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Stories from Frequent Attenders: A Qualitative Study in Primary Care

¹ University Liverpool, Merseyside UK
² The Elms Medical Centre, Liverpool, UK
³ Fazakerley Hospital, Liverpool, UK

CORRESPONDING AUTHOR: Paula Hodgson, PhD, BSc, Division of Primary Care, University Liverpool, Whelan Building, Brownlow Hill, Liverpool, Merseyside, UK L69 3GB, phodgson{at}liv.ac.uk

PURPOSE Patients who make frequent office visits (frequent attenders) in primary care are often considered a major burden on resources, yet we know little about their perceptions and expectations. We wanted to explore how these patients viewed their rates of consultation, what they expected from the consultation, and how they perceived their relationship with the primary health care team.

METHODS Using a qualitative study design, we undertook in-depth semi-structured interviews with frequent attenders at 4 primary care practices of the Mersey Primary Care R&D Consortium in the North West of England. Participants were identified on the basis of office visits at least twice the mean standardized rate for 1 year and a medical assessment that these visits had no important clinical outcome. Interviews with 30 patients aged 24 to 81 years (18 men) were audiotaped and transcribed, and the text was methodically coded; data were analyzed by generating common themes.

RESULTS Participants were unable or unwilling to quantify their consultation rates. Despite the assertion by many participants that family doctors are caring, authority figures, there was an underlying tension between such perceptions and the apparent medical mismanagement of symptoms. Their expectations of the consultation were complex and included the presentation of old and new symptoms implicitly embedded within an illness framework. Gaining access to family doctors was generally perceived as problematic.

CONCLUSION The criteria held by family doctors and researchers regarding the appropriate rate of consultations in primary care may not be shared by patients who attend frequently. Such patients require family doctors to acknowledge their symptoms and to provide reassurance

Key Words: Frequent attendance • primary care • patient perceptions • medically unexplained symptoms (MUS)

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