Risk factors for persistent frequent use of the primary health care services among frequent attenders: A Bayesian approach

Figures & data

Table I. Characteristics of the demographic factors of the study patients.

	Temporary FAs^1		Persistent FAs^1
	n	%^2	n	%^2	p-value^3
Total	59		26
Female gender	38	64	21	81	0.131
Age (years)
20–49	21	36	7	27	0.433
50–64	38	64	19	73	0.433
Body Mass Index (BMI)
3=30	9	15	11	42	<0.010**
Alcohol consumption
Abstinence	10	17	11	44	<0.010**
Smoking
Current smoker	21	36	5	19	0.131
Education
No vocational education	16	27	14	54	<0.050*
Marital status					na
Single	6	10	1	4
Married or live together	34	58	12	48
Widowed	3	5	4	16
Separated/divorced	16	27	8	32
Children
3= 3	16	27	2	8	<0.050*

Notes: ¹Frequent attenders.

²Percentage of the class in this FA group.

³Bivariate analyses, categorical variables: Pearson's chi-squared test.³ Year 2002, first year of the follow-up.

^*Significant at 0.050 level.

^**Significant at 0.010 level.

Table II. Numbers of illnesses, medicines, and visits by the study patients.

	Temporary FAs median (mean)	Persistent FAs median (mean)	p-value^1
Chronic illnesses	4 (4.4)	5 (5.1)	0.144
Regular medicines	2 (2.6)	3.5 (3.9)	0.083
Health centre visits^2	10 (10.3)	12 (14.2)	<0.010**

Notes: ¹Mann–Whitney U-test.

²Year 2002, first year of the follow-up.

^**Significant at 0.010 level.

Table III. Characteristics of the psychosocial factors of the study patients.

	Temporary FAs^1		Persistent FAs^1
	n	%^2	n	%^2	p-value^3
Psychiatric illnesses
At least one diagnosis previously	26	44	14	54	0.405
Depression^4
At least mild^5	19	32	11	44	0.302
Patient satisfaction^6
Low^7	8	14	11	44	<0.010**
15D^8
Low^9	17	29	11	42	0.223
Social support network^10
Thin^11	14	25	8	32	0.513

Notes: ¹Frequent attenders.

²Percentage of the class in this FA group.

³Bivariate analyses, categorical variables: Pearson's chi-squared test.

⁴Beck Depression Inventory.

⁵Cut-off point ≥ 10.

⁶This item was measured by 13 item (grades from 4 to 10) scale.

⁷Cut-off point of the classified mean of all 13 questions <7.

⁸Generic, comprehensive (15-dimensional), self-administered instrument for measuring health-related quality of life among adults. 15D score on a 0–1 scale. Average in this study population is 0.84. Age- and sex-matched average with this study population in the general (Finnish) population is 0.92.

⁹Cut-off point here for the low health-related quality of life is <0.8, which is the lowest third of the responses.

¹⁰Brief Social Support Questionnaire.

¹¹Less than two persons who provide with help or support.

Table IV. Classified results of the questionnaires cross-tabulated with the outcome.

	Temporary FAs^1		Persistent FAs^1
	n	%^2	n	%^2	p-value^3
Sense of Cohererence^4
Low^5	16	27	7	27	0.985
Alexithymia^6
Remarkable^7	10	17	7	28	0.265
Difficulty describing emotions^8	12	21	10	40	0.067
Difficulty identifying emotions^9	20	34	13	52	0.135
Externally oriented thinking^10	20	34	10	40	0.631
Fear of death^11
Remarkable^12	12	20	12	46	<0.050*
Somatisation^13
Remarkable^14	18	31	7	27	0.738
Hypochondria^15
Remarkable^16	26	44	16	64	0.095

Notes: Results are given as number of respondents and percentage of those in the frequent attender (FA) class who provided a positive answer.

¹Frequent attenders.

²Percentage of the class in this FA group.

³Bivariate analyses, categorical variables: Pearson's chi-squared test.

⁴13 item Sense of Coherence scale.

