Sant Joan de Déu, Servicios de Salud Mental y Fundación Sant Joan de Déu, Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain.
Br J Gen Pract. 2010 Feb;60(571):49-55. doi: 10.3399/bjgp10X483139.
The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors.
To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition.
One-phase cross-sectional study.
Seventy-seven primary care centres in Catalonia, Spain.
A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used.
The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively.
The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).
文献中频繁就诊的定义多样性妨碍了其准确性、有效性和相关因素的比较。
根据不同的定义，检查频繁就诊的不同定义，以确定与初级保健中频繁就诊相关的社会人口学和临床因素。
单阶段横断面研究。
西班牙加泰罗尼亚的 77 个初级保健中心。
2005 年 10 月至 2006 年 3 月期间对 3815 名初级保健患者进行了访谈。测试了三种频繁就诊的定义：（1）就诊次数最多的前 25%和前 10%的患者；（2）就诊次数最多的前 25%和前 10%的患者按年龄和性别分层；（3）就诊次数最多的前 25%和前 10%的患者按身体/精神状况分层（只有精神障碍、只有慢性身体疾病、共病和无疾病的患者）。使用多水平逻辑回归。
以下因素与频繁就诊者的状态有系统关联：请病假、出生在西班牙以外、报告心理健康问题作为就诊的主要原因，以及患有关节炎/风湿病或支气管炎。在三种定义中的两种中，重度抑郁症与频繁就诊有关。当使用十分位数截断点时，“GP”与频繁就诊相关。10%截断点的模型比 25%截断点的模型更具辨别力：25%截断点和 10%截断点模型的接收者操作特征曲线下面积分别在 0.71（95%置信区间[CI] = 0.70 至 0.73）和 0.75（95%CI = 0.74 至 0.77）之间和 0.79（95%CI = 0.78 至 0.81）和 0.85（95%CI = 0.83 至 0.86）之间。
频繁就诊的定义方式至关重要。建议使用更具辨别力的频繁就诊定义（前 10%）。
