Hiperfreqüentadors

WIKI FEINA

Paraules Mesh

Cerques fetes

• "Primary Health Care"[Mesh] AND "Health Services Misuse/statistics and numerical data"[Mesh]
• Primary Health Care[Mesh]AND "Utilization Review/methods"[MAJR]

• "Primary Health Care/utilization"[Mesh] AND "Models, Theoretical"[Mesh] AND "Cross-Sectional Studies"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND Attitude to Health [mesh]
• "Primary Health Care/utilization"[Mesh] AND "Models, Theoretical"[Mesh] AND"Cohort Studies"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND "Religion and Psychology"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND "Age Factors"[Mesh] AND "Models, Theoretical"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND "Age Factors"[Mesh] AND "Health Services Research"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND Capitation Fee[Mesh]
• "Primary Health Care/utilization"[Mesh] AND Chronic Disease/epidemiology [Mesh]
• "Primary Health Care/utilization"[Mesh] AND Chronic Disease/psychology
• "Primary Health Care/utilization"[Mesh] AND Educational Status
• "Primary Health Care/utilization"[Mesh] AND Health Status[mesh] AND "Health Services Research"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND Morbidity[Mesh] AND Health Services Research[mesh]
• "Primary Health Care/utilization"[Mesh] AND "Patient Acceptance of Health Care/statistics and numerical data"[Mesh] AND Health Services Research[mesh]
• "Primary Health Care/utilization"[Mesh] AND "Appointments and Schedules"[Mesh] AND "Models, Theoretical"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND "Physician's Practice Patterns"[Mesh]
• "Primary Health Care/utilization"[Mesh] AND Practice Management, Medical [mesh]
• "Primary Health Care/utilization"[Mesh] AND "Religion and Psychology"[Mesh]

Freqüentació

Ambulatory Care/utilization* Appointments and Schedules Continuity of Patient Care/statistics & numerical data* Health Services/utilization* Health Services Misuse/statistics & numerical data Health Services Needs and Demand*/statistics & numerical data Office Visits/statistics & numerical data* Office Visits/utilization* Primary Health Care*/statistics & numerical data Primary Health Care/utilization* utilization Utilization Review Utilization Review/statistics & numerical data Workload*

Factors associats

Affective Symptoms/epidemiology Age Factors Attitude to Health Attitude of Health Personnel* Capitation Fee Catholicism Chronic Disease Chronic Disease/epidemiology Chronic Disease/psychology Depression/epidemiology* Educational Status Family Characteristics* Family Characteristics* Family Practice* Family Practice/organization & administration Family Practice/statistics & numerical data* Family Relations Health Behavior Health Care Rationing* Health Services Accessibility* Health Services for the Aged/utilization* Health Services Needs and Demand Health Status Jews/psychology Jews/statistics & numerical data Marital Status Mental Disorders/diagnosis Mental Disorders/epidemiology Mental Disorders/psychology Models, Organizational* Morbidity Motivation Neurotic Disorders/epidemiology* Outpatients/classification* Outpatients/psychology Patient Acceptance of Health Care Patient Acceptance of Health Care/ethnology Patient Acceptance of Health Care/psychology* Patient Acceptance of Health Care/statistics & numerical data* Patients/psychology* Patient Satisfaction Personality Assessment Personality Inventory Poverty Areas* Physician-Patient Relations* Physicians, Family/utilization* Physician's Practice Patterns Physician's Practice Patterns/statistics & numerical data* Practice Management, Medical Practice Management, Medical/organization & administration* Protestantism Psychology, Social Religion and Psychology* Risk Factors Self Assessment (Psychology) Severity of Illness Index Sex Factors Sick Role* Social Class Social Support Socioeconomic Factors Utilization Review Utilization Review/methods Urban Health

Mètodes

Case-Control Studies Chi-Square Distribution Cross-Sectional Studies Cohort Studies Follow-Up Studies Confidence Intervals Health Care Surveys Health Services Research Health Surveys Interviews Likelihood Functions Logistic Models Models, Theoretical Odds Ratio Prospective Studies Qualitative Research Questionnaires Regression Analysis Retrospective Studies

Estat actual del tema

Es necessiten més estudis, però el què si que està clar que una major freqüentació, no necessàriament millors resultats de salut [1].

