Social vulnerability and primary care: the case of frequent attenders

Author/s Maurizio Marino, Raffaella Rusciani, Giuseppe Costa, Teresa Spadea
Publishing Year 2019 Issue 2018/1
Language Italian Pages 13 P. 73-85 File size 224 KB
DOI 10.3280/WE2018-001004
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

Using data from the Multipurpose ISTAT surveys on health and the use of health services of the years 2005 and 2013, the study describes the characteristics of the patients who most fre-quently visit their general practitioner, the frequent attenders (FA) and identifies the main de-terminants of access, analyzing the differences between the two surveys. In 2005, 7% is a FA, compared to 8.1% in 2013. The main determinant of the probability of being an FA is obviously the health conditions, both physical and mental; there is also a strong association with the use of other health ser-vices, namely medicines and diagnostic tests. The study highlights the importance of socio-economic characteristics, with a variable impact by gender, age and social indicator: among the elderly (> 64 years of age), individual conditions such as availability of economic re-sources, education and family type have the strongest impact; while among the younger ones, contextual characteristics are more relevant. In the analysis of the temporal trend, the impact of the health conditions on the probability of being a FA appears slightly diminished among the elderly, which suggests a future increase in the role of social determinants.

Keywords: General practitioner; primary care; frequent attenders; determinants of access; so-cioeconomic characteristics.

  1. Allen J., Gay B., Crebolder H., Heyrman J., Svab I. and Ram P. (2011). The European Definitions of General Practice/Family Medicine, Short Version. European Academy of Teachers in General Practice (Network within WONCA Europe). -- Testo disponibile al sito:; ultima consultazione 26/03/2018.
  2. Atella V., Brindisi F., Deb P. and Rosati F.C. (2004). Determinants of access to physician services in Italy: a latent class seemingly unrelated probit approach. Health Economics, 13: 657-668.
  3. Buja A., Toffanin R., Rigon S., Lion C., Sandona P., Carraro D., Damiani G. and Baldo V. (2015). What determines frequent attendance at out-of-hours primary care services? European Journal of Public Health, 25(4): 563-8.
  4. Campbell S.M. and Roland M.O. (1996). Why do people consult the doctor? Family Practice, 13: 75-83.
  5. Carr-Hill R.A., Rice N. and Roland M. (1996). Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices. BMJ, Apr 20, 312(7037): 1008-12.
  6. Diaz E., Gimeno-Feliu L.A., Calderón-Larrañaga A. and Prados-Torres A. (2014). Frequent attenders in general practice and immigrant status in Norway: a nationwide cross-sectional study. Scandinavian Journal of Primary Health Care, 32(4): 232-240. DOI: 10.3109/02813432.2014.982368
  7. Donald M., Ware R.S., Ozolins I.Z., Begum N., Crowther R. and Bain C. (2011). The role of patient activation in frequent attendance at primary care: a population-based study of people with chronic disease. Patient Education and Counseling, 83(2): 217-221.
  8. Ferrari S., Galeazzi G.M. and Rigatelli M. (2004). Frequent attenders of primary care: getting to know them. Journal of Psychosomatic Research, 56: 561-580.
  9. Gill D. and Sharpe M. (1999). Frequent consulters in general practice: a systematic review of studies of prevalence, associations and outcome. Journal of Psychosomatic Research, Aug, 47(2): 115-30.
  10. Gili M., Luciano J.V., Serrano M.J., Jiménez R., Bauza N. and Roca M. (2011). Mental disorders among frequent attenders in primary care: a comparison with routine attenders. The Journal of Nervous and Mental Disease, Oct, 199(10): 744-9.
  11. Hand C., McColl M.A., Birtwhistle R., Kotecha J.A., Batchelor D. and Barber K.H. (2014). Social isolation in older adults who are frequent users of primary care services. Canadian Family Physician, Jun, 60(6): e322, e324-9.
  12. Ministero della salute (2016). Piano Nazionale della Cronicità. Testo Accordo tra lo Stato, le Regioni e le Province Autonome di Trento e di Bolzano del 15 settembre 2016, -- disponibile al sito:; ultima consultazione 26/03/2018.
  13. Ministero della Salute, CCM (2013). Linee di indirizzo per la prevenzione degli effetti del caldo sulla salute. -- Testo disponibile al sito:; ultima consultazione 26/03/2018.
  14. Odone A., Landriscina T. e Costa G. (2016). Salute mentale e crisi economica: analisi sulla popolazione in Italia. In: Costa G., Crialesi R., Migliardi A., Gargiulo L., Sebastiani G., Ruggeri P. e Menniti Ippolito F., Salute in Italia e livelli di tutela: approfondimenti dalle indagini ISTAT sulla salute. Roma: Istituto Superiore di Sanità. Rapporti ISTISAN 16/26.
  15. Palmer E., Leblanc-Duchin D., Murray J. and Atkinson P. (2014). Emergency department use: is frequent use associated with a lack of primary care provider? Canadian Family Physician, Apr, 60(4): e223-9.
  16. Presidenza del Consiglio dei Ministri, Conferenza permanente per i rapporti tra lo Stato, le Regioni e le Province Autonome di Trento e Bolzano (2014). Nuovo Patto per la Salute 2014-2016. -- Testo disponibile al sito:; ultima consultazione 26 marzo 2018.
  17. Scaife B., Gili P.S., Heywood P.L. and Neal R.D. (2000). Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Family Practice,
  18. Smits F.T., Wittkampf K.A., Schene A.H., Bindels P.J. and Van Weert H.C. (2008). Interventions on frequent attenders in primary care. A systematic literature review. Scandinavian Journal of Primary Health Care, 26(2): 111-6. DOI: 10.1080/02813430802112997
  19. Smits F.T., Brouwer H.J., van Weert H.C., Schene A.H. and ter Riet G. (2009). Predictability of persistent frequent attendance: a historic 3-year cohort study. BMJ Open, General Practice, 59(559): e44-50.
  20. Smits F.T., Brouwer H.J., Zwinderman A.H., Mohrs J., Smeets H.M., Bosmans J.E., Schene A.H., Van Weert H.C. and Riet G. (2013). 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 Family Practice, Sep 17: 14-138. DOI: 10.1186/1471-2296-14-138
  21. Smits F.T., Brouwer H.J., Zwinderman A.H., Mohrs J., Schene A.H., van Weert H.C. and ter Riet G. (2014). Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. Journal of psychosomatic research, 77(6): 492-503.
  22. Vedsted P. and Olesen F. (2005). Social environment and frequent attendance in Danish general practice. British Journal of General Practice, 55(516): 510-5.
  23. Vedsted P. and Christensen M.B. (2005). Frequent attenders in general practice care: A literature review with special reference to methodological considerations. Public Health, 119(2): 118-137.
  24. Welzel F.D., Stein J., Hajek A., König H.H. and Riedel-Heller S.G. (2017). Frequent attenders in late life in primary care: a systematic review of european studies. BMC Family Practice, 18(1): 104.

Maurizio Marino, Raffaella Rusciani, Giuseppe Costa, Teresa Spadea, Vulnerabilità sociale e cure primarie: il caso dei frequent attenders in "WELFARE E ERGONOMIA" 1/2018, pp 73-85, DOI: 10.3280/WE2018-001004