title: Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study.
abstract: BACKGROUND
  Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use.
  
  
  OBJECTIVE
  To explore the feasibility and acceptability of cognitive behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost effectiveness.
  
  
  METHODS
  A CBT case series was carried out in five GP practices in the East Midlands.
  
  
  METHODS
  Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments.
  
  
  RESULTS
  Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over a median of 3 months. Twenty-four (75%) attended at least six sessions. Eighteen FAs (86%, n = 21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (54%, n = 24), achieved clinically important improvement on the SF-36 Mental-Component Scale at 6-month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from a median of eight contacts in 3 months at baseline (n = 32) to three contacts in 3 months at 1 year (n = 18).
  
  
  CONCLUSIONS
  CBT appears feasible and acceptable to a subset of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach could contribute to decreasing GP workload and merits larger-scale evaluation.
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Samuel
authors.initials: S
authors.lastname: Malins
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham.
authors.forename: Joe
authors.initials: J
authors.lastname: Kai
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Christopher
authors.initials: C
authors.lastname: Atha
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham.
authors.forename: Anthony
authors.initials: A
authors.lastname: Avery
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Boliang
authors.initials: B
authors.lastname: Guo
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham.
authors.forename: Marilyn
authors.initials: M
authors.lastname: James
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Shireen
authors.initials: S
authors.lastname: Patel
authors.affiliation: Division of Rehabilitation and Ageing, University of Nottingham, Nottingham.
authors.forename: Christopher
authors.initials: C
authors.lastname: Sampson
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Michelle
authors.initials: M
authors.lastname: Stubley
authors.affiliation: Division of Psychiatry and Applied Psychology and CLAHRC East Midlands, University of Nottingham, Nottingham.
authors.forename: Richard
authors.initials: R
authors.lastname: Morriss
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods; D003362:Cost-Benefit Analysis; D004739:England / Q000453:epidemiology; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration; D016730:Program Development; D015397:Program Evaluation; D036301:Qualitative Research; D013001:Somatoform Disorders / Q000175:diagnosis* / Q000191:economics / Q000628:therapy
keywords: cognitive behaviour therapy; costs; frequent attendance; health anxiety; medically unexplained symptoms; primary health care; quality of life