2.3. Summary of the literature

Since Backett’s report of a minority of patients who are responsible for most of the workload of GPs (Backett et al. 1954), major progress has been made in the research on frequent attenders. Because of the difficulties and differences in the definition of frequent attender, the observed prevalence of the problem in primary health care varies notably, also depending on the populations studied. The portrait of these individuals at the top end of the consultation spectrum has been outlined, and the complex social, psychological and illness-related factors underlying frequent attendance have been clarified. Some previous studies can be criticized for problems in definition or study design, such as small sample size or the lack of a control group. Many of the studies must be interpreted with caution because of the differences in the health care systems of different countries. The studies of frequent attendance often focus on details, and certain uncritical body-mind dualism can be found in the previous literature.

Various theoretical models have been established for explaining and conceptualizing the use of health care services. However, the studies concerning frequent attendance are seldom based on any specific theoretical framework. Some efforts to categorize frequent attenders have been made, but the experiences of such categorization in everyday practice are scant (Kokko 1988, Karlsson 1996). Altogether, there is a general agreement that we need a comprehensive approach to frequent attenders, taking into account both biomedical, social and psychological elements of the patient, his/her life, and the family (McArdle et al. 1974, Westhead 1985, Larivaara 1987, Báez et al. 1998).