⁵Cut-off point <58.

⁶20-item Toronto Alexithymia Scale.

⁷Cut-off point >60.

⁸Toronto Alexithymia Scale subscale 1.

⁹Toronto Alexithymia Scale subscale 2.

¹⁰Toronto Alexithymia Scale subscale 3.

¹¹This item was measured by a four-item Likert-scale questionnaire. Questions were: I am afraid of death. I am afraid that my close relative will die. I worry about the sorrow caused by my death to my relatives. I become distressed if I think that I won't exist any more one day.

¹²Cut-off point ≥14.

¹³Symptom Check List; somatisation subscale.

¹⁴Cut-off point ≥8.

¹⁵Whitely Index for measuring hypochondriac worries and beliefs.

¹⁶Cut-off point >6.

Table V. Protective and risk factors explaining the persistent frequent attendance (FA).

Factors for FA persistence	Predicted class						Evidence strength
	Temporary FA						Inversed (if temporary FA)
Protective	%	95% CrI (%)		PO	95% CrI		%	95% CrI (%)		PO	95% CrI
Male gender	80*	70.6	87.4	4.0*	2.4	6.9	36*	24.3	48.3	0.6*	0.3	0.9
Health centre visits < 12	78*	68.0	85.5	3.5*	2.1	5.9	74*	62.5	84.3	2.8*	1.7	5.4
Body Mass Index <25	83*	74.6	90.2	4.9*	2.9	9.2	42	30.4	55.1	0.7	0.4	1.2
No fear of death	77*	66.7	84.5	3.3*	2.0	5.5	79*	68.1	88.4	3.8*	2.1	7.6
No alcohol abstinence	77*	67.6	85.3	3.3*	2.1	5.8	83*	72.0	90.9	4.9*	2.6	10.0
No irritable bowel syndrome	72*	61.6	80.5	2.6*	1.6	4.1	93*	84.7	97.7	13.3*	5.5	41.9
Moderate patient satisfaction	81*	71.3	88.1	4.3*	2.5	7.4	67*	55.2	78.6	2.0*	1.2	3.7

Table

	Persistent FA						Inversed (If persistent FA)
Risk	%	95% CrI (%)		PO	95% CrI		%	95% CrI (%)		PO	95% CrI
Female gender	36*	26.8	47.0	0.6*	0.4	0.9	80*	62.9	92.3	4.0*	1.7	11.9
Health centre visits ≥12	48	37.8	58.8	0.9	0.6	1.4	54	35.1	71.8	1.2	0.5	2.5
Body Mass Index ≥30	55	44.7	65.5	1.2	0.8	1.9	42	25.0	61.3	0.7	0.3	1.6
Fear of death	50	40.1	61.0	1.0	0.7	1.6	46	28.2	64.9	0.9	0.4	1.8
Alcohol abstinence	53	42.9	64.0	1.1	0.8	1.8	44	25.0	61.3	0.8	0.3	1.6
Irritable bowel syndrome	55	44.7	65.5	1.2	0.8	1.9	20*	7.7	37.1	0.3*	0.1	0.6
Low patient satisfaction	58	47.1	68.0	1.4	0.9	2.1	44	25.0	61.3	0.8	0.3	1.6

Notes: Presented together with posterior odds (PO) and their 95% credibility intervals (Crl). CrI: 95% credibility intervals based on Jeffreys interval.

^* Credible difference. According to CrIs, all protective factors are credible presenting good-to-moderate POs. However, only female gender is a credible risk factor (PO 0.6; 95% CrI 0.4–0.9). Thus, model gives good guidance for avoiding persistent frequent attendance and is a feasible proactive prevention model, but it does not predict the risk very well. Most notably, this is due to modest sample size in the frequent FA group, because the evidence strength for risk factors is only credible for female gender (PO 4.0; 95% CrI 1.7–11.9) and irritable bowel syndrome (PO 0.3; 95% CrI 0.1–0.6). The evidence strength for protective factors is credible for all variables except for BMI.