Abstract
The aim of this cross-sectional controlled study was to determine frequent
attenders' chronic diseases and their reasons for encounter in primary health
care. Furthermore, the study aimed to determine the associations of social,
psychological and family factors with frequent attendance in a Finnish health
centre.
Patients who made eight or more annual visits to physicians in the health
centre during one year were defined as frequent attenders (FA). All the FAs
during 1994 (N=304) and 304 randomly selected age- and sex-matched controls
constituted the study population. The data were collected from annual statistics,
medical records and postal questionnaires. Over one third of the study population
was interviewed. International Classification of Primary Care (ICPC) was used to
determine the reasons for encounter and Symptom Checklist - 36 (SCL-36) to assess
the psychological distress. Toronto Alexithymia Scale -20 (TAS-20) was used as a
measure of alexithymia and Whiteley Index (WI) to determine hypochondriacal
beliefs.
The results showed that 4.7% of the whole population aged 15 years or older
in Oulainen were FAs. They accounted for 23.5% of all visits made within the
respective age group. The mean age of the FAs was 49.8 years. Over two thirds of
them were female. The FAs had lower basic education and occupational status than
the controls.
The FAs visited physicians in the health centre mostly for reasons related to the
musculoskeletal, respiratory and digestive systems. There appeared to be more
chronic diseases among the FAs than among the controls. The FAs had over three
times more mental disorders than the controls.
The interviewed FAs had significantly more psychological distress,
somatization and hypochondriacal beliefs than the controls. The risk of frequent
attendance was higher in the older family life cycle phases than in the younger
family life cycle phases. Multivariate analyses showed chronic somatic disease
and hypochondriacal beliefs to be risk factors for frequent attendance.
Concurrence of somatization and hypochondriacal beliefs increased the risk to be
a FA.
As a conclusion, the results emphasize the need to consider the FAs' own
bodily concerns expressed as hypochondriacal beliefs when managing them.
Furthermore, the study implicates a need to integrate the biomedical,
psychological and social dimensions in the care of FAs in primary health
care.
| Identifer | oai:union.ndltd.org:oulo.fi/oai:oulu.fi:isbn951-42-6446-0 |
| Date | 30 July 2001 |
| Creators | Jyväsjärvi, S. (Simo) |
| Publisher | University of Oulu |
| Source Sets | University of Oulu |
| Language | English |
| Detected Language | English |
| Type | info:eu-repo/semantics/doctoralThesis, info:eu-repo/semantics/publishedVersion |
| Format | application/pdf |
| Rights | info:eu-repo/semantics/openAccess, © University of Oulu, 2001 |
| Relation | info:eu-repo/semantics/altIdentifier/pissn/0355-3221, info:eu-repo/semantics/altIdentifier/eissn/1796-2234 |
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