Definició d'hiperfreqüentador

• Majors de 14 anys i amb més de 8 visites/metge/any.
• Número de visites superior a 2 desviacions estàndard de la mitja de freqüentació.

Perfil de l'hiperfreqüentador

• Són una part important de la demanda, son un 12-21% de la població que usa el 46-50% de les consultes.
• Edat mitja.
• Predomini femení.
• Múltiples problemes de salut tant físics com mentals.
• Valorar si cal recollir si el pacient és pensionista o no. En l'article [2], ho tenen en compte, però no sé en què es basen.

Factors que condicionen la hiperfreqüentació

Segons Bellón [1], hi ha 2 tipus de visites en funció de qui fa la demanda. Les visites iniciades per l'usuari-pacient que dependran de les variables lligades al pacient (d'això se'n diu la teoria de la demanda sanitària en dues etapes o model de la demanda seqüencial i l'avançada teoria del joc). I les iniciades pel proveïdor, que els seus factors predictors seran variables del metge i de l'organització.

Factors de la població

• L'edat cada cop més gran de la població.
• Estat de salut de la població.
• Segons la importància que se li dóna a la malaltia [2]. Sobretot les cardiovasculars, osteoarticulars, però també les cròniques i mentals.
• El nivell socioeconòmic podria influir en la HF dels serveis públics, ja que se sposa que els rics van a la privada [2].
• Falta de suport social o familiar augmenten la HF [2].

Factors del professional i de l'organització

S'ha pogut comprovar que els factors del professional i de l'organització arriben a explicar el 55% i el 63% de la variabilitat de la utilització de les consultes d'atenció primària [1].

Factors del professional

Segons Bellón [1], l'atenció primària té una relació d'agència amb els pacients, com podria ser un taller mecànic o un advocat. Aquesta relació pot ser completa (o perfecta) o incompleta (o imperfecta), i d'això en depèn la demanda.

• La relació perfecta pretén maximitzar l'estat de salut del pacient, la utilitat del pacient i l'estat de salut o utilitat de la societat.
• La relació imperfecta podria ser per vàries raons del professional: desig d'ingressos econòmics, estil de pràctica particular segons els gustos del professional, medicina defensiva, característiques inherents al metge com l'edat o el sexe, o característiques modificables dels metges.

No influeix la satisfacció amb el seu metge o infermera.

El 40% de les visites dels metges de família son per demanda induïda administrativa de baixa efectivitat [1]: receptes cròniques i partes de baixa.

Factors de la organització

Un augment d'accessibilitat augmenta la freqüentació segons els propis pacients [2].

Es va trobar una relació positiva entre les visites d'iniciativa mèdica i la ratio de metges per habitant [1], que seria més o menys el mateix que una correlació entre la població atesa assignada per metge i la freqüentació d'aquell metge.

La satisfacció amb el centre podria augmentar la HF [2].

Característiques del centre de treball [1]: lideratge clínic, acceptació grupal dels estàndards de qualitat assistencial, rols de grup, clima organitzacional...

Metodologia utilitzada

• Per als factors que determinen l'hiperfreqüentació:
  • Metodologia qualitativa amb grups focals [2].

Bibliografia

Llegits

• Factors explicatius de la HF amb metodologia qualitativa [2].
• Demanda induïda, factors explicatius [1].
• Característiques dels HF (sobretot per polifarmàcia) [3].

Pendents de llegir

• Definició HF [4, 5, 6, 7, 8, 9, 10].
• Descripció de la freqüentació [3, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23].
• Variabilitat [24, 25, 26].
• Perfil de l'HF [27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40].
• Factors explicatius de l'HF [41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68], el model explicatiu d'Andersen [69], socio-economics [70, 71, 72], factors psicològics [73, 74, 75, 76, 77, 78, 79, 80, 81], sistemes d'organització dels serveis sanitaris [82], religió [83].
• Mesures [84].
• Metodologia [85].
  • Estudis qualitatius [86, 87].
  • Multivariant [88].
  • Assaig clínic, intervenció per disminuir la freqüentació [89].

