Why do they keep coming back? Persistent frequent attenders in primary care

The background of frequent attenders (FAs) of the General Practitioner (GP) often remains unclear. This thesis examines persistent frequent attendance, the relationship with (medical) conditions, methods to treat FAs, the impact of FAs on the GP’s workload and costs of healthcare, which medical file data may predict persistence of frequent attendance and whether treating anxiety and depression among FAs could be (cost)effective.
We studied GP databases, followed prospectively a cohort of new FAs during 2 years and simulated in a Markov model a cohort of 10,000 FAs over a period of 5 years.
Short-term and persistent FAs have respectively 2-4 times more problems and cost the GP 4 to 5 more time than non FAs. FAs, and persistent FAs, make more costs (respectively 1.157 and 3.593 Euros per year more than non FAs), which can be partly explained by registered diseases. Anxiety, life events and poor coping contribute to persistence of frequent attendance and may (partly) explain these increased costs. Analysis and intervention by the GP has proven to decrease FAs’ use of healthcare. Our simulation study suggests that detection and treatment of anxiety and depression in FAs will not be cost-effective.