Frequent attendance in primary care: comparison and implications of different definitions.
BACKGROUND
The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors.


OBJECTIVE
To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition.


METHODS
One-phase cross-sectional study.


METHODS
Seventy-seven primary care centres in Catalonia, Spain.


METHODS
A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used.


RESULTS
The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively.


CONCLUSIONS
The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).
Sant Joan de Déu, Servicios de Salud Mental y Fundación Sant Joan de Déu, Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain. jvluciano@sjd-ssm.com
Juan V
JV
Luciano
Ana
A
Fernández
Alejandra
A
Pinto-Meza
Leila
L
Luján
Juan A
JA
Bellón
Javier
J
García-Campayo
María T
MT
Peñarrubia
Rita
R
Fernández
Marta
M
Sanavia
María E
ME
Blanco
Josep M
JM
Haro
Diego J
DJ
Palao
Antoni
A
Serrano-Blanco
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013030:Spain; D009626:Terminology as Topic; D055815:Young Adult