title: Clinical characteristics of persistent frequent attenders in primary care: case-control study.
abstract: BACKGROUND
  Most frequent attendance in primary care is temporary, but persistent frequent attendance is expensive and may be suitable for psychological intervention. To plan appropriate intervention and service delivery, there is a need for research involving standardized psychiatric interviews with assessment of physical health and health status.
  
  
  OBJECTIVE
  To compare the mental and physical health characteristics and health status of persistent frequent attenders (FAs) in primary care, currently and over the preceding 2 years, with normal attenders (NAs) matched by age, gender and general practice.
  
  
  METHODS
  Case-control study of 71 FAs (30 or more GP or practice nurse consultations in 2 years) and 71 NAs, drawn from five primary care practices, employing standardized psychiatric interview, quality of life, health anxiety and primary care electronic record review over the preceding 2 years.
  
  
  RESULTS
  Compared to NAs, FAs were more likely to report a lower quality of life (P < 0.001), be unmarried (P = 0.03) and have no educational qualifications (P = 0.009) but did not differ in employment status. FAs experienced greater health anxiety (P < 0.001), morbid obesity (P = 0.02), pain (P < 0.001) and long-term pathological and ill-defined physical conditions (P < 0.001). FAs had more depression including dysthymia, anxiety and somatoform disorders (all P < 0.001).
  
  
  CONCLUSIONS
  Persistent frequent attendance in primary care was associated with poor quality of life and high clinical complexity characterized by diverse and often persistent physical and mental multimorbidity. A brokerage model with GPs working in close liaison with skilled psychological therapists is required to manage such persistent complexity.
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands.
authors.forename: Shireen
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Primary Care and.
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands.
authors.forename: Christopher
authors.initials: C
authors.lastname: Atha
authors.affiliation: Division of Primary Care and.
authors.forename: Anthony
authors.initials: A
authors.lastname: Avery
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands.
authors.forename: Boliang
authors.initials: B
authors.lastname: Guo
authors.affiliation: Health Economics, Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
authors.forename: Marilyn
authors.initials: M
authors.lastname: James
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands.
authors.forename: Samuel
authors.initials: S
authors.lastname: Malins
authors.affiliation: Health Economics, Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sampson
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands.
authors.forename: Michelle
authors.initials: M
authors.lastname: Stubley
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, richard.morriss@nottingham.ac.uk.
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D055815:Young Adult
keywords: Frequent attendance; health anxiety; medically unexplained symptoms; primary care; quality of life.