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Psychosocial, lifestyle and health status variables in predicting high attendance among adults

Psychosocial, lifestyle and health status variables in predicting high attendance among adults
Psychosocial, lifestyle and health status variables in predicting high attendance among adults
Background: increasing consultation rates have implications for the organisation of health services, the quality of care, and understanding the decision to consult. Most quantitative studies have concentrated on very high attenders - not those attending five or more times a year, who are responsible for most (60%) consultations - and have assessed neither the role of lifestyle nor patients' attitudes.

Aims: to assess associations with higher than average attendance (five or more times a year).

Design of study: postal questionnaire sent to a random sample. Setting: Four thousand adults (one per household) from six general practices.

Method: data were analysed to identify predictors significantly associated with higher than average attendance. Results: The response rate was 74%. Self-reported attendance agreed with the notes (r = 0.80, likelihood ratio for a positive test = 9.4). Higher attendance was independently predicted by the severity of ill health (COOP score = 0-7, 8-9, and 10+; adjusted odds ratios = 1, 1.72, 1.91 respectively; test for trend P<0.001) and the number of reported medical problems (COOP score = 0, 1, 2, and 3+ respectively; adjusted ORs = 1,2.05, 2.31, 4.29; P<0.001). After controlling for sociodemographic variables, medical problems, the severity of physical ill health, and other confounders, high attendance was more likely in those with medically unexplained somatic symptoms (0, 1-2, 3-5, and 6+ symptoms respectively, ORs = 1, 1.15, 1.48 and 1.62; P<0.001); health anxiety (Whitely Index = 0, 1-5, 6-7, and 8+ respectively; ORs = 1, 1.2 , 1.7 , and 2.78; P<0.0 1); and poor perceived health ('very good', 'good', 'poor' respectively; ORs = 1,1.61, and 2.93; P<0.001). Attendance was less likely in those with negative attitudes to repeated surgery use (OR = 0.61, 95% CI = 0.47-0.78), or to doctors (Negdoc scale <18, 18-20, and 21+ respectively; ORs = 1, 0.87, 0.67; P<0.001), in those usually trying the pharmacy first (OR = 0.61, 95% CI 0.48-0.78), and those consuming alcohol (0, 1, 2, 3+ units/day respectively; ORs = 1, 0.62, 0.41, 0.29; P<0.001). Anxiety or depression predicted perceived health, unexplained symptoms, and health anxiety.

Conclusion: strategies to manage somatic symptoms, health anxiety, dealing with the causes of – or treating – anxiety and depression, and encouraging use of the pharmacy have the potential both to help patients manage symptoms and in the decision to consult. Sensitivity to the psychological factors contributing to the decision to consult should help doctors achieve a better shared understanding with their patients and help inform appropriate treatment strategies.
frequent attenders, consultation, lifestyle, patient attitude, practice, health, quality, care, patient, adult, surgery
0960-1643
987 -994
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Somerville, J.
26c66236-0af5-495a-b26c-64ccab85a9fb
Williamson, I.
12381296-edbf-4ac5-969b-dcb559c22f27
Warner, G.
a7c8d450-67a4-46c9-ad1e-4a17d6816590
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Wiles, R.
333013d1-2144-400b-8f71-7cc6374f0967
George, S.
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Smith, Ann
0cd60e9c-5215-48f6-889d-2f3b7077c904
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96
Little, P.
1bf2d1f7-200c-47a5-ab16-fe5a8756a777
Somerville, J.
26c66236-0af5-495a-b26c-64ccab85a9fb
Williamson, I.
12381296-edbf-4ac5-969b-dcb559c22f27
Warner, G.
a7c8d450-67a4-46c9-ad1e-4a17d6816590
Moore, Michael
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
Wiles, R.
333013d1-2144-400b-8f71-7cc6374f0967
George, S.
bdfc752b-f67e-4490-8dc0-99bfaeb046ca
Smith, Ann
0cd60e9c-5215-48f6-889d-2f3b7077c904
Peveler, Robert
93198224-78d9-4c1f-9c07-fdecfa69cf96

