Frequent Attendance and Effectiveness of Related Interventions in Primary Care

doi:10.12114/j.issn.1007-9572.2020.00.397

Abstract

Abstract: Frequent attendance is a well-known phenomenon in primary care caused by physical illness，mental illness and social difficulties，which probably leads to inappropriate use of community medical resources and imposes increased burden on general practitioners and the society， but can be reduced by clinical interventions．This article reviews the current status and influencing factors of frequent attendance as well as the effectiveness of related interventions in primary care，in order to provide a basis for reducing unnecessary frequent visits and making more reasonable use of community medical resources.

Key words: Primary health care, Frequent attenders, Root cause analysis, Intervention program, Intervention effects, Review

摘要： 频繁就诊是初级卫生保健机构中普遍存在的现象，不仅造成社区医疗资源不合理应用，而且增加全科医生和社会的负担。频繁就诊与患者身体疾病、精神病疾病和社会困难等相关，通过临床干预可影响其就诊率。文章结合国内外相关文献对初级卫生保健系统中的频繁就诊现状、影响因素和干预效果进行综述，以期为减少不必要的频繁就诊现象、更加合理利用社区医疗资源提供依据。

关键词: 初级卫生保健, 频繁就诊, 影响因素分析, 干预方案, 干预效果, 综述

JI Yan,DING Jing,DING Lan, et al. Frequent Attendance and Effectiveness of Related Interventions in Primary Care　[J]. Chinese General Practice, 2020, 23(25): 3160-3163. DOI: 10.12114/j.issn.1007-9572.2020.00.397.
季燕,丁静,丁兰等. 初级卫生保健机构频繁就诊与干预现状研究[J]. 中国全科医学, 2020, 23(25): 3160-3163. DOI: 10.12114/j.issn.1007-9572.2020.00.397.

