Hiperfreqüentadors

Paraules Mesh

Cerques fetees

• "Primary Health Care/utilization"[Mesh] AND "Models, Theoretical"[Mesh] AND "Cross-Sectional Studies"[Mesh]

Freqüentació

Appointments and Schedules Health Services/utilization* Health Services Misuse/statistics & numerical data Office Visits/statistics & numerical data* Office Visits/utilization* Primary Health Care*/statistics & numerical data Primary Health Care/utilization* utilization Workload*

Factors associats

Age Factors Attitude to Health Chronic Disease/epidemiology Chronic Disease/psychology* Depression/epidemiology* Family Practice/organization & administration Family Practice/statistics & numerical data* Family Relations Health Behavior Health Care Rationing* Health Services Accessibility* Health Services Needs and Demand Health Status Marital Status Mental Disorders/diagnosis Mental Disorders/epidemiology Mental Disorders/psychology Models, Organizational* Morbidity* Outpatients/classification* Outpatients/psychology Patient Acceptance of Health Care Patient Acceptance of Health Care/psychology* Patient Acceptance of Health Care/statistics & numerical data* Patient Satisfaction Personality Inventory Physician-Patient Relations* Practice Management, Medical Practice Management, Medical/organization & administration* Risk Factors Sex Factors Sick Role* Social Class Social Support Socioeconomic Factors

Mètodes

Case-Control Studies Cross-Sectional Studies Cohort Studies Health Services Research Interviews Logistic Models Models, Theoretical Odds Ratio Prospective Studies Qualitative Research Questionnaires Regression Analysis Retrospective Studies

Estat actual del tema

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 [1], ho tenen en compte, però no sé en què es basen.

Factors que condicionen la hiperfreqüentació

• Característiques 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 [1]. 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 [1].
  • Falta de suport social o familiar augmenten la HF [1].
• Factors del professional.
  • No influeix la satisfacció amb el seu metge o infermera.
• Factors de la organització.
  • Un augment d'accessibilitat augmenta la freqüentació segons els propis pacients [1].
  • La satisfacció amb el centre podria augmentar la HF [1].

Metodologia utilitzada

• Per als factors que determinen l'hiperfreqüentació:
  • Metodologia qualitativa amb grups focals [1].

Bibliografia

Llegits

• Factors explicatius de la HF amb metodologia qualitativa [1].

Pendents de llegir

• Perfil de l'HF [2, 3, 4, 5, 6, 7, 8].
• Factors explicatius de l'HF [9, 10, 11, 12, 13], el model explicatiu d'Andersen [14], socials [15], personalitat neuròtica [16], sistemes d'organització dels serveis sanitaris [17]. Estudis qualitatius [18, 19].
• Freqüentació [20].

Pendents de buscar

• Referència 15, 22 de [1].

Referències

1. 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 |
2. 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 |
3. Kapur N, Macfarlane G, and Creed F. Frequent attenders in general practice. Br J Gen Pract. 2001 Sep;51(470):756-7.
4. 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 |
5. 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 |
6. 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 |
7. 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.
8. 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 |
9. 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 |
10. 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.
11. 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 |
12. 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 |
13. 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 |
14. Andersen RM. Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995 Mar;36(1):1-10.

15. 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.

16. 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 |
17. 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 |
18. 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.
19. 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 |
20. 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.