Frequent attendance in family practice and common mental disorders in an open access health care system.
Frequent attenders in family practice are known to have higher rates of mental disorder. However little is known about specific psychiatric disorders and whether this behavior extends to specialist services, in an open access fee-for-service health care system.


METHODS
1060 patients from 46 family practices completed the Patient Health Questionnaire and the Client Service Receipt Inventory. During the consultation, family practitioners blind to the questionnaire responses rated the severity of mental health and physical disorders. The 10% of patients with the highest number of 6-month consultations in six age and sex stratified groups were defined as frequent attenders.


RESULTS
After adjustments for sociodemographic variables, physical health and other psychiatric diagnoses, patients with a somatoform disorder were more likely to be frequent attenders, with an odds ratio of 2.3 (95% CI: 1.3-3.8, p=.002).


CONCLUSIONS
When adjusting for confounders, among the four psychiatric diagnoses investigated only somatoform disorders remain significantly associated with frequent attendance. Physical health and chronic disease were no longer associated with frequent attendance which does not support the hypothesis that in an open access fee-for-service system, patients will consult for a wider range of health problems. Greater investigation into unexplained somatic symptoms could help reduce the frequency of attendance in both primary and secondary care, as this behaviour appears to be a general health-seeking drive than extends beyond family practice.
INSERM, U1061, Montpellier, France. joanna.norton@inserm.fr
Joanna
J
Norton
Michel
M
David
Guilhem
G
de Roquefeuil
Jean-Philippe
JP
Boulenger
Josip
J
Car
Karen
K
Ritchie
Anthony
A
Mann
D000328:Adult; D004522:Educational Status; D005194:Family Practice / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D017533:Marital Status; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D013001:Somatoform Disorders / Q000523:psychology; D011795:Surveys and Questionnaires