How do GPs and patients experience Persistent Frequent Attendance in primary care? A qualitative study

Persistent frequent attendance in primary care in the UK can be seen as problematic for the health service as persistent frequent attenders (PFAs) take up a disproportionate amount of time and resources and impact on the clinical workload of GPs (General Practitioners) (Smits, 2009 & Smits, 2013). These patients can be frustrating and difficult for GPs to manage particularly when frequent attendance continues for longer periods of time (Lin et al 1991, Hanel et al 2009). Research shows that only one in seven frequently attending patients continue to attend primary care so frequently for two years (Smits 2009, 2013). Therefore, it seems useful to focus on persistent Frequent attenders in primary care. In the UK, unlike long-term conditions that are typically managed by a multi-disciplinary team of GPs, nurses and other professionals, the management of PFAs in primary care has largely been the responsibility of GPs. Therefore, it is also important to understand how GPs experience managing the care of PFAs. There is a lack of knowledge about PFAs and GPs experiences. A better understanding of their experiences might help us to improve service provision and management and ultimately improve patient well-being. Aims and objectives Aims To better understand persistent frequent attendance, how PFAs perceive their life and healthcare use and to better understand how GPs perceive these patients and experience caring for them. Objectives • To carry out explorative interviews with PFAs in order to explore their experiences in relation to their health, their use of healthcare and their life experiences. • To carry out explorative interviews with GPs to explore their experiences of caring for PFAs. • To explore what the findings tell us about PFAs and their GPs. For example; do the participant’s experiences tell us anything about their psychological or social needs. • To discuss the findings in relation to the current literature and theories of Persistent Frequent attendance. Findings Twelve GPs and fifteen PFAs were interviewed about their experiences of PFA in primary care. Thematic analysis resulted in five main themes. The focus of Theme 1 is PFAs health and that they experience it as complex, worrying and poor. It is evident that complex poor health is a major reason for PFAs continued attendance with their GP. Theme 2 focuses on the importance of the GP and patient relationship and how experiencing trust, feelings of safety and continuity is valuable to PFAs but presents further challenges to the GP. Theme 3 focuses on how PFAs experience their mental and emotional health and their current circumstances. GPs seek to find and offer understanding with these issues but fail to know how best to move these patients on with limited resources and options. Theme 4 explains how PFAs negative experiences of other health services impacts on their health-seeking behaviour and may act as a deterrent to them receiving mental health care out with primary care services. Theme 5 describes the impact managing the care of PFA patients has on the GP, leaving them feeling responsible and yet powerless to meet the needs of this patient group. Although GPs acknowledge the importance of managing PFA care, for them it engenders feelings of anxiety and responsibility in a situation in which they feel powerless to resolve or improve. An overarching theme throughout the data is the importance of attachment issues and how these need to be carefully considered with regards to the care of PFA patients. Conclusion The findings offer some clear insights into how GPs and patients experience persistent frequent attendance in primary care with overlaps in the two sets of data that support each other and provide a rounded account of the situation. Overall, the way GPs and patients experience PFA can be frustrating for both parties and there is a need for more support for GPs in managing this care. PFA patients and their GPs may become locked into a relationship that, although supportive and offering high levels of care in terms of time and effort, is inadequate in meeting the PFAs complex needs. This situation can cause anxiety, impacts on their self-esteem and creates a feeling of hopelessness in GPs. Further research into the training needs of GPs and potential resources to meet the holistic care needs of PFAs is needed. Consideration of the impact of attachment issues seems like an important factor in developing interventions for PFA patients