Sandvik Hogne, Hunskaar Steinar
National Centre for Emergency Primary Health Care, Uni Research Health, Kalfarveien 31, 5018, Bergen, Norway.
Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway.
BMC Health Serv Res. 2018 Jun 25;18(1):492. doi: 10.1186/s12913-018-3310-8.
Out-of-hours (OOH) services are often consulted for problems that are non-urgent. Some of these patients are frequent attenders (FAs) who may constitute a heavy burden on the OOH service. The aim of the present study was to analyse FAs in a comprehensive material, covering all patients who have visited OOH services in Norway during a 10-year period.
FA was defined as a patient having ≥5 consultations during one year. A cohort of all 15,172 FAs in 2008 was followed until 2017, with a description of demographics, consultations, and diagnoses for each year. FAs in 2017 were also analysed with more extreme definitions (≥10, ≥20, ≥30 consultations). To analyse predictors for FA a logistic regression analysis was performed on the 2017 data.
FAs constituted 2% of all patients (U-shaped age curve and female overrepresentation) and approximately 10% of all consultations each year. 59.8% of the cohort was never FA again, 17.7% had one relapse, 8.6% two, and 4.4% had three relapses. 22.8% was also a FA in 2009. Thereafter the percentage gradually declined to 6.2% in 2017. Only 0.8% of the original cohort were persistent FAs throughout the 10-year period. FAs were three times as likely to be given a psychological diagnosis as the average OOH patient, and this percentage increased in persistent and more extreme FAs. FAs tended to seek help at inconvenient hours (late evening and night), and increasingly so the more extreme they were. Also, they needed more consultation time and more often received home visits. The logistic regression analysis identified the following predictors for becoming FA (odds ratio = OR): Female (OR 1.17), age 0-1 years (OR 3.46), age 70+ (OR 1.57), small municipality (OR 1.61), psychological diagnosis (OR 10.00), social diagnosis (OR 5.97), cancer (OR 6.76), diabetes (OR 4.65), and chronic obstructive pulmonary disease (OR 7.81).
FAs were most common among the youngest children and among the elderly, increasing with age. Females were overrepresented, as were patients with psychosocial problems and various chronic somatic conditions. The majority were only temporary FAs.
非工作时间（OOH）服务经常被用于咨询非紧急问题。这些患者中有一些是频繁就诊者（FAs），他们可能给OOH服务带来沉重负担。本研究的目的是在一个全面的材料中分析频繁就诊者，该材料涵盖了挪威10年间所有就诊于OOH服务的患者。
频繁就诊者被定义为一年内就诊≥5次的患者。对2008年所有15172名频繁就诊者组成的队列进行随访直至2017年，描述每年的人口统计学特征、就诊情况和诊断。还对2017年的频繁就诊者采用更极端的定义（≥10次、≥20次、≥30次就诊）进行分析。为了分析频繁就诊者的预测因素，对2017年的数据进行了逻辑回归分析。
频繁就诊者占所有患者的2%（年龄呈U形曲线，女性占比过高），每年约占所有就诊的10%。该队列中59.8%的人不再是频繁就诊者，17.7%的人有一次复发，8.6%的人有两次复发，4.4%的人有三次复发。2009年22.8%的人也是频繁就诊者。此后，这一比例逐渐下降至2017年的6.2%。在整个10年期间，原队列中只有0.8%的人是持续频繁就诊者。频繁就诊者被给予心理诊断的可能性是OOH普通患者的三倍，并且在持续和更极端的频繁就诊者中这一比例有所增加。频繁就诊者倾向于在不方便的时间（深夜和夜间）寻求帮助，而且越极端的频繁就诊者越是如此。此外，他们需要更多的就诊时间，并且更常接受家访。逻辑回归分析确定了以下成为频繁就诊者的预测因素（比值比=OR）：女性（OR 1.17）、0至1岁（OR 3.46）、70岁以上（OR 1.57）、小市政区（OR 1.61）、心理诊断（OR 10.00）、社会诊断（OR 5.97）、癌症（OR 6.76）、糖尿病（OR 4.65）和慢性阻塞性肺疾病（OR 7.81）。
频繁就诊者在最小的儿童和老年人中最为常见，且随年龄增加。女性占比过高，有心理社会问题和各种慢性躯体疾病的患者也是如此。大多数只是临时频繁就诊者。