Pendents de buscar

• Referència 15, 22 de [2].

Referències

1. Bellón Saameño JA. [Doctor-induced demand: Applications of economic theory in clinical practice]. Aten Primaria. 2006 Sep 30;38(5):293-8. DOI:10.1157/13092989 |
2. Guerra de Hoyos JA and de Anca Contreras IA. [Motives that condition use of the health services by over-users: study with focus groups]. Aten Primaria. 2007 Jul;39(7):349-54. DOI:10.1157/13107722 |
3. O'Hare CD and Corlett J. The outcomes of open-access scheduling. Fam Pract Manag. 2004 Feb;11(2):35-8.
4. Lourenço OD and Ferreira PL. Utilization of public health centres in Portugal: effect of time costs and other determinants. Finite mixture models applied to truncated samples. Health Econ. 2005 Sep;14(9):939-53. DOI:10.1002/hec.1046 |
5. Neal RD, Heywood PL, Morley S, Clayden AD, and Dowell AC. Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices. Br J Gen Pract. 1998 Jan;48(426):895-8.
6. Wilson J. Frequent attendance. Br J Gen Pract. 2003 May;53(490):408.
7. Howe A, Parry G, Pickvance D, and Hockley B. Defining frequent attendance: evidence for routine age and sex correction in studies from primary care settings. Br J Gen Pract. 2002 Jul;52(480):561-2.
8. Neal RD, Heywood PL, and Morley S. Frequent attenders' consulting patterns with general practitioners. Br J Gen Pract. 2000 Dec;50(461):972-6.
9. Andersson SO, Mattsson B, and Lynoe N. Patients frequently consulting general practitioners at a primary health care centre in Sweden--a comparative study. Scand J Soc Med. 1995 Dec;23(4):251-7. DOI:10.1177/140349489502300406 |
10. Knishkowy B, Furst A, Fassberg Y, Anor E, Matthews S, and Paz Y. Multiple family member visits to family physicians. Terminology, classification, and implications. J Fam Pract. 1991 Jan;32(1):57-63; discussion 63-4.
11. Crampton P, Jatrana S, Lay-Yee R, and Davis P. Exposure to primary medical care in New Zealand: number and duration of general practitioner visits. N Z Med J. 2007 Jun 15;120(1256):U2582.
12. Busato A, Dönges A, Herren S, Widmer M, and Marian F. Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study. Fam Pract. 2006 Feb;23(1):116-24. DOI:10.1093/fampra/cmi078 |
13. Lou Arnal S, Arto Serrano A, Betorz Latorre JJ, Ucar Hernández F, and Pons Pons L. [Descriptive studies of the demand of care]. Aten Primaria. 1990 Jun;7(6):468, 470.
14. Arenas del Pozo S, Candela Pérez C, Quirce Andrés F, Marco D, Mancheño J, and Tobías J. [Evaluation of the demand for care in a primary care center in Alicante]. Aten Primaria. 1990 Jun;7(6):468.
15. Are 'persistently high users' burdening your primary care practice?. Capitation Rates Data. 2005 Oct;10(10):114-6.
16. Sidorov J and Shull R. "My patients are sicker:" using the Pra risk survey for case finding and examining primary care site utilization patterns in a medicare-risk MCO. Am J Manag Care. 2002 Jun;8(6):569-75.
17. Carlsson L, Strender LE, Fridh G, and Nilsson GH. Clinical categories of patients and encounter rates in primary health care - a three-year study in defined populations. BMC Public Health. 2006 Feb 16;6:35. DOI:10.1186/1471-2458-6-35 |
18. Pappa E and Niakas D. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res. 2006 Nov 2;6:146. DOI:10.1186/1472-6963-6-146 |
19. Suominen-Taipale AL, Martelin T, Koskinen S, Holmen J, and Johnsen R. Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey. BMC Health Serv Res. 2006 Sep 4;6:110. DOI:10.1186/1472-6963-6-110 |
