Data from: Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care

Objectives: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with non-FAs. Design: Retrospective analysis of all episodes of care (ECs) in 15 116 consultations in 1 year. Reasons for encounter (RFEs) linked to patients’ problem lists were defined as chronic ECs (CECs), other episodes as TECs. Setting: 1 Dutch urban primary healthcare centre served by 5 GPs. Participants: All 5712 adult patients were enlisted between 2007 and 2009. FAs were patients whose attendance rate ranked within the top decile of their sex and age group in at least one of the years between 2007 and 2009. Outcome measures: Number of RFEs linked to TECs/CECs for non-FAs and 1-year (1yFAs), 2-year (2yFAs) and 3-year FAs (3yFAs), and the adjusted effect of frequent attendance of different duration on the number of TECs. Results: The average number of RFEs linked to TECs (non-FAs 1.4; 3yFAs 7.3) and to CECs (non-FAs 0.9; 3yFAs 6.2) increased substantially with the duration of frequent attendance. The ratio of TECs to all ECs differed little for FAs (52–54%) and non-FAs (64%). Compared with non-FAs, the adjusted additional number of TECs was 3.4 (95% CI 3.2 to 3.7, 1yFAs), 6.6 (95% CI 6.1 to 7.0, 2yFAs) and 9.4 (95% CI 8.8 to 10.1, 3yFAs). Conclusions: FAs present more TECs and CECs with longer duration of frequent attendance. The constant ratio of TECs might be a sign of a low threshold for FAs to consult their GP. The large numbers of TECs in FAs might be associated with their high level of anxiety and low mastery. The consultation pattern of FAs may best be characterised by describing both TECs and CECs.研究目的：高频就诊者（FAs，Frequent attenders）相较于非高频就诊者，更频繁地因慢性躯体疾病、精神类疾病、社交困境及心理痛苦向全科医生（GPs，general practitioners）就诊。然而目前尚不明确，与非FAs相比，FAs出现暂时性就诊事件（TECs，transient episodes of care）的程度究竟如何。 研究设计：对1年内15116次就诊的全部就诊事件（ECs，episodes of care）开展回顾性分析。将与患者问题清单相关联的就诊原因（RFEs，Reasons for encounter）定义为慢性就诊事件（CECs，chronic ECs），其余就诊事件则归类为暂时性就诊事件（TECs）。 研究地点：荷兰某城市的1家基层医疗中心，由5名全科医生坐诊。 研究对象：2007年至2009年间登记的全部5712名成年患者。高频就诊者（FAs）指在2007至2009年至少1年内，就诊率位列其性别与年龄组前十百分位的患者。 结局指标：统计非高频就诊者、1年高频就诊者（1yFAs）、2年高频就诊者（2yFAs）及3年高频就诊者（3yFAs）中，与暂时性就诊事件（TECs）/慢性就诊事件（CECs）相关的就诊原因（RFEs）数量，以及不同时长的高频就诊状态对暂时性就诊事件（TECs）数量的校正后影响。 研究结果：随着高频就诊时长的增加，与暂时性就诊事件（TECs）相关的就诊原因（RFEs）数量（非FAs为1.4；3yFAs为7.3）以及与慢性就诊事件（CECs）相关的就诊原因（RFEs）数量（非FAs为0.9；3yFAs为6.2）均显著升高。高频就诊者的暂时性就诊事件（TECs）占全部就诊事件的比例为52%~54%，与非高频就诊者的64%相比，二者差异较小。与非高频就诊者相比，校正后的额外暂时性就诊事件（TECs）数量分别为：1yFAs组3.4（95%置信区间Confidence Interval, CI：3.2~3.7）、2yFAs组6.6（95%置信区间CI：6.1~7.0）、3yFAs组9.4（95%置信区间CI：8.8~10.1）。 研究结论：高频就诊者（FAs）的暂时性就诊事件（TECs）与慢性就诊事件（CECs）数量随高频就诊时长延长而增加。暂时性就诊事件（TECs）占比恒定提示，高频就诊者咨询全科医生的阈值较低。高频就诊者大量的暂时性就诊事件可能与其高水平焦虑感及低掌控感相关。高频就诊者的就诊模式可通过同时描述暂时性就诊事件（TECs）与慢性就诊事件（CECs）来最佳表征。