title: Determinants of frequent attendance in Danish general practice: a cohort-based cross-sectional study.
abstract: BACKGROUND
  Previous studies addressing determinants of frequent attendance have mainly focused on socio-demographic, psychosocial and medical factors, and few had data on lifestyle and gender-specific factors. This study aims to describe determinants of general practice frequent attendance in Danish adult population, by examining lifestyle, socio-demographic, medical and gender-specific factors.
  
  
  METHODS
  For 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 year old) we obtained data on visits to general practitioner (GP) from the Danish National Health Service Register at cohort baseline (1993-97), when information on medical conditions and lifestyle, socio-demographic and gender-specific factors was collected by questionnaire. Logistic regression was used to identify determinants of frequent attendance, defined as top 10% GP users at the year of recruitment into the cohort (baseline) in the period between 1993 and 1997.
  
  
  RESULTS
  Frequent attenders accounted for 40% of all face-to-face GP consultations with a mean 12 visits/year. Women were more likely to be frequent attenders, in crude (Odds ratio: 1.95; 95% Confidence Interval: 1.85-2.06) and fully adjusted (1.26; 1.09-1.47) model. In a fully adjusted model, strongest determinants of frequent attendance were pre-existing medical conditions, with hypertension (2.58; 2.42-2.75), diabetes (2.24; 1.94-2.59), and mental illness (2.29; 2.09-2.52) more than doubling the odds of being FA. High education (0.63; 0.57-0.69, >4 years higher education vs. no vocational training) and employment (0.61; 0.57-0.65) were inversely associated with frequent attendance. Finally, obesity (1.54; 1.14-2.08), smoking (1.21; 1.12-1.30, current vs. never), physical activity (0.84; 0.80-89), alcohol consumption (0.83; 0.78-0.87 above vs. below recommended level), and hormone therapy in women (1.52; 1.42-1.63) were all significant determinants of frequent attendance.
  
  
  CONCLUSIONS
  In addition to pre-existing medical conditions, gender, socio-demographic and gender-specific factors, lifestyle (obesity, smoking, exercise and alcohol use) is also an independent determinant of frequent attendance at general practitioner.
authors.affiliation: Department of Public Health, Centre for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark. jethe@sund.ku.dk.
authors.forename: Jeanette Therming
authors.initials: JT
authors.lastname: Jørgensen
authors.affiliation: Department of Public Health, Section of General Practice, University of Copenhagen, Copenhagen, Denmark. sal@sund.ku.dk.
authors.forename: John Sahl
authors.initials: JS
authors.lastname: Andersen
authors.affiliation: Danish Centre for Cancer Research, Danish Cancer Society, Copenhagen, Denmark. annet@cancer.dk.
authors.forename: Anne
authors.initials: A
authors.lastname: Tjønneland
authors.affiliation: Department of Public Health, Centre for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark. vlp961@sund.ku.dk.
authors.forename: Zorana Jovanovic
authors.initials: ZJ
authors.lastname: Andersen
mesh_terms: D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D015444:Exercise; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology
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