20. O'Halloran J, Ng A, Britt H, and Charles J. EPC encounters in Australian general practice. Aust Fam Physician. 2006 Jan-Feb;35(1-2):8-10.
21. Fleming DM. Health care utilization in the British National Health Service. Health Care Manag. 1995 Oct;2(1):161-73.
22. Sihvonen M and Kekki P. Unnecessary visits to health centres as perceived by the staff. Scand J Prim Health Care. 1990 Dec;8(4):233-9. DOI:10.3109/02813439008994964 |
23. Ovaskainen PT, Rautava PT, Ojanlatva A, Päkkilä JK, and Päivärinta RM. Analysis of primary health care utilisation in south-western Finland--a tool for management. Health Policy. 2003 Dec;66(3):229-38. DOI:10.1016/s0168-8510(03)00116-7 |
24. Guerra Aguirre J. [Variation in the utilization of resources in primary care]. Aten Primaria. 1999 Sep 15;24(4):243-4.
25. Bolaños-Carmona V, Ocaña-Riola R, Prados-Torres A, and Gutiérrez-Cuadra P. Variations in health services utilization by primary care patients. Health Serv Manage Res. 2002 May;15(2):116-25. DOI:10.1258/0951484021912888 |
26. Okkes IM, Polderman GO, Fryer GE, Yamada T, Bujak M, Oskam SK, Green LA, and Lamberts H. The role of family practice in different health care systems: a comparison of reasons for encounter, diagnoses, and interventions in primary care populations in the Netherlands, Japan, Poland, and the United States. J Fam Pract. 2002 Jan;51(1):72-3.
27. Byrne M, Murphy AW, Plunkett PK, McGee HM, Murray A, and Bury G. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003 Mar;41(3):309-18. DOI:10.1067/mem.2003.68 |
28. Kapur N, Macfarlane G, and Creed F. Frequent attenders in general practice. Br J Gen Pract. 2001 Sep;51(470):756-7.
29. Bergh H and Marklund B. Characteristics of frequent attenders in different age and sex groups in primary health care. Scand J Prim Health Care. 2003 Sep;21(3):171-7. DOI:10.1080/02813430310001149 |
30. Vedsted P, Christensen MB, Sørensen HT, Fink P, and Olesen F. Special status consultation for frequent attenders. Who are the candidates?. J Public Health Med. 2002 Mar;24(1):53-7. DOI:10.1093/pubmed/24.1.53 |
31. Bellón JA, Delgado A, Luna JD, and Lardelli P. Psychosocial and health belief variables associated with frequent attendance in primary care. Psychol Med. 1999 Nov;29(6):1347-57. DOI:10.1017/s0033291799008995 |
32. Dowrick CF, Bellón JA, and Gómez MJ. GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms. Br J Gen Pract. 2000 May;50(454):361-5.
33. Ortega Tallón MA, Roca Figueres G, Iglesias Rodríguez M, and Jurado Serrano JM. [Patients over-using a primary care centre: their social, demographic and clinical characteristics, and their use of health service facilities]. Aten Primaria. 2004 Feb 15;33(2):78-85. DOI:10.1016/s0212-6567(04)79355-5 |
34. Frostholm L, Fink P, Christensen KS, Toft T, Oernboel E, Olesen F, and Weinman J. The patients' illness perceptions and the use of primary health care. Psychosom Med. 2005 Nov-Dec;67(6):997-1005. DOI:10.1097/01.psy.0000189164.85653.bc |
35. Aguirre Rodríguez CJ, Hernández Martínez N, Aguirre Rodríguez FJ, and González Expósito JM. [Study of some parameters of ongoing care in a health district and the problem of over-use of the service]. Aten Primaria. 2004 Jun 30;34(2):105-6. DOI:10.1016/s0212-6567(04)79471-8 |
36. Segovia Martínez A, Pérez Fuentes C, Torío Durántez J, and García Tirado MC. [Psychological malaise and the sociodemographic and familial characteristics of the over-user of primary care]. Aten Primaria. 1998 Nov 30;22(9):562-9.
