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[Frequent attenders in general practice. Who are they and how are they managed?].

INTRODUCTION
Frequent attenders (FAs) account for a large number of the consultations and a large part of the workload in general practice. We need knowledge about the way general practitioners (GPs) characterise this group of patients and about their proposals for clinical management. This study aims to describe the types of FAs seen in general practice and their proposed management.


MATERIAL AND METHODS
Six randomly sampled CME groups in Aarhus County were offered a meeting about frequent attendance in general practice, and five groups with a total of 89 GPs accepted. FAs were defined as the top 10% patients attending during 12 months. One week before the meeting, each GP received an introduction to the meeting and the names of two FAs listed with the practice. Through exploratory focus group interviews, supplemented by a small group-based CME method, the GPs were asked to discuss FA characteristics and to make proposals for clinical management. A total of 59 (66.3%) participated in the five meetings.


RESULTS
Eight FA types consistently emerged from the discussions, and the GPs suggested 12 possible ways of managing them. These aspects involved communicative, organisational (planning), and biopsychosocial skills.


DISCUSSION
The variety of types shows that FAs are not solely the so-called difficult patients, but a diverse group demanding many different aspects of care. Hence, the GPs are in a key position demanding specific skills to manage these patients.