Little, P., Somerville, J., Williamson, I., Warner, G., Moore, Michael, Wiles, R., George, S., Smith, Ann and Peveler, Robert (2001) Psychosocial, lifestyle and health status variables in predicting high attendance among adults. British Journal of General Practice, 51 (473), 987 -994. (PMID:11766871)

Record type: Article

Abstract

Background: increasing consultation rates have implications for the organisation of health services, the quality of care, and understanding the decision to consult. Most quantitative studies have concentrated on very high attenders - not those attending five or more times a year, who are responsible for most (60%) consultations - and have assessed neither the role of lifestyle nor patients' attitudes.

Aims: to assess associations with higher than average attendance (five or more times a year).

Design of study: postal questionnaire sent to a random sample. Setting: Four thousand adults (one per household) from six general practices.

Method: data were analysed to identify predictors significantly associated with higher than average attendance. Results: The response rate was 74%. Self-reported attendance agreed with the notes (r = 0.80, likelihood ratio for a positive test = 9.4). Higher attendance was independently predicted by the severity of ill health (COOP score = 0-7, 8-9, and 10+; adjusted odds ratios = 1, 1.72, 1.91 respectively; test for trend P<0.001) and the number of reported medical problems (COOP score = 0, 1, 2, and 3+ respectively; adjusted ORs = 1,2.05, 2.31, 4.29; P<0.001). After controlling for sociodemographic variables, medical problems, the severity of physical ill health, and other confounders, high attendance was more likely in those with medically unexplained somatic symptoms (0, 1-2, 3-5, and 6+ symptoms respectively, ORs = 1, 1.15, 1.48 and 1.62; P<0.001); health anxiety (Whitely Index = 0, 1-5, 6-7, and 8+ respectively; ORs = 1, 1.2 , 1.7 , and 2.78; P<0.0 1); and poor perceived health ('very good', 'good', 'poor' respectively; ORs = 1,1.61, and 2.93; P<0.001). Attendance was less likely in those with negative attitudes to repeated surgery use (OR = 0.61, 95% CI = 0.47-0.78), or to doctors (Negdoc scale <18, 18-20, and 21+ respectively; ORs = 1, 0.87, 0.67; P<0.001), in those usually trying the pharmacy first (OR = 0.61, 95% CI 0.48-0.78), and those consuming alcohol (0, 1, 2, 3+ units/day respectively; ORs = 1, 0.62, 0.41, 0.29; P<0.001). Anxiety or depression predicted perceived health, unexplained symptoms, and health anxiety.

Conclusion: strategies to manage somatic symptoms, health anxiety, dealing with the causes of – or treating – anxiety and depression, and encouraging use of the pharmacy have the potential both to help patients manage symptoms and in the decision to consult. Sensitivity to the psychological factors contributing to the decision to consult should help doctors achieve a better shared understanding with their patients and help inform appropriate treatment strategies.

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More information

Published date: December 2001
Keywords: frequent attenders, consultation, lifestyle, patient attitude, practice, health, quality, care, patient, adult, surgery

Identifiers

Local EPrints ID: 24395
URI: http://eprints.soton.ac.uk/id/eprint/24395
ISSN: 0960-1643
PURE UUID: 0de07f5a-8138-433d-918f-79f32af22a07
ORCID for Michael Moore: ORCID iD orcid.org/0000-0002-5127-4509
ORCID for Robert Peveler: ORCID iD orcid.org/0000-0001-5596-9394

Catalogue record

Date deposited: 29 Mar 2006
Last modified: 09 Jan 2022 03:17

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Contributors

Author: P. Little
Author: J. Somerville
Author: I. Williamson
Author: G. Warner
Author: Michael Moore ORCID iD
Author: R. Wiles
Author: S. George
Author: Ann Smith
Author: Robert Peveler ORCID iD

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