Background
Methods
Search terms and search strategy
Selection criteria
Data extraction and data synthesis
Quality assessment
Study objective and design | |
1. | Clearly stated study objectives and hypotheses. |
Study population | |
2. | Study sample is nationally and regionally representative, study sample includes representative sample of elderly individuals. |
3. | Sample inclusion and/or exclusion criteria are formulated. |
4. | Sociodemographic characteristics of the study sample are described. |
5. | Participation and response rates are reported, Participation rate > 75%. |
Assessment | |
6. | Detailed description of methods, procedures and instruments is given. |
7. | Stratification (e.g. age, gender) was used to assess frequent attendance. |
Data reporting and analysis | |
8. | Characteristics of responders and non-responders are presented. |
9. | Descriptive data (mean or median, standard deviations or percentages) are provided for the most important outcome measures and for different age groups. |
10. | Data on frequent attendance among elderly is given. |
11. | Precision of estimates is given (e.g. 95% Confidence Intervals). |
12. | The handling of missing values is described. |
Other | |
13. | Conflicts of interest reported and identification of funding sources is possible. |
Results
Literature search results
Methodological quality
Author and year | Country | Study type | Study population | Sample | Number GP’s/practices | Study quality (score) | ||
---|---|---|---|---|---|---|---|---|
n (FA)/n (Controls) | Age | Sex | ||||||
Bergh and Marklund, 2003 [37] | Sweden | cross-sectional | listed patients | elderly (≥65 years): 85/126 | women (≥65 years): M = 77.1 (Fa), M = 76.4 (CG) men (≥65 years): M = 77.0 (Fa), M = 74.1 (CG) | elderly (≥65 years): 46.4% female | 7/1 | High quality (9) |
Gilleard et al., 1998 [38] | UK | cross-sectional | listed patients aged 65 years and over | 95/919 | range: ≥65 | n/a | n/a /1 | Low quality (6) |
Menchetti et al., 2006 [39] | Italy | cross-sectional | attending patients aged 14 years and older | elderly (≥ 60 years): 136/470 | elderly (≥ 60 years): n/a | elderly (≥ 60 years): 61% female | 191/ n/a | High quality (10) |
Rennemark et al., 2009 [40] | Sweden | cross-sectional | registered patients with the Swedish National Study on Aging and Care | 229/511 | Median = 66 range: 60–78 | 54.2% female | n/a | High quality (10) |
Scherer et al., 2008 [46] | Germany | cohort-study | listed patients with diagnosis of heart failure | 48/262 | M = 72.9 (SD = 9) | 68.8% female (FA)/ 50.4% female (CG) | n/a /44 | Moderate quality (8) |
Sheehan et al., 2003 [45] | UK | cross-sectional | attending patients aged 65 years and over | 53/87 | M = 76.8 (SD = 7.3) range: ≥ 65 | 57.9% female | 14/2 (centres) | Moderate quality (9) |
Svab and Zaletel-Kragelj, 1993 [43] | Slovenia | cross-sectional | listed patients | elderly (>65): 34/78 | elderly (>65): n/a | elderly (>65): n/a | 8/1 (primary care centre) | Low quality (5) |
van den Bussche et al., 2016 [44] | Germany | cross-sectional | registered patients with a health insurance company | 23,590 (19.1%)/99,634 (80.9%) | FA: M = 73, SD = 6.4 CG: M = 71.7, SD = 6.1 | 46.3% female (FA)/ 41.4% female (CG) | n/a | High quality (9) |
Vedsted et al., 2001 [42] | Denmark | cross-sectional | listed patients aged 20 years and over | elderly (>65): n/a | elderly (>65): n/a | elderly (>65): n/a | n/a | High quality (9) |
Vedsted et al., 2004 [41] | Denmark | cross-sectional | attending patients aged 20 years and over | elderly (≥65 years):6718/n/a | elderly (≥65 years): n/a | elderly (≥65 years): 57.8% female (FA) | 320/179 | High quality (10) |
General and methodological characteristics of the reviewed studies
Definition of frequent attendance
Author and year | FA definition | Included contacts | Excluded contacts | Data sources | Main results |
---|---|---|---|---|---|