37. Orueta Sánchez R, Vigueras F, Orgaz P, and Torres C. [The family characteristics of overusers of primary care health services]. Aten Primaria. 1993 Jun 30;12(2):92-4.
38. Probst JC, Moore CG, Baxley EG, and Lammie JJ. Rural-urban differences in visits to primary care physicians. Fam Med. 2002 Sep;34(8):609-15.
39. Rubio Montañés ML, Adalid Villar C, Cordón Granados F, Solanas Saura P, Masó Casadellà D, Fernández Punset D, Ràfols Crestani A, Arroyo Cardona E, Auquer Framis F, and Buñuel Alvarez JC. [Overattendance at primary care: a study of psychosocial factors]. Aten Primaria. 1998 Dec;22(10):627-30.
40. Carlsson L, Strender LE, Fridh G, and Nilsson G. Types of morbidity and categories of patients in a Swedish county. Applying the Johns Hopkins Adjusted Clinical Groups System to encounter data in primary health care. Scand J Prim Health Care. 2004 Sep;22(3):174-9. DOI:10.1080/02813430410006567 |
41. Al-Windi A. Determinants of medicine use in a Swedish primary health care practice population. Pharmacoepidemiol Drug Saf. 2005 Jan;14(1):47-51. DOI:10.1002/pds.1047 |
42. Wahls TL, Barnett MJ, and Rosenthal GE. Predicting resource utilization in a Veterans Health Administration primary care population: comparison of methods based on diagnoses and medications. Med Care. 2004 Feb;42(2):123-8. DOI:10.1097/01.mlr.0000108743.74496.ce |
43. Reinke T, Hobson J, and Hilbert T. Upgrading the service mix in primary care practices may increase revenue. Healthc Financ Manage. 2001 Aug;55(8):66-8.
44. Eggen P, Maeland JG, and Skjaerven R. Use of primary medical care: does place of residence play a role?. Scand J Prim Health Care. 1993 Mar;11(1):31-7. DOI:10.3109/02813439308994899 |
45. Krasnik A, Hansen E, Keiding N, and Sawitz A. Determinants of general practice utilization in Denmark. Dan Med Bull. 1997 Nov;44(5):542-6.
46. Foster A, Jordan K, and Croft P. Is frequent attendance in primary care disease-specific?. Fam Pract. 2006 Aug;23(4):444-52. DOI:10.1093/fampra/cml019 |
47. Vedsted P, Fink P, Sørensen HT, and Olesen F. Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study. Soc Sci Med. 2004 Aug;59(4):813-23. DOI:10.1016/j.socscimed.2003.11.027 |
48. Brugos Larumbe A, Guillén Grima F, Mallor Giménez F, and Fernández Martínez de Alegría C. [Models to explain and predict medical case-loads: their use in calculating the maximum family medicine list that allows at least ten minutes per consultation]. Aten Primaria. 2003 Jun 15;32(1):23-9. DOI:10.1016/s0212-6567(03)78853-2 |
49. Smucker DR, Zink T, Susman JL, and Crabtree BF. A framework for understanding visits by frequent attenders in family practice. J Fam Pract. 2001 Oct;50(10):847-52.
50. Kapur N, Hunt I, Lunt M, McBeth J, Creed F, and Macfarlane G. Psychosocial and illness related predictors of consultation rates in primary care--a cohort study. Psychol Med. 2004 May;34(4):719-28. DOI:10.1017/S0033291703001223 |
51. Mancera Romero J, Muñoz Cobos F, Paniagua Gómez F, Fernández Lozano C, Fernández Tapia M, and Blanca Barba F. [Health problems and factors determining the number of on-demand visits of over-users of a health centre]. Aten Primaria. 2001 May 31;27(9):658-62. DOI:10.1016/s0212-6567(01)78876-2 |
52. van der Meer JB and Mackenbach JP. Low education, high GP consultation rates: the effect of psychosocial factors. J Psychosom Res. 1998 May;44(5):587-97. DOI:10.1016/s0022-3999(97)00217-1 |
