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      Characteristics of Frequent Attenders Compared with Non-Frequent Attenders in Primary Care: Study of Remote Communities in Taiwan

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          Abstract

          Frequent attenders (FAs) have an impact on the medical resources and the quality of care. In Taiwan, the characteristics of FAs remain unclear in primary care. Outpatient data were screened from a central clinic within six surrounding fishing villages in northeastern Taiwan in 2017. FAs were defined as those who made >18 visits in one year, and those who made ≤18 visits were defined as non-frequent attenders (NFAs). Data of FAs and NFAs were collected and compared. The major diagnoses were reported using International Classifications of Diseases, Tenth Edition (ICD-10) codes. A total of 1586 subjects and 9077 visits were enrolled, including 119 FAs and 1467 NFAs. FAs had a more advanced age compared to NFAs. Both FAs and NFAs had more visits in summer. FAs had consumed high prescriptions and related costs. FAs also had higher therapeutic and first visit costs than NFAs. Comparing with age- sex-matched NFAs, FAs were positively associated with musculoskeletal diseases (M00-M99), hematological diseases (D50-D89), endocrine diseases (E00-E90), and mental disorders (F00-F99). Large-scale local datasets and suitable definitions of FAs for Taiwanese subjects are needed.

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          Characteristics of frequent users of emergency departments.

          We identify frequent users of the emergency department (ED) and determine the characteristics of these patients. Using the 2000 to 2001 population-based, nationally representative Community Tracking Study Household Survey, we determined the number of adults (aged 18 and older) making 1 to 7 or more ED visits and the number of visits for which they accounted. Based on the distribution of visits, we established a definition for frequent user of 4 or more visits. Multivariate analysis assessed the likelihood that individuals with specific characteristics used the ED more frequently. An estimated 45.2 million adults had 1 or more ED visits. Overall, 92% of adult users made 3 or fewer visits, accounting for 72% of all adult ED visits; the 8% of users with 4 or more visits were responsible for 28% of adult ED visits. Most frequent users had health insurance (84%) and a usual source of care (81%). Characteristics independently associated with frequent use included poor physical health (odds ratio [OR] 2.54; 95% confidence interval [CI] 2.08 to 3.10), poor mental health (OR 1.70; 95% CI 1.42 to 2.02), greater than or equal to 5 outpatient visits annually (OR 3.02; 95% CI 1.94 to 4.71), and family income below the poverty threshold (OR 2.36; 95% CI 1.70 to 3.28). Uninsured individuals were more likely to report frequent use, but this result was only marginally significant (OR 2.38; 95% CI 0.99 to 5.74). Individuals who lacked a usual source of care were actually less likely to be frequent users. The majority of adults who use the ED frequently have insurance and a usual source of care but are more likely than less frequent users to be in poor health and require medical attention. Additional support systems and better access to alternative sites of care would have the benefit of improving the health of these individuals and may help to reduce ED use.
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            An overview of the healthcare system in Taiwan

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              Frequent attendance in primary care: comparison and implications of different definitions.

              The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors. To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition. One-phase cross-sectional study. Seventy-seven primary care centres in Catalonia, Spain. A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used. The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively. The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).
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                Author and article information

                Journal
                Healthcare (Basel)
                Healthcare (Basel)
                healthcare
                Healthcare
                MDPI
                2227-9032
                13 April 2020
                June 2020
                : 8
                : 2
                : 96
                Affiliations
                [1 ]Division of Family Medicine, National Yang-Ming University Hospital, Yilan 260, Taiwan; insly58@ 123456hotmail.com (Y.-H.L.); duz555@ 123456yahoo.com.tw (C.-F.H.)
                [2 ]Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan; yuchn.chen@ 123456gmail.com
                [3 ]Division of Occupational Medicine, Taipei Veterans Hospital, Taipei 112, Taiwan; doc1554j@ 123456gmail.com
                [4 ]Department of Internal Medicine, National Yang-Ming University Hospital, Yilan 260, Taiwan; jjthsai@ 123456yahoo.com.tw
                [5 ]Department of Family Medicine, Taipei Veterans Hospital, Taipei 112, Taiwan
                Author notes
                [* ]Correspondence: sckang@ 123456ym.edu.tw ; Tel.: +886-3-9325192; Fax: +886-3-9315521
                Author information
                https://orcid.org/0000-0002-4124-1949
                Article
                healthcare-08-00096
                10.3390/healthcare8020096
                7349067
                32295021
                6cb702d4-e98a-4b60-9fab-07c32d264707
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 28 February 2020
                : 11 April 2020
                Categories
                Article

                community medicine,family medicine,frequent attendance,icd-10 code,primary care,taiwan

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