Bergh and Marklund, 2003 [37] | 10% most frequent attenders in 12 months/ by sex and age group | face-to-face visits to GP | medical records | Elderly (≥ 65 years): • Most diagnostic groups and medical prescriptions more frequent among FAs than non-FAs for both sexes Most common diseases: • Women: diseases of circulatory and musculoskeletal system, similar for FAs and non-FAs • Men: circulatory & endocrine diagnoses (FAs), circulatory and musculoskeletal problems (non-FAs) | |
Gilleard et al., 1998 [38] | Very High Attenders: 10% most frequent attenders in 12 months (> 15 contacts in 12 months) | face-to-face visits to GP, visits to the practice nurse | home visits, out-of-hour visits | computerized records, interviews, questionnaires | Elderly (≥ 65 years): • 10% FAs responsible for 33% of all visits • Frequent attendance not associated with psychiatric morbidity, self-reported depression, use of hypnotic or antipsychotic medication • Use of antidepressants: 9.5% of FAs received prescriptions for antidepressants compared to 2.8% of low average attenders (chi-square = 13.6, df 3, p < 0.01) |
Menchetti et al., 2006 [39] | > 1 contact to GP per month in 6 months | n/a | n/a | registered data, questionnaires, clinical judgments of GPs | Elderly (≥ 60 years): • Frequent attendance associated with moderate or severe physical illness (aOR = 2.89, 95% CI: 1.63–5.11), depression (aOR = 1.92, 95% CI: 1.10–3.35) and unexplained somatic symptoms (aOR = 1.99, 95% CI: 1.05–3.77) • Depression increased risk of being an FA fivefold and was a risk factor for frequent attendance independent of other clinical predictors |
Rennemark et al., 2009 [40] | 30% most frequent attenders in 12 months (≥3 contacts in 12 months) | n/a | n/a | questionnaires, cognitive tests, medical records | Elderly (≥ 60 years): • Number of GP visits positively correlated with age (0.53, p < 0.001), and comorbidity (0.93, p < 0.001), and negatively correlated with functional ability (−0.18, p < 0.001), education level (−0.12, p < 0.01) and internal locus of control (−0.12, p < 0.01) Results from logistic regression analyses: • Physical comorbidity as main factor determining frequent attendance (OR = 8.17, 95% CI: 5.54–12.04) • Sense of coherence (OR = 1.03, 95% CI: 1.00–1.06) and locus of control (OR = 1.14, 95% CI: 1.02–1.27) significantly related to frequent attendance • Education level and social anchorage not associated with frequent attendance |
Scherer et al., 2008 [46] | > 17 contacts in 9 months | n/a | n/a | questionnaires, telephone interviews | Elderly: • Frequent attendance associated with female sex, living alone, severity of heart failure, psychological distress and quality of life • In multivariate analysis physical problems (OR = 1.1, 95% CI: 1.0–1.1, p < 0.001) and living alone (OR = 2.4, 95% CI: 1.1–5.1) independently related to frequent attendance |
Sheehan et al., 2003 [45] | top third of attenders in 9 months | medical contacts with GP at primary care centre or at home | consultations with practice nurse | patient interview, GP records, GP assessment of patients tendency to somatise | Elderly (≥ 65 years): • Frequent attendance related to depression (OR = 2.24, 95% CI: 1.11–4.50, p < 0.05), high rates of physical disorder (OR = 1.78, 95% CI:1.16–2.71, p < 0.05), somatic symptom reporting (OR = 1.83, 95% CI:1.13–2.97, p < 0.05), and low social support (OR = 1.73, 95% CI:1.01–2.94, p < 0.05) • In multivariate regression only low social support and somatic symptoms significantly related to frequent attendance |
Svab and Zaletel-Kragelj, 1993 [43] | 25% most frequent attenders in 12 months/ by age group | face-to-face visits with GP, contacts for administrative purposes | telephone contacts | medical records and registered data | Elderly (>65): • Probability for superficial (administrative) contacts larger for FAs compared to non-FAs (median percentage of superficial contacts among all contacts: FAs = 27.1%/non-FAs = 0.5%, p = 0.05) • Non-significant trend: larger probability of referral to specialists for FAs compared to non-FAs (median index-value for referral to a specialist: FAs = 8.0/non-FAs = 0.4). |
