Frequent attenders in out-of-hours general practice care: attendance prognosis.

OBJECTIVE

We aimed to describe the use of out-of-hours service and analyse attendance prognosis for frequent attenders and other groups of attenders, and to present a concept describing frequent attendance over time.

METHODS

All adult attenders in 1990 were included in a 4-year follow-up study. Frequent attenders (FAs) were defined as those 10% among the attenders who most frequently used the out-of-hours service during a calendar year (12 months). This gave an intersection point of four or more contacts for frequent attenders. Three more groups were defined according to whether they had one, two or three contacts per year. The setting was out-of-hours general practice in Aarhus County, Denmark. Data were collected from the database of the Public Health Insurance, Aarhus County. The county had approximately 600,000 inhabitants, of whom 465,000 were aged 18 years and over. The subjects were 101,321 individuals aged 18 years and over who contacted the out-of-hours service in 1990. Outcome measures were attendance per year, age and sex.

RESULTS

FAs made 42% of the out-of-hours contacts in 1990, and 33% of those who were FAs in 1990 were also FAs in 1991. Among the 1990 FAs, 67% contacted the out-of-hours service at least once in 1991, 25% contacted the service at least once in each of the following 4 years and 7% remained FAs in the following 4 years. The probability of being an FA rose with the duration of previous frequent attendance. Age above 50 years significantly predicted future status as an FA. Females made up two-thirds of FAs, but sex did not predict future frequent attendance.

CONCLUSION

Frequent attendance could be regarded as a short-lived phenomenon. On the other hand, FAs were the most stable attenders of all groups of attenders over the years. Older FAs had the highest probability of remaining FAs.