Phenomena that underpin frequent attendance need clarification

BMJ 1996; 313 doi: https://doi.org/10.1136/bmj.313.7064.1085a (Published 26 October 1996) Cite this as: BMJ 1996;313:1085
  1. Richard D Neal, Research fellow,
  2. Philip L Heywood, Deputy director,
  3. Anthony C Dowell, Director,
  4. Stephen Morley, Senior lecturer in clinical psychology
  1. Centre for Research in Primary Care, University of Leeds, Leeds LS2 9LN
  2. Division of Psychiatry and Behavioural Sciences in Relation to Medicine, University of Leeds, Leeds LS2 9LT

    EDITOR,—Paul Aylin and colleagues' found that 1.3% of patients accounted for almost 40% of all home visits in their study.1 We performed a similar analysis using data from a validated dataset consisting of a date record of all contacts with four practices in and around Leeds in 1992, 1993, and 1994.2 While in general we found a correlation between consultations in the surgery and home visits—for example, patients who seldom attended the surgery were visited infrequently—this was not true among the 1 in 50 patients who received frequent home visits. Combined data from the four practices showed a visiting rate of 428 visits/1000 patient years. In 1992, 1993, and 1994, 13.1%, 13.8%, and 13.0% of all contacts, respectively, were visits and 2.2%, 2.3%, and 2.3% of patients (those with five or more visits in the year) accounted for 49.3%, 47.6%, and 48.6% of all visits. These figures are higher than those quoted by Aylin and colleagues but are in keeping with national trends.

    We found that the number of home visits and the number of consultations in the surgery per individual was positively and significantly correlated for each of the three years, and when the sample was limited to the high users of home visits the two variables were negatively and significantly correlated for each of the three years (table 1). While overall there was a relation between the number of home visits and consultations in the surgery, high users of home visits were not frequent attenders at the surgery.

    Table 1

    Correlation of number of visits with number of surgery consultations and of number of visits in one year with number of visits in subsequent years

    View this table:

    The number of home visits per person was stable from year to year. A positive correlation was found for the annual number of home visits between years for high users of home visits in 1992. The correlation was stronger when all patients were included (for example, infrequent users of home visits in one year were likely to be infrequent users of visits in subsequent years) (table 1).

    While the high workload of home visits is important, it should be considered in the context of the overall disproportionate workload, whether at the surgery or at home, that is generated by the minority of patients who consult frequently. The phenomena that underpin high use of services and frequent attendance are not yet understood—for example, our data suggest that this behaviour is not constant, as the correlation of the number of visits was weaker between 1992 and 1994 than between 1992 and 1993. Until these phenomena are understood, it is premature to suggest that the appropriate response will lie with “allocation of budgets for prescribing and fundholding.”


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