Frequent attenders in primary care: Patient characteristics, help seeking patterns and cognitive behavioral therapy

  • Date:
  • Location: Eva Netzelius-salen (10:K201), von Kraemers Allé 1A, Uppsala
  • Doctoral student: Strömbom, Ylva
  • About the dissertation
  • Organiser: Institutionen för psykologi
  • Contact person: Strömbom, Ylva
  • Disputation

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.

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 Iaimed 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.