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Cognitive behavioural therapy cuts GP visits by frequent attenders, finds study

BMJ 2016; 355 doi: (Published 04 October 2016) Cite this as: BMJ 2016;355:i5350
  1. Susan Mayor
  1. London

Cognitive behavioural therapy (CBT) is acceptable to long term frequent attenders and more than halved the frequency of their visits to primary care, a study has shown.

Most people who consult their GP frequently do so for only a limited time and return to normal consultation rates within 12 months. But a small group of patients, who typically have more than one long term condition and anxiety about their health, continue to attend frequently on a long term basis. Previous research has indicated that CBT could reduce this frequent attendance.

The study, reported in the British Journal of General Practice, explored the feasibility and acceptability of CBT for long term frequent attenders at five GP practices in the East Midlands in the UK.1

GPs invited 462 frequent attenders to a clinical interview assessing their physical and emotional health. They were identified from searching practice records for adults with 30 or more consultations with a GP or nurse over two years, excluding visits for routine monitoring and people with serious physical or mental illness. Fewer than one in five patients (19%; 87 of 462) agreed to assessment, and 32 of these (7%) had CBT over a median of three months. CBT was delivered by a therapist and based on the individual patient’s psychosocial factors and psychological problems causing frequent consultation.

Primary care consultations fell from a median of eight contacts in three months at baseline for the 32 patients who started CBT to three contacts in three months at one year (n=18).

Eighteen of 21 patients who completed a questionnaire said that they were satisfied with their treatment. They said that they particularly valued being listened to without judgment and being offered support to develop coping strategies. Just over half of patients (13 of 24) who had CBT showed clinically important improvements on the SF-36 mental component scale at six months’ follow-up but no improvement in other outcomes.

“This study suggests offering CBT is feasible and acceptable for a small but substantial proportion of long term frequent attenders in primary care,” said the researchers, led by Richard Morriss, professor of psychiatry at the University of Nottingham. They added, “This study highlights the promise and potential of an intervention that could create greater capacity in primary care and support for GPs in managing a demanding group of patients.”


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