Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Frequent attenders in primary care: Patient characteristics, help seeking patterns and cognitive behavioral therapy
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Frequent attenders consist of a small proportion of the total population seek-ing health care non-proportionally often for various symptoms. This hetero-genic group of patients requires special attention as symptoms often cannot be explained medically and influence both physical and psychological well-being.

The overall aim was to describe characteristics and health issues that insti-gate help seeking behavior among frequent attenders and to piece together a treatment program addressing heterogeneous health problems with the pur-pose to reduce psychological distress, enhance quality of life and reduce visiting rates at general practitioners. Study I aimed to characterize frequent attenders in primary care with respect to symptomatology and utilization of health care resources. Data was collected from medical journals and compar-isons were made between frequent attenders and a comparison group. Among frequent attenders proportionally more women than men visited the health care system and both sexes had a large diversity and amount of health complaints and utilized health care staff resources more frequently. In study II health related quality of life was examined in relation to frequent attend-ance. Questionnaires were sent out to frequent attenders and a comparison. Results show a substantially reduced life quality among frequent attenders affecting almost all facets of life and individual differences in complaints translated into corresponding areas of reduced life quality. Cognitive behav-ior therapy given in a group format was performed and evaluated in study III. Improvements of illness symptoms and negative affect were found and remained over a year, but visits to health care did not diminish.

In summation, frequent attenders used more health care resources and dis-played more health complaints as compared to non-frequent attenders. The nature of complaints was relatively independent suggesting symptom speci-ficity. They also experienced lower health related quality of life and symp-tom profiles matched domains with reduced life quality. Group CBT may be an efficient way to deal with some aspects related to health issues connected to frequent attenders. Generally, a biopsychosocial model seemed to account better for data than a purely biological model.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2019. , p. 76
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 168
National Category
Applied Psychology
Identifiers
URN: urn:nbn:se:uu:diva-381973ISBN: 978-91-513-0656-8 (print)OAI: oai:DiVA.org:uu-381973DiVA, id: diva2:1305457
Public defence
2019-06-04, Eva Netzelius-salen (10:K201), von Kraemers Allé 1A, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2019-05-14 Created: 2019-04-16 Last updated: 2019-06-18
List of papers
1. Frequent attendersreport a higher number of symptoms and utilise more primary health care resources
Open this publication in new window or tab >>Frequent attendersreport a higher number of symptoms and utilise more primary health care resources
(English)Manuscript (preprint) (Other academic)
National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-381970 (URN)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-04-16
2. Health-related quality of life among frequent attenders in Swedish primary care: a cross-sectional observational study
Open this publication in new window or tab >>Health-related quality of life among frequent attenders in Swedish primary care: a cross-sectional observational study
2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 7, p. 1-7, article id e026855Article in journal (Refereed) Published
Abstract [en]

Objectives The aim was to examine health-related quality of life (HRQoL), patient characteristics and reasons for visits to general practitioners (GPs) by frequent attenders (FAs) and a comparison group (CG) in primary care.

Methods Patients aged 18–64 years were eligible for the study. Medical records were scrutinised concerning reasons for visits. Questionnaires including short-form health survey (SF-36) were mailed to 331 FAs (≥5 visits at GPs during 2000) and 371 patients in a CG randomly selected from two healthcare centres and returned by 49% and 57%, respectively. FAs’ SF-36 health profiles were compared both to CG and general Swedish population norms.

Results FAs report lower HRQoL than CG and below the general Swedish population norms in all eight SF-36 domains including both mental and physical component summary scores (MCS and PCS). Effect sizes (ESs) for differences between FAs and norms ranged from 0.79 to 1.08 for specific domains and was 0.94 for PCS and 0.71 for MCS. ESs of FAs versus CG ranged between 0.60 and 0.95 for the domains and was 0.76 for PCS and 0.49 for MCS. There were no significant differences between the FAs and CG with regard to sex, being married or cohabiting, number of children in household or educational level. FAs were more often unemployed, obese, slightly older and used complementary medicine more frequently. Except for injuries, all health complaints as classified in 10 categories were more common among FAs than CG, particularly musculoskeletal pain and psychosocial distress related to compromised HRQoL.

