Data from: Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care

Objectives: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs. Design: Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients’ problem lists were defined as chronic ECs (CECs), other episodes as TECs. Setting: 1 Dutch urban primary healthcare centre served by 5 GPs. Participants: All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009. Outcome measures: Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs. Results: The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52–54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs). Conclusions: FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs.研究目标：与非高频就诊者（non-FAs）相比，高频就诊者（FAs）罹患慢性躯体疾病、精神疾病，遭遇社交困境与心理痛苦的比例更高，且更频繁地向全科医生（GPs）就诊。然而目前尚不明确，相较于非FAs，FAs的暂访诊次（TECs）占比究竟处于何种水平。 研究设计：对1年内15116次就诊中的全部就诊诊次（ECs）开展回顾性分析。将与患者问题清单相关联的就诊原因（RFEs）归类为慢性就诊诊次（CECs），其余诊次则定义为暂访诊次（TECs）。 研究场景：荷兰某城市基层医疗中心，由5名全科医生坐诊。 研究对象：2007年至2009年间纳入的全部5712名成年患者。高频就诊者的定义为：在2007至2009年的至少1个自然年内，其就诊率在同性别、同年龄组中位列前十分位的患者。 结局指标：非FAs、1年高频就诊者（1yFAs）、2年高频就诊者（2yFAs）以及3年高频就诊者（3yFAs）中，与暂访诊次/慢性就诊诊次相关的就诊原因数量；以及不同持续时长的高频就诊对暂访诊次数量的校正效应。 研究结果：随着高频就诊持续时长的增加，与暂访诊次相关的就诊原因平均数量（非FAs为1.4；3yFAs为7.3）以及与慢性就诊诊次相关的就诊原因平均数量（非FAs为0.9；3yFAs为6.2）均显著升高。FAs的暂访诊次占全部就诊诊次的比例（52%~54%）与非FAs（64%）相差不大。与非FAs相比，校正后的额外暂访诊次数量分别为：1yFAs为3.4（95%置信区间[95% CI]：3.2~3.7）、2yFAs为6.6（95%置信区间[95% CI]：6.1~7.0）、3yFAs为9.4（95%置信区间[95% CI]：8.8~10.1）。 研究结论：高频就诊者的暂访诊次与慢性就诊诊次数量均随高频就诊持续时长的增加而增多。暂访诊次占比恒定这一现象，或许提示FAs向全科医生就诊的阈值较低。FAs的大量暂访诊次可能与其较高的焦虑水平以及较低的掌控感有关。对FAs就诊模式的最佳描述方式，应同时涵盖暂访诊次与慢性就诊诊次两类情况。