References

［1］KIRSI K，SATU E，MARIA K．Frequent attenders in primary health care：a concept analysis［J］．International Journal of Nursing Studies，2018，86：115-124．
［2］SCHMIDT M．Frequent visitors at the psychiatric emergency room：ａ literature review［J］．Psychiatr Q，2018，89（1）：11-32．
［3］World Health Organization．The World Health Report 2008：primary health care（now more than ever）［EB/OL］．［2019-07-15］．https://www.who.int/whr/2008/en/．
［4］VEDSTED P，CHRISTENSEN M B．Frequent attenders in general practice care：a literature review with special reference to methodological considerations［J］．Public Health，2005，119（2）：118-137．DOI：10.1016/j.puhe.2004.03.007.
［5］SANTALAHTI A K，VAHLBERG T J，LUUTONEN S H，et al．Effect of administrative information on visit rate of frequent attenders in primary health care：ten-year follow-up study［J］.BMC Family Practice，2018，19（1）：142.
［6］BACKETT E M，HEADY J A，EVANS J．Studies of a general practice（Ⅱ）［J］．Br Med J，1954，1（4854）：109-115.
［7］HAROUN D，SMITS F，ETTEN-JAMALUDIN F V，et al．The effects of interventions on quality of life，morbidity and consultation frequency in frequent attenders in primary care：a systematic review［J］．Eur J Gen Pract，2016，22：71-82．
［8］SUN K S，LAM T P，LAM K F，et al．Views of Hong Kong Chinese primary care attenders on psychological distress：causes，management and recovery［J］．Family Practice，2019，36（1）：84-90．DOI：10.1093/fampra/cmy102．
［9］SMITS F T，BROUWER H J，RIET G T，et al．Epidemiology of frequent attenders：a 3-year historic cohort study comparing attendance，morbidity and prescriptions of one-year and persistent frequent attenders［J］．BMC Public Health，2009，9（1）：36-40．DOI：10.1186/1471-2458-9-36．
［10］REHO T，ATKINS S，TALOLA N，et al．Comparing occasional and persistent frequent attenders in occupational health primary
care ：a longitudinal study［J］．BMC Public Health，2018，18（1）：1291．DOI：10.1186/s12889-018-6217-8．
［11］李娜娜，寿涓，李娅玲，等．上海市某社区卫生服务中心频繁就诊老年患者的疾病特征及持续频繁就诊相关因素分析［J］．中华全科医师，2019，18（3）：232-235．
［12］高凤娟，杜学锋，史宇晖，等．全科医生签约服务在北京德胜社区原发性高血压病患者分级诊疗中的效果评价［J］．中国全科医学，2018，21（9）：1070-1074．DOI：10.3969/j.issn.1007-9572.2018.00.056.
GAO F J，DU X F，SHI Y H，et al．Evaluation of the effect of contracted service mode of the general practitioner on the hierarchical diagnosis and treatment of patients with primary hypertension in the Desheng Community of Beijing City［J］．Chinese General Practice，2018，21（9）：1070-1074．DOI：10.3969/j.issn.1007-9572.2018.00.056.
［13］NEAL R，DOWELL A，HEYWOOD P，et al．Frequent attenders：who need streatment?［J］．Br J Gen Pract，1996，46：131-132．DOI：10.1093/fampra/12.3.370．
［14］SMITS F T，BROUWER H J，ZWINDERMAN A H，et al．Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders：a record linkage study between patient data and reimbursements data［J］．BMC Fam Pratt，2013，14：138．
［15］HU T，DATTANI N D，COX K A，et al．Effect of eomorbidities and medications on frequency of primary care visits among older patients［J］．Can Fam Physician，2017，63（1）：45-50．
［16］VEDSTED P，FINK P，SORENSEN H T，et al．Physical，mental and social factors associated with frequent attendance in Danish general practice．A population-based cross-sectional study［J］.Soc Sci Med，2004，59（4）：813-823．
［17］KOSKELA T．Terveyspalveluiden pitk?aikaisen suurk?ytt?j?n ennustekij?t［EB/OL］.［2019-07-15］．https://www.researchgate.net/publication/42426065_Terveyspalveluiden_pitkaaikaisen_suurkayttajan_ennustekijat．
［18］BERGH H，MARKLUND B．Characteristics of frequent attenders in different age and sex groups in primary health care［J］．Scand J Prim Health Care，2003，21（3）：171-177.
［19］JORGENSEN J T，ANDERSEN J S，TJONNELAND A，et al．Determinants related to gender differences in general practice utilization：Danish diet，cancer and health cohort［J］．Scand J Prim Health Care，2016，34（3）：240-249．
［20］WELZEL F D，STEIN J，HAJEK A，et al．Frequent attenders in late life in primary care：a systematic review of European studies［J］．BMC Fam Pract，2017，18（1）：104．
［21］SAVAGEAU J A，MCLOUGHLIN M，URSAN A，et al．Characteristics of frequent attenders at a community health center［J］．J Am Board Fam Med，2006，19（3）：265-275．DOI：10.1.1.535.9230&rank=4.
［22］REHO T T M，ATKINS S A，TALOLA N，et al．Frequent attenders at risk of disability pension：a longitudinal study combining routine and register data［J］．Scandinavian Journal of Public Health，2020，48（2）：181-189．
［23］毛雪琴，张蕊，王梦欣．综合医院“医学无法解释的躯体症状”患者症状特点及相关因素分析［J］．山东大学学报（医学版），2014，52（9）：90-94．
［24］PATERSON C，TAYLOR R S，GRIFFITHS P，et al．Acupuncture for "frequent attenders" with medically unexplained symptoms：ａ randomised controlled trial（CACTUS study）［J］.British Journal of General Practice，2011，61（587）：e295-305．DOI：10.3399/bjgp11X572689.
［25］OLBRISCH M E．Evaluation of a stress management program for high utilizers of a prepaid university health service［J］．Med Care，1981，19（2）：153-159．
［26］LUUTONEN S，SANTALAHTI A，MAKINEN M，et al．One-session cognitive behavior treatment for long-term frequent attenders in primary care：randomized controlled trial［J］．Scandinavian Journal of Primary Health Care，2019，37（1）：98-104．
［27］BELLóN J á，RODRíGUEZ-BAYóN A，JUAN D D L，et al．Successful GP intervention with frequent attenders in primary care：randomised controlled trial［J］．British Journal of General Practice，2008，58（550）：324-330．
［28］BAKER M，STALLARD J，GIBSON S．A pilot project targeting frequent attenders at the emergency department with medically unexplained symptoms［J］．Emergency Medicine Journal，2013，30（10）：866-866．
［29］PATEL S，KAI J，ATHA C，et al．Clinical characteristics of persistent frequent attenders in primary care：case-control study［J］．Fam Pract，2015，32（6）：624-630．
［30］KATON W，VON KM，LIN E，et al．A randomized trial of psychiatric consultation with distressed high utilizers［J］．Gen Hosp Psychiatry，1992，14（2）：86-98.
［31］陈琴，肖俊辉，刘瑞明，等.基于PEST模型的全科医生规范化培养宏观环境分析［J］.中国全科医学，2014，17（34）：80-82，87．DOI：10.3969 /j.issn.1007－9572.2014.34.021.
CHEN Q，XIAO J H，LIU R M，et al．Macro-environment analysis of general practitioners on standardized training based on pEST model［J］．Chinese General Practice，2014，17（34）：80-82，87．DOI：10.3969 /j.issn.1007－9572.2014.34.021.
［32］武宁，程明羕，闫丽娜，等．中国全科医生培养发展报告（2018）［J］．中国全科医学，2018，21（10）：1135-1142.DOI：10.3969/j.issn.1007-9572.2018.10.001.
WU N，CHENG M Y，YAN L N，et al．Training development report of GPs （2018）［J］．Chinese General Practice，2018，21（10）：1135-1142．DOI：10.3969/j.issn.1007-9572.2018.10.001.

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