RT Journal Article
SR Electronic
T1 Predictability of persistent frequent attendance: a historic 3-year cohort study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e44
OP e50
DO 10.3399/bjgp09X395120
VO 59
IS 559
A1 Frans ThM Smits
A1 Henk J Brouwer
A1 Henk CP van Weert
A1 Aart H Schene
A1 Gerben ter Riet
YR 2009
UL http://bjgp.org/content/59/559/e44.abstract
AB Background Few patients who attend GP consultations frequently continue to do so long term. While transient frequent attendance may be readily explicable, persistent frequent attendance often is not. It increases GPs' workload while reducing work satisfaction. It is neither reasonable, nor efficient to target diagnostic assessment and intervention at transient frequent attenders.Aim To develop a prediction rule for selecting persistent frequent attenders, using readily available information from GPs' electronic medical records.Design of study A historic 3-year cohort study.Method Data of 28 860 adult patients from 2003 to 2005 were examined. Frequent attenders were patients whose attendance rate ranked in the (age- and sex-adjusted) top 10% during 1 year (1-year frequent attenders) or 3 years (persistent frequent attenders). Bootstrapped multivariable logistic regression analysis was used to determine which predictors contained information on persistent frequent attendance.Results Of 3045 1-year frequent attenders, 470 (15.4%) became persistent frequent attenders. The prediction rule could update this prior probability to 3.3% (lowest value) or 43.3% (highest value). However, the 10th and 90th centiles of the posterior probability distribution were 7.4% and 26.3% respectively, indicating that the model performs modestly. The area under the receiver operating characteristic curve was 0.67 (95% confidence limits 0.64 and 0.69).Conclusion Among 1-year frequent attenders, six out of seven are transient frequent attenders. With the present indicators, the rule developed performs modestly in selecting those more likely to become persistent frequent attenders.