In our study, it seems to be a tendency for female patients around 55 years of age, probably overweight and with special chronic diseases to become persistent FAs more often than other one-year FAs. Five-year frequent attenders had many chronic diseases, of which depression, epilepsy, heart failure, asthma, chronic obstructive pulmonary disease and recurrent back pain / lumbago were significantly more common in our persistent FA group than in the one-year FA control group. Significant proportion, 47 %, of our five-year persistent frequent attenders made appointment to GP for recurrent back pain/lumbago. This has not been reported in previous studies. Whether this relates to variable diagnostic criteria or to other circumstances, e.g., differences in the culture of recording symptoms related to low back pain, is speculative. Koskela 2008 in his dissertation did not find that chronic diseases predict persistent attendance unlike we, but the cohort in Koskela`s study consisted of patients younger than 64 years and the cohort was homogenous by age and chronic diseases . Smits et al (2009) reported, in agreement with our findings, that chronic psychiatric problems and chronic somatic diseases were an important contributor to permanent frequent attendance . Smits et al. (2014) found that panic disorders, other anxiety, negative life events, illness behavior and lack of mastery were associated with persistent frequent attendance . We could not confirm this finding in this study.
Smits et all ( 2009) and Pymont and Butterworth (2015) reported that persistent FAs used analgesic medication more often than one-year FAs, but the indication for pain medication was not specified [6, 11]. We found out that pFAs had more back pain, but we did not have information about prescriptions of our study group. Reho et al (2018) found out that musculoskeletal disorders were associated to working aged persistent frequent attenders . This is in agreement with our findings that the five-year pFAs were 51.7 years old and significant proportion of them had recurrent back pain or lumbago.
We found that the majority of pFAs were women (75.5%). In the study of Pymont and Butterworth (2015), the proportion of female persistent FAs was 75.8% , which fits in with our finding. Also Jörgensen et al. reported that women are more likely to be FAs over five years .
In the healthcare centers of the study city, the number of persistent FAs approached zero over the six-year period. Carney et al in 2001 found that most frequent attenders resort to the normal consulting pattern within five years , which fits with our findings. Smits et al (2009) also found that frequent attending is usually a self-limiting condition .
We found out that GPs had registered only 1.3 diagnoses of chronic diseases per five-year FAs to patient record entries. One of the authors (AKS) scrutinized all patient record entries and she found from the same patient entries on average 21.2 different diagnoses per five-year FAs. It seems that GPs didn`t recognize their own persistent frequent attenders well enough or they didn`t record FA patients` diagnoses to the patient record well enough and so it is speculative if this patient group got treatment which they were seeking again and again year after year.
The strength of this study is that we obtained data directly from the electronic patient records used by each of the GPs involved in the healthcare centers of the study city. The FA-cohort is substantial (4 392 patients). The chosen persistent FA study group was quite small (N=49) but the profile of them based on analysis of no less than 20 571 patient record entries. Albeit, the modest size of the study group constitutes a weakness of this study because some diagnoses had been recorded so seldom that meaningful statistical analyses were not always feasible. Information about health behavior habits of FAs has been registered poorly and this did not allow us to compare our findings to other studies.