Interventions on frequent attenders in primary care. A systematic literature review.
OBJECTIVE
To analyse which interventions are effective in influencing morbidity, quality of life, and healthcare utilization of frequently attending patients (FAs) in primary care.


METHODS
A systematic literature search was performed for articles describing interventions on FAs in primary care (Medline, Embase, and PsycINFO). Outcomes were morbidity, quality of life (QoL), and use of healthcare. Two independent assessors selected all randomized clinical trials (RCT) and assessed the quality of the selected RCTs. Results. Five primary care based RCTs were identified. Three RCTs used frequent attendance to select patients at risk of distress, major depression, and anxiety disorders. These RCTs applied psychological and psychiatric interventions and focused on undiagnosed psychiatric morbidity of FAs. Two of them found more depression-free days and a better QoL after treating major depressive disorder in FAs. No other RCT found any positive effect on morbidity or QoL. Two RCTs studied an intervention which focused on reducing frequent attendance. No intervention significantly lowered attendance. Due to the difference in study settings and the variation in methods of selecting patients, meta-analysis of the results was not possible.


CONCLUSIONS
No study showed convincing evidence that an intervention improves QoL or morbidity of frequent attending primary care patients, although a small effect might be possible in a subgroup of depressed frequent attenders. No evidence was found that it is possible to influence healthcare utilization of FAs.
Department of General Practice Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. f.t.m.Smits@chello.nl
Frans Th M
FT
Smits
Karin A
KA
Wittkampf
Aart H
AH
Schene
Patrick J E
PJ
Bindels
Henk C P M
HC
Van Weert
D019317:Evidence-Based Medicine; D005194:Family Practice / Q000706:statistics & numerical data; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D009819:Office Visits / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D013001:Somatoform Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy