9.4. Conclusions

About five percent of the patients in a health centre were frequent attenders, and they accounted for about one fourth of the daily workload of GPs. Frequent attenders were sick people both subjectively and objectively. They had more chronic diseases than controls, but they also rated their health and quality of life as poorer than controls. Frequent attenders’ demand for care was connected mainly with somatic symptoms, although they had more psyhological distress and mental disorders than controls. Male frequent attenders had more mental disorders, psychological distress, alexithymia, somatization and hypochondriacal beliefs than female frequent attenders. The risk of frequent attendance was higher in the older family life cycle phases than in the younger family life cycle phases. A chronic somatic disease and hypochondriacal beliefs were risk factors for frequent attendance. Simultaneous occurrence of hypochondriacal beliefs and somatization increased the risk. Hypochondriacal beliefs and poor perceived health were the risk factors for frequent attenders’ somatization.

The study implicates the need to consider frequent attenders’ own bodily concerns expressed as hypochondriacal beliefs. Furthermore, the study implicates the need to develop appropriate and comprehensive clinical guidelines for the care of frequent attenders and the need to integrate the biomedical, psychological and social dimensions when implementing these guidelines in primary health care.