Understanding patient-initiated frequent attendance in primary care: a case-control study.

BACKGROUND Frequent attendance, which accounts for a high proportion of the general practitioner's (GP's) workload, is still poorly understood. AIM To assess the association and impact of exposure to chronic physical illness, mental disorders, life stress, and sociodemographic factors on the frequent attendance of primary health care medical services. METHOD Nine general practices in Bizkaia, Spain, participated in a case-control study. Cases were patients who exceeded the 90th percentile in the distribution of the number of visits that they made on their own initiative from January 1993 to March 1994. Controls were those for whom a single, patient-initiated consultation was registered. A total of 102 cases and 100 controls were selected by stratified sampling proportional to the size of each practice. We estimated odds ratios and population attributable fractions for frequent attendance in relation to being exposed to the study variables, adjusted by demographic characteristics by means of logistic regression analysis. RESULTS Medium-high life stress (adjusted odds ratio (AOR) = 4.5, 95% confidence interval (CI) = 1.7-12.8), chronic physical illness (AOR = 3.1; 95% CI = 1.4-6.9), mental disorder (AOR = 2.5; 95% CI = 1.3-5.1), and age were associated with patient-initiated frequent attendance. The adjusted population attributable fraction for chronic physical illness was 41%, 30.9% for mental disorder, and 15.2% for life stress. CONCLUSION There is evidence that patient-initiated frequent attendance is related to genuine physical and psychosocial needs; therefore, recognition requires a bio-psychosocial approach on the part of GP.