van den Bussche et al., 2016 [44] | A: ≥ 50 contacts with physician practices in 12 months B: contacts with ≥10 different practices in 12 months C: contacts with ≥3 different practices of the same medical specialty in 12 months | visits to the practice, home, nursing home visits, telephone contacts, contacts with practice staff | appointments by phone and administrative contacts | insurance claims data/ registered data | Elderly (≥65): • Type A attendance associated with higher age, dependency on nursing care, multi-morbidity, and high impact somatic diseases • Types B and C attendance associated with younger age, less dependency on nursing care, and presence of mental diseases • Number of chronic conditions reduced the risk of being Type C FA |
Vedsted et al., 2001 [42] | daytime: 10% most frequent attenders (≥ 12 contacts) in 12 months/ by sex and age group out-of-hours: 10% most frequent attenders (≥ 4 contacts) in 12 months | daytime: face-to-face visits with GP out-of-hours: telephone advice, surgery consultations, home visits | telephone contacts during daytime and administrative and routine consultations | electronic records | Elderly (≥ 65 years): • Frequent attendance during daytime strongly related to the risk of being an out-of-hours FA: OR and 95% CI of daytime users to be an FA in out-of-hours service compared to non-attenders: men with 10% most daytime contacts: OR = 72.5 (CI: 48.7–107.9) women with 10% most daytime contacts: OR = 40.7 (CI: 28.2–58.8) |
Vedsted et al., 2004 [41] | 10% most frequent attenders (≥ 12 contacts) in 12 months/ by sex and age group | face-to-face visits to GP, home visits during daytime | telephone contacts, administrative and routine consultations (e.g. driver’s licenses) | electronic records | Elderly (≥ 65 years): • Prevalence ratio for using one or more drugs only slightly higher among FAs compared to the 50%-group with the fewest contacts • Prevalence for polypharmacy (drugs from 5 or more drug groups) 6.7 times (men) and 4.2 times (women) higher among FAs compared to the 50%-group with the fewest contacts |
Author and year | Percentage of FAs | Threshold for frequent attendance |
---|---|---|
Bergh and Marklund, 2003 | 10% | n/a |
Gilleard et al., 1998 | 10% | > 15 contacts in 12 months |
Menchetti et al., 2006 | 22.4% | > 1 contact per month in 6 months |
Rennemark et al., 2009 | 30% | ≥ 3 contacts in 12 months |
Scherer et al., 2008 | 15.5% | > 17 contacts in 9 months |
Sheehan et al., 2003 | 33.3% | ≥ 11 contacts in 12 months |
Svab and Zaletel-Kragelj, 1993 | 25% | n/a |
van den Bussche et al., 2016 | In total: 19% Def. A: 14.2% Def. B: 8.9% Def. C: 5.1% | Def. A: ≥ 50 contacts in 12 months |
Vedsted et al., 2001 | 10% | ≥ 12 contacts in 12 months |
Vedsted et al., 2004 | 10% | ≥ 12 contacts in 12 months |
Factors associated with frequent attendance
Bergh and Marklund, 2003 | Gilleard et al., 1998 | Menchetti et al., 2006 | Rennemark et al., 2009 | Scherer et al., 2008 | Sheehan et al., 2003 | Svab and Zaletel-Kragelj, 1993 | van den Bussche et al., 2016 | Vedsted et al., 2001 | Vedsted et al., 2004 | |
---|---|---|---|---|---|---|---|---|---|---|
No. or severity of somatic diseases | + | + | + | + | + | +/− | ||||
presence of mental illness/psychological distress | 0 | + | + | + | + | |||||
medical prescriptions | + | 0/+ | + | |||||||
low social support or social anchorage | 0 | 0 | + | |||||||
sociodemographic factors: | ||||||||||
older age | + | 0 | 0 | +/− | ||||||
female gender | 0 | + | + | 0 | ||||||
educational level | 0 | −/0 | ||||||||
living alone | + | |||||||||
lower quality of life | + | |||||||||
No. of superficial contacts | + | |||||||||
No. of referrals to specialists | 0 | |||||||||
frequent attendance out-of-hours | + |