Background:
The top 3% of frequent attendance in primary care is associated with 15% of all appointmentsin primary care, a fivefold increase in hospital expenditure, and more mental disorder andfunctional somatic symptoms compared to normal attendance. Although often temporary ifthese rates of attendance last more than two years, they may become persistent (persistentfrequent or regular attendance). However, there is no long-term study of the economic impactor clinical characteristics of regular attendance in primary care. Cognitive behaviourformulation and treatment (CBT) for regular attendance as a motivated behaviour may offeran understanding of the development, maintenance and treatment of regular attendance in thecontext of their health problems, cognitive processes and social context.
Methods:
A case control design will compare the clinical characteristics, patterns of health care use andeconomic costs over the last 10 years of 100 regular attenders ([greater than or equal to]30 appointments with general practitioner [GP] over 2 years) with 100 normal attenders (6-22 appointments withGP over 2 years), from purposefully selected primary care practices with differingorganisation of care and patient demographics. Qualitative interviews with regular attendingpatients and practice staff will explore patient barriers, drivers and experiences ofconsultation, and organisation of care by practices with its challenges. Cognitive behaviourformulation analysed thematically will explore the development, maintenance and therapeuticopportunities for management in regular attenders. The feasibility, acceptability and utility ofCBT for regular attendance will be examined.DiscussionThe health care costs, clinical needs, patient motivation for consultation and organisation ofcare for persistent frequent or regular attendance in primary care will be explored to developtraining and policies for service providers. CBT for regular attendance will be piloted with aview to developing this approach as part of a multifaceted intervention.