初级保健中持续频繁就诊者：就诊费用、就诊原因、护理组织和认知行为治疗干预的潜力。
Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention.
机构信息
Psychiatry and Community Mental Health, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom.
出版信息
BMC Fam Pract. 2012 Jul 6;13:39. doi: 10.1186/1471-2296-13-39.
BACKGROUND
The top 3% of frequent attendance in primary care is associated with 15% of all appointments in primary care, a fivefold increase in hospital expenditure, and more mental disorder and functional somatic symptoms compared to normal attendance. Although often temporary if these rates of attendance last more than two years, they may become persistent (persistent frequent or regular attendance). However, there is no long-term study of the economic impact or clinical characteristics of regular attendance in primary care. Cognitive behaviour formulation and treatment (CBT) for regular attendance as a motivated behaviour may offer an understanding of the development, maintenance and treatment of regular attendance in the context of their health problems, cognitive processes and social context.
METHODS/DESIGN: A case control design will compare the clinical characteristics, patterns of health care use and economic costs over the last 10 years of 100 regular attenders (≥30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments with GP over 2 years), from purposefully selected primary care practices with differing organisation of care and patient demographics. Qualitative interviews with regular attending patients and practice staff will explore patient barriers, drivers and experiences of consultation, and organisation of care by practices with its challenges. Cognitive behaviour formulation analysed thematically will explore the development, maintenance and therapeutic opportunities for management in regular attenders. The feasibility, acceptability and utility of CBT for regular attendance will be examined.
DISCUSSION
The health care costs, clinical needs, patient motivation for consultation and organisation of care for persistent frequent or regular attendance in primary care will be explored to develop training and policies for service providers. CBT for regular attendance will be piloted with a view to developing this approach as part of a multifaceted intervention.
背景
在初级保健中，最频繁就诊的前 3%的患者占初级保健总预约量的 15%，其在医院的支出增加了五倍，并且与正常就诊者相比，更多患有精神障碍和功能性躯体症状。尽管如果这些就诊率持续超过两年，通常是暂时的，但它们可能会成为持续性（频繁或定期）就诊。然而，目前还没有关于初级保健中定期就诊的经济影响或临床特征的长期研究。认知行为定式和治疗（CBT）作为一种有动机的行为，可能有助于理解在其健康问题、认知过程和社会背景下，定期就诊的发展、维持和治疗。
方法/设计：病例对照设计将比较 100 名固定就诊者（2 年内与全科医生 [GP] 的就诊次数≥30 次）和 100 名普通就诊者（2 年内与 GP 的就诊次数为 6-22 次）的临床特征、医疗保健使用模式和过去 10 年的经济成本，这些患者来自于具有不同医疗保健组织形式和患者人口统计学特征的有目的选择的初级保健实践。对固定就诊患者和实践工作人员的定性访谈将探讨患者就诊的障碍、动机和就诊经历，以及实践的医疗保健组织形式所带来的挑战。通过对认知行为定式的主题分析，将探讨固定就诊者的发展、维持和治疗机会。还将研究 CBT 对固定就诊者的可行性、可接受性和实用性。
讨论
将探索初级保健中持续性频繁或定期就诊者的医疗保健费用、临床需求、患者就诊动机和医疗保健组织形式，以便为服务提供者制定培训和政策。将对 CBT 治疗固定就诊者进行试点，以期将这种方法作为多方面干预措施的一部分进行开发。
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