCLUSIONS
The new intervention with GPs resulted in a significant and relevant reduction in frequent-attender consultations. Although further trials are needed, this intervention is recommended to GPs interested in reducing consultations by their frequent attenders.
Bellón
Juan Angel
JA
El Palo Health Centre, Department of Preventive Medicine, University of Málaga, Spain. JABELLON@terra.es
Rodríguez-Bayón
Antonina
A
de Dios Luna
Juan
J
Torres-González
Francisco
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D001071:Appointments and Schedules; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011216:Practice Management, Medical / Q000706:statistics & numerical data*; D013030:Spain