53. Báez K, Aiarzaguena JM, and Grandes G. [Overutilization and psychosocial factors: myth or reality?]. Aten Primaria. 1999 May 31;23(9):555-7.
54. Bago d'Uva T. Latent class models for use of primary care: evidence from a British panel. Health Econ. 2005 Sep;14(9):873-92. DOI:10.1002/hec.1047 |
55. Crampton P, Dowell A, Woodward A, and Salmond C. Utilisation rates in capitated primary care centres serving low income populations. N Z Med J. 2000 Oct 27;113(1120):436-8.
56. Bellón Saameño JA, Delgado Sánchez A, Luna del Castillo Jde D, and Lardelli Claret P. [Influence of age and sex on various types of utilization of the primary health care]. Gac Sanit. 1995 Nov-Dec;9(51):343-53.
57. Portella E, Juncosa S, Carrillo E, and Bolibar B. [The reasons for consultation and active problems. A key for the understanding of information in primary care]. Gac Sanit. 1992 Sep-Oct;6(32):216-9. DOI:10.1016/s0213-9111(92)71116-9 |
58. Martín Pérez J and Otero Rodríguez JA. [The demand for care at a health center according to the regional information system]. Aten Primaria. 1992 Jun 15;10(1):554-6.
59. Dovey SM, Tilyard MW, Phillips DE, and Whitney RK. The effect of employment status and household composition on health care utilisation in a general practice. N Z Med J. 1992 May 27;105(934):188-90.
60. Conrad DA, Maynard C, Cheadle A, Ramsey S, Marcus-Smith M, Kirz H, Madden CA, Martin D, Perrin EB, Wickizer T, Zierler B, Ross A, Noren J, and Liang SY. Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations?. JAMA. 1998 Mar 18;279(11):853-8. DOI:10.1001/jama.279.11.853 |
61. Jyväsjärvi S, Keinänen-Kiukaanniemi S, Väisänen E, Larivaara P, and Kivelä SL. Frequent attenders in a Finnish health centre: morbidity and reasons for encounter. Scand J Prim Health Care. 1998 Sep;16(3):141-8. DOI:10.1080/028134398750003089 |
62. Karlsson H, Lehtinen V, and Joukamaa M. Frequent attenders of Finnish public primary health care: sociodemographic characteristics and physical morbidity. Fam Pract. 1994 Dec;11(4):424-30. DOI:10.1093/fampra/11.4.424 |
63. Parslow R, Jorm A, Christensen H, Jacomb P, and Rodgers B. Gender differences in factors affecting use of health services: an analysis of a community study of middle-aged and older Australians. Soc Sci Med. 2004 Nov;59(10):2121-9. DOI:10.1016/j.socscimed.2004.03.018 |
64. Scott KM, Marwick JC, and Crampton PR. Utilization of general practitioner services in New Zealand and its relationship with income, ethnicity and government subsidy. Health Serv Manage Res. 2003 Feb;16(1):45-55. DOI:10.1258/095148403762539130 |
65. Gross R, Brammli-Greenberg S, and Remennick L. Self-rated health status and health care utilization among immigrant and non-immigrant Israeli Jewish women. Women Health. 2001;34(3):53-69. DOI:10.1300/J013v34n03_04 |
66. Sutton M, Carr-Hill R, Gravelle H, and Rice N. Do measures of self-reported morbidity bias the estimation of the determinants of health care utilisation?. Soc Sci Med. 1999 Oct;49(7):867-78. DOI:10.1016/s0277-9536(99)00169-0 |
67. Mendoza-Sassi R and Béria JU. Prevalence of having a regular doctor, associated factors, and the effect on health services utilization: a population-based study in Southern Brazil. Cad Saude Publica. 2003 Sep-Oct;19(5):1257-66. DOI:10.1590/s0102-311x2003000500004 |
68. Keene J and Li X. Age and gender differences in health service utilization. J Public Health (Oxf). 2005 Mar;27(1):74-9. DOI:10.1093/pubmed/fdh208 |
69. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995 Mar;36(1):1-10.

