Factors associated with frequent attendance in a Bedouin primary care setting

BACKGROUND: Frequent attendance affects delivery and cost of effective health services, quality of care, and burden on primary care physicians. The aim of this study was to investigate factors associated with frequent attendance, as well as types of health care utilization, in a Bedouin primary care setting. METHODS: A case-control study was conducted on adult frequent attenders (FAs) and controls in a primary care clinic serving a Bedouin population in southern Israel. Social, demographic and clinical data were manually extracted by reviewing the clinic's computerized medical records. The associations between these factors and frequent attendance were analyzed. RESULTS: The study included 118 cases and 121 controls (59% female, mean age: 39.6 +/- 14.9 years). FAs were more likely to use consultation referrals, prescriptions, investigative studies, laboratory tests, and emergency department referrals than controls and were prescribed more sick-leave days than controls. Controlling for age and gender, FAs were significantly more likely to have a chronic disease (OR = 4.46, 95% CI: 1.86-10.71), use chronic medications (OR = 3.31, 95% CI: 1.57-6.99), have a musculoskeletal disease (OR = 2.08, 95% CI: 1.02-7.49) and be of African Bedouin ethnicity (OR = 2.77, 95% CI: 1.02-7.49). CONCLUSIONS: FAs in a Bedouin community pose a special challenge for the primary care clinic, as they are more likely to be chronically ill, and utilize referrals to various services and consultations more frequently than controls.