Problem patients in general practice: identifying young women with recurrent abnormal illness behaviour

Abstract

The concept of recurrent illness behaviour and the importance of problem patients in general practice are discussed. The need for further research and the early identification of these patients is emphasized. The medical records of 1134 women between the ages of 16 and 25 years were analysed. The annual rate of potentially functional complaints was determined for each woman. The 51 women with the highest annual rates were selected as cases for interview, along with 51 randomly selected controls.

Analysis showed there were significant differences between the cases and controls. The cases reported more health and emotional problems and had a higher dependence on alcohol and cigarettes than the controls. They had more social disadvantages, such as a history of parental death and unemployment; they were more likely to be housewives with children; they had fewer qualifications, held jobs for shorter periods of time and had a history of truancy from school. They were heavy users of primary care facilities and also hospital services but, despite this, were dissatisfied with the service provided and were less compliant with treatment. Finally, despite a need to discuss health problems, they experienced less family support in this area. Significant variables were entered into a step-wise multiple regression analysis to predict rates of potentially functional complaints and a logistic discriminant analysis was also carried out. The results of these analyses were used in a further discriminant function to form an index for the identification of recurrent abnormal illness behaviour.