RT Journal Article
SR Electronic
T1 Cognitive behaviour therapy for long-term frequent attenders in primary care: a feasibility case series and treatment development study
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e729
OP e736
DO 10.3399/bjgp16X686569
VO 66
IS 651
A1 Samuel Malins
A1 Joe Kai
A1 Christopher Atha
A1 Anthony Avery
A1 Boliang Guo
A1 Marilyn James
A1 Shireen Patel
A1 Christopher Sampson
A1 Michelle Stubley
A1 Richard Morriss
YR 2016
UL http://bjgp.org/content/66/651/e729.abstract
AB Background Most frequent attendance in primary care is temporary. Long-term frequent attendance may be suitable for psychological intervention to address health management and service use.Aim To explore the feasibility and acceptability of cognitive behaviour therapy (CBT) for long-term frequent attendance in primary care and obtain preliminary evidence regarding clinical and cost effectiveness.Design and setting A CBT case series was carried out in five GP practices in the East Midlands.Method Frequent attenders (FAs) were identified from case notes and invited by their practice for assessment, then offered CBT. Feasibility and acceptability were assessed by CBT session attendance and thematic analysis of semi-structured questionnaires. Clinical and cost effectiveness was assessed by primary care use and clinically important change on a range of health and quality of life instruments.Results Of 462 FAs invited to interview, 87 (19%) consented to assessment. Thirty-two (7%) undertook CBT over a median of 3 months. Twenty-four (75%) attended at least six sessions. Eighteen FAs (86%, n = 21) reported overall satisfaction with treatment. Patients reported valuing listening without judgement alongside support to develop coping strategies. Thirteen (54%, n = 24), achieved clinically important improvement on the SF-36 Mental-Component Scale at 6-month follow-up and improved quality of life, but no improvement on other outcomes. Primary care use reduced from a median of eight contacts in 3 months at baseline (n = 32) to three contacts in 3 months at 1 year (n = 18).Conclusion CBT appears feasible and acceptable to a subset of long-term FAs in primary care who halved their primary care use. With improved recruitment strategies, this approach could contribute to decreasing GP workload and merits larger-scale evaluation.