The effects of interventions on quality of life, morbidity and consultation frequency in frequent attenders in primary care: A systematic review.
BACKGROUND
Patients visiting their GPs exceptionally often (frequent attenders, FAs) have high rates of somatic disease, emotional distress, psychiatric illnesses and social problems and require a disproportionate amount of their GPs' time.


OBJECTIVE
To summarize which types of FA have been studied and what the effects of interventions were on quality of life (QoL), symptom severity of underlying illness(es) and consultation frequency. To discover when patients are considered FAs.


METHODS
Systematic review of RCTs using a comprehensive search (MEDLINE, PsycINFO, CINAHL and EMBASE, from 1980 to August 2015) and no language restrictions. Two investigators extracted data. Results were summarized qualitatively.


RESULTS
We included 17 RCTs. Heterogeneity at the level of populations, interventions and outcomes precluded statistical pooling. In-depth analysis by GPs assessing a patient's reasons for frequent attendance decreased consultation frequency by four to six per year. A small effect on symptom severity was noted in depressed FAs, although this finding was not replicated in a recent trial. Multi-component therapy and medication in FAs with medically unexplained symptoms (MUS) improved QoL (SF36 odds ratio: 1.92; 95%CI: 1.08-3.40) and morbidity (CES-D 3.17; 95%CI: 1.27-5.08).


CONCLUSIONS
RCTs on intervention effects in frequent attenders to primary care used different patient populations, interventions, comparators and outcome measures. Consistent evidence on the effects of particular interventions in specific patient domains is lacking. A tailored approach based on in-depth analysis among GPs of potential reasons for frequent attendance may decrease consultation frequency. Research involving the screening and treating for FAs with MUS may be useful in future trials.
a Department of General Practice , University of Amsterdam , Amsterdam , The Netherlands ;
Dany
D
Haroun
a Department of General Practice , University of Amsterdam , Amsterdam , The Netherlands ;
Frans
F
Smits
b Medical Library, Academic Medical Center , Amsterdam , The Netherlands ;
Faridi
F
van Etten-Jamaludin
c Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands ;|d Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands.
Aart
A
Schene
a Department of General Practice , University of Amsterdam , Amsterdam , The Netherlands ;
Henk
H
van Weert
a Department of General Practice , University of Amsterdam , Amsterdam , The Netherlands ;
Gerben
G
Ter Riet
D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D009819:Office Visits / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013001:Somatoform Disorders / Q000628:therapy
Primary healthcare; health services misuse; quality of life; randomized controlled trials; somatoform disorders; systematic review