70. Pescosolido B. Beyond Rational Choice: The Social Dynamics of How People Seek Help. The American Journal of Sociology, Vol. 97, No. 4, New Directions in the Sociology of Medicine. (Jan., 1992), pp. 1096-1138.

71. Martínez de la Iglesia J, Mateos C, Pérula de Torres LA, Rodríguez Torronteras A, Criado A, Jiménez García C, and Baena M. [Socioeconomic factors: do they influence the demand for care and the degree of satisfaction in primary care?]. Aten Primaria. 1990 Feb;7(2):106-8, 110-1.
72. Gómez Rodríguez E, Moreno Raymundo P, Hernández Monsalve M, and Gérvas J. Socio-economic status, chronic morbidity and health services utilization by families. Fam Pract. 1996 Aug;13(4):382-5. DOI:10.1093/fampra/13.4.382 |
73. Bebbington PE, Meltzer H, Brugha TS, Farrell M, Jenkins R, Ceresa C, and Lewis G. Unequal access and unmet need: neurotic disorders and the use of primary care services. Psychol Med. 2000 Nov;30(6):1359-67. DOI:10.1017/s0033291799002950 |
74. Thode N, Bergmann E, Kamtsiuris P, and Kurth BM. [Predictors for ambulatory medical care utilization in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2005 Mar;48(3):296-306. DOI:10.1007/s00103-004-1004-3 |
75. Virtanen P, Kivimäki M, Vahtera J, and Koskenvuo M. Employment status and differences in the one-year coverage of physician visits: different needs or unequal access to services?. BMC Health Serv Res. 2006 Oct 2;6:123. DOI:10.1186/1472-6963-6-123 |
76. ten Have M, Oldehinkel A, Vollebergh W, and Ormel J. Does neuroticism explain variations in care service use for mental health problems in the general population? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemiol. 2005 Jun;40(6):425-31. DOI:10.1007/s00127-005-0916-z |
77. Cortés JA, Peñalver C, Alonso J, Arroyo A, and Gonzálvez L. [The prevalence of mental illness in primary care and its relation to the degree of consultation frequency]. Aten Primaria. 1993 May 31;11(9):459-60, 462-3.
79. Von Korff M, Ormel J, Katon W, and Lin EH. Disability and depression among high utilizers of health care. A longitudinal analysis. Arch Gen Psychiatry. 1992 Feb;49(2):91-100. DOI:10.1001/archpsyc.1992.01820020011002 |
80. López-Torres Hidalgo J, Escobar F, Fernández C, González C, Urbistondo L, and Requeza M. [Mental disorders and the utilization of the general medicine consultation]. Aten Primaria. 1992 Sep 1;10(3):665-70.
81. ten Have M, de Graaf R, Vollebergh W, and Beekman A. What depressive symptoms are associated with the use of care services? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). J Affect Disord. 2004 Jun;80(2-3):239-48. DOI:10.1016/S0165-0327(03)00132-0 |
82. Suominen-Taipale AL, Koskinen S, Martelin T, Holmen J, and Johnsen R. Differences in older adults' use of primary and specialist care services in two Nordic countries. Eur J Public Health. 2004 Dec;14(4):375-80. DOI:10.1093/eurpub/14.4.375 |
83. Reindl Benjamins M and Brown C. Religion and preventative health care utilization among the elderly. Soc Sci Med. 2004 Jan;58(1):109-18. DOI:10.1016/s0277-9536(03)00152-7 |
84. Del Fante P, Allan D, and Babidge E. Getting the most out of your practice--the Practice Health Atlas and business modelling opportunities. Aust Fam Physician. 2006 Jan-Feb;35(1-2):34-8.
85. Vedsted P and Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health. 2005 Feb;119(2):118-37. DOI:10.1016/j.puhe.2004.03.007 |
86. Neal RD, Heywood PL, and Morley S. 'I always seem to be there'--a qualitative study of frequent attenders. Br J Gen Pract. 2000 Sep;50(458):716-23.
87. Hodgson P, Smith P, Brown T, and Dowrick C. Stories from frequent attenders: a qualitative study in primary care. Ann Fam Med. 2005 Jul-Aug;3(4):318-23. DOI:10.1370/afm.311 |
88. Bellón Saameño JA. [Multivariate methodology in the studies of utilization and satisfaction in primary care]. Aten Primaria. 1991 Dec;8(11):983.
89. Matalon A, Nahmani T, Rabin S, Maoz B, and Hart J. A short-term intervention in a multidisciplinary referral clinic for primary care frequent attenders: description of the model, patient characteristics and their use of medical resources. Fam Pract. 2002 Jun;19(3):251-6. DOI:10.1093/fampra/19.3.251 |