Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses

Background: Anxiety, mild depression and somatization are common in Primary Care (PC). Several studies have suggested that they may play a role in causing an excessive use of health care services, especially when combined to medical morbidity. The present case-control study explored how psychiatric and psychosomatic diagnoses and perceived quality of life are associated to the phenomenon of frequent attendance.Methods: The 50 most frequent attenders (FAs) in a one-year period at a PC clinic in Italy were compared to 50 randomly selected average frequency attenders at the same clinic. Socio-demographic and medical data were collected from PC files. The SCID-brief version for research and the Structured Interview for Diagnostic Criteria for use in Psychosomatic Research (DCPR) were administered to both patient groups. Quality of life was also assessed.Results: FA status was associated with being female, older, less well educated, and living with their spouse and/or children. Medical-psychiatric comorbidity was more frequent in the FA group than in the control group. The median number of psychosomatic-DCPR syndromes per patient was 4 among FAs compared to only 1 in controls. Functional somatic symptoms secondary to a psychiatric disorder, type A behaviour, irritable mood, and demoralization were significantly associated with being an FA. Perceived quality of life was significantly lower among FAs, although this was no longer significant after adjusting for socio-demographic variables. Conclusions: The present study confirms the association between medical-psychiatric comorbidity and frequent utilization of PC resources. It suggests a role for DCPR criteria in revealing sub-threshold psychiatric comorbidity predicting a pattern of frequent attendance.