[Overattendance at primary care: a study of psychosocial factors]

Abstract

Objective: To determine the effect of various psychological and social factors--family function, social support, psychological malaise and social class--on frequency of attendance.

Design: Study with cases and controls.

Setting: Health Districts Girona-3 and La Bisbal.

Participants: Criteria for inclusion: being older than 14, being on a list as a user, and having been seen at least once during the study period. The person over-attending is defined as someone attending 7 or more times in a year. The normal attender attends less than 7 times. The sample was 441 patients (209 cases and 232 controls).

Measurements and main results: The Smilkestein family Apgar and the DUKE-UNC social support questionnaires, and the Goldberg anxiety and depression scale, were administered. Social class was defined according to the job of the head of the family. Statistical analysis was undertaken in two steps: firstly, bivariate analysis; and second, multivariate. The social support and age variables were related to frequency of attendance: they explained 8.1% of it (through multiple regression). Depression increased by between 1.21 and 2.58 the risk of over-attending and explained 10.53% of the variability of over-attendance, in line with the logistical regression analysis.

Conclusions: The psychological and social variables studied fail to explain most of the variability. We should demystify the importance of psychological and social factors in the use of health resources.