Conclusion The HRQoL is compromised in FAs, both when compared with patients who do not often seek care and to general Swedish population norms. Commonly reported reasons for visiting GPs among FAs were musculoskeletal pain and psychosocial distress. Thus, perceived ill health, particularly pain and distress, seems important for high utilisation of healthcare resources.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-381971 (URN)10.1136/bmjopen-2018-026855 (DOI)000485269700046 ()
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-10-22Bibliographically approved
3. Cognitive behavioral therapy for frequent attenders in primary care
Open this publication in new window or tab >>Cognitive behavioral therapy for frequent attenders in primary care
Show others...
2018 (English)In: Health Science Reports, ISSN Online ISSN 2398-8835Article in journal (Refereed) Published
Abstract [en]

AbstractAim:The aim of the study is to investigate if cognitive behavioral therapy given in agroup setting affects anxiety and depression, stress, pain, coping strategies duringdaily life, and health‐related quality of life (HRQoL), among frequent attenders (FAs)in primary care.Methods:Cognitive behavioral therapy was offered to 331 FAs between 18 and65 years of age, of whom 89 accepted and 54 completed all steps in the protocol;patients were assigned to 1 of 3 groups: 0, 6, and 12‐month waiting time. The therapyconsisted of 12 sessions administered in group format. Outcome measures wereBeck's Anxiety Inventory (BAI), Beck's Depression Inventory (BDI), Hospital Anxietyand Depression Scale (HADS), Everyday Life Stress (ELS), Coping Strategy Question-naire, Multidimensional Pain Inventory‐Swedish version, and Short Form‐36.Results:Mean age among patients who completed cognitive behavioral therapywas 49.9 years, with a female majority (79.6%). Anxiety and depression scores werereduced after treatment (BAI 16.7 vs 13.6; BDI 16.3 vs 15.7; HADS‐Anxiety 8.41 vs6.05; HADS‐Depression 7.09 vs 5.69). Because waiting time itself did not affectsymptoms, differences reflect treatment effects. Stress ratings were not affected bytreatment. Use of nonadaptive coping strategies likepraying and hopingandcatastrophizingdecreased. Frequent attenders experienced a higher sense of lifecontrol. Frequent attenders reported significantly lower HRQoL than general Swedishpopulation norms in all 8 Short Form‐36 domains including mental and physicalcomponent summary scores (MCS and PCS), and all domains were unaffected bytreatment.Conclusion:Cognitive behavioral therapy exerts some beneficial effects in FAs.Content of treatment addressed musculoskeletal pain, stress, anxiety, and depression.This broad approach resulted in reduced anxiety, depression, and impact of painbecause of enhanced life control.

National Category
Applied Psychology
Identifiers
urn:nbn:se:uu:diva-381960 (URN)10.1002/hsr2.80 (DOI)
Available from: 2019-04-16 Created: 2019-04-16 Last updated: 2019-09-02Bibliographically approved

Open Access in DiVA

fulltext(1259 kB)68 downloads
File information
File name FULLTEXT01.pdfFile size 1259 kBChecksum SHA-512
cad2cc9f14aed8509f6e2ec7e7ce10cac4e7adda6cd99d30374c6572736854c59f19048a965e6491f3d4318e00279a934dfbf39bc472d9c0a3a7f92e4d9b7ba2
Type fulltextMimetype application/pdf
Buy this publication >>

Search in DiVA

By author/editor
Strömbom, Ylva
By organisation
Department of Psychology
Applied Psychology

Search outside of DiVA

GoogleGoogle Scholar
Total: 68 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

isbn
urn-nbn

Altmetric score

isbn
urn-nbn
Total: 379 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf