Frequent Attendance Patterns in Primary Healthcare

Frequent attendance in primary healthcare refers to the repeated use of frontline health services by a small proportion of patients who account for a disproportionate share of consultations. Definitions vary, but it is commonly operationalised as the top decile of users over a 12-month period, with persistent frequent attenders representing those who remain in this group for two or more consecutive years. Globally, frequent attenders often span a U-shaped age distribution, encompassing infants, younger adults and the elderly, with a modest female predominance. The principal drivers include multimorbidity, mental health disorders, psychosocial stressors and perceived poor health, although socioeconomic factors such as unemployment and low income may also play a role. Persistent frequent attenders tend to present more chronic somatic diseases alongside psychological and social difficulties, generating elevated workloads for primary care teams and higher expenditures across primary and secondary care sectors. The heterogeneity in case definitions and study designs has hampered cross-setting comparisons, yet recent work underscores the need for integrated care pathways, targeted interventions and improved identification of high-need patients to optimise resource allocation and enhance patient outcomes.

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Frequent Attendance Patterns in Primary Healthcare publication trend

The graph below shows the total number of articles in frequent attendance patterns in primary healthcare across all publications each year (not limited to Nature Index journals).

Technical terms

Frequent attender: A patient whose number of primary care consultations places them in the highest decile of service use over a specified period.

Persistent frequent attender: A frequent attender who maintains high consultation rates for two or more consecutive years.

Primary care consultation: A clinical encounter in a first-contact healthcare setting, typically involving a general practitioner or nurse.

Longitudinal study: Research design that follows the same individuals over time to assess how variables and outcomes evolve.

Retrospective cohort study: An observational design that examines historical data on a group of individuals to investigate associations between exposures and outcomes.

References

1. Determinants of Frequent Attendance in Primary Care. A Systematic Review of Longitudinal Studies. Frontiers in Medicine (2021).
2. Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data. BMC Primary Care (2013).
3. Consultation patterns and frequent attenders in UK primary care from 2000 to 2019: a retrospective cohort analysis of consultation events across 845 general practices. BMJ Open (2021).
4. Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Primary Care (2012).
5. Defining frequent attendance in general practice. BMC Primary Care (2008).
6. Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS). BMC Primary Care (2020).