{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T03:48:59Z","timestamp":1762660139514},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T00:00:00Z","timestamp":1636675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This cross-sectional study was conducted in six community health service centers in Shanghai, China, from August to December 2018 based on stratified sampling. On the basis of our preliminary study, FAs were defined as those attending at least four consultations in a month. A self-administered questionnaire was used to collect the clinicodemographic data of the participants. Social support, pain severity, depression, and anxiety were evaluated using the Social Support Revalued Scale, six-point Behavioral Rating Scale, Patient Health Questionnaire\u20139, and Generalized Anxiety Disorder Scale, respectively.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>This study included 619 patients aged &gt;\u200960\u2009years. Among these patients, 155 (25%) were FAs to a community health service center, 366 (59.1%) had 1 or 2 chronic diseases, 179 (28.9%) had \u22653 chronic diseases, 313 (50.4%) opted for a family doctor service, and 537 (86.8%) chose a community health service center for the first consultation. The following were identified as independent risk factors for frequent attendance: widowed status, unmarried status, the presence of &gt;\u20093 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication, the use of both traditional Chinese and Western medicine services, and depression.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>This study summarizes the characteristics of older FAs to community health service centers in China and identifies 10 risk factors significantly associated with frequent attendance.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12875-021-01575-w","type":"journal-article","created":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T18:02:36Z","timestamp":1636740156000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk factors for the frequent attendance of older patients at community health service centers in China: a cross-sectional study based on stratified sampling"],"prefix":"10.1186","volume":"22","author":[{"given":"Nana","family":"Li","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Shou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,12]]},"reference":[{"key":"1575_CR1","doi-asserted-by":"publisher","first-page":"595674","DOI":"10.3389\/fmed.2021.595674","volume":"8","author":"A Hajek","year":"2021","unstructured":"Hajek A, Kretzler B, K\u00f6nig HH. Determinants of Frequent Attendance in Primary Care. A Systematic Review of Longitudinal Studies. Front Med (Lausanne). 2021;8:595674.","journal-title":"Front Med (Lausanne)"},{"key":"1575_CR2","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1186\/s12875-016-0412-4","volume":"17","author":"JT J\u00f8rgensen","year":"2016","unstructured":"J\u00f8rgensen JT, Andersen JS, Tj\u00f8nneland A, Andersen ZJ. Determinants of frequent attendance in Danish general practice: a cohort-based cross-sectional study. BMC Fam Pract. 2016;17:9.","journal-title":"BMC Fam Pract"},{"key":"1575_CR3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1016\/j.ijnurstu.2018.06.003","volume":"86","author":"K Kivel\u00e4","year":"2018","unstructured":"Kivel\u00e4 K, Elo S, K\u00e4\u00e4ri\u00e4inen M. Frequent attenders in primary health care: a concept analysis. Int J Nurs Stud. 2018;86:115\u201324.","journal-title":"Int J Nurs Stud"},{"issue":"3","key":"1575_CR4","doi-asserted-by":"publisher","first-page":"255","DOI":"10.17294\/2330-0698.1747","volume":"7","author":"DM Shukla","year":"2020","unstructured":"Shukla DM, Faber EB, Sick B. Defining and characterizing frequent attenders: systematic literature review and recommendations. J Patient Cent Res Rev. 2020;7(3):255\u201364.","journal-title":"J Patient Cent Res Rev"},{"key":"1575_CR5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1186\/1471-2296-14-138","volume":"14","author":"FT Smits","year":"2013","unstructured":"Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Smeets HM, Bosmans JE, et al. Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data. BMC Fam Pract. 2013;14:138.","journal-title":"BMC Fam Pract"},{"issue":"1","key":"1575_CR6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1177\/1403494818777436","volume":"47","author":"TTM Reho","year":"2019","unstructured":"Reho TTM, Atkins SA, Talola N, Viljamaa M, Sumanen MPT, Uitti J. Frequent attenders in occupational health primary care: a cross-sectional study. Scand J Public Health. 2019;47(1):28\u201336.","journal-title":"Scand J Public Health"},{"issue":"1","key":"1575_CR7","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1186\/s12889-018-6217-8","volume":"18","author":"T Reho","year":"2018","unstructured":"Reho T, Atkins S, Talola N, Sumanen M, Viljamaa M, Uitti J. Comparing occasional and persistent frequent attenders in occupational health primary care - a longitudinal study. BMC Public Health. 2018;18(1):1291.","journal-title":"BMC Public Health"},{"issue":"6","key":"1575_CR8","first-page":"624","volume":"32","author":"S Patel","year":"2015","unstructured":"Patel S, Kai J, Atha C, Avery A, Guo B, James M, et al. Clinical characteristics of persistent frequent attenders in primary care: case-control study. Fam Pract. 2015;32(6):624\u201330.","journal-title":"Fam Pract"},{"issue":"10","key":"1575_CR9","doi-asserted-by":"publisher","first-page":"e008975","DOI":"10.1136\/bmjopen-2015-008975","volume":"5","author":"C Pymont","year":"2015","unstructured":"Pymont C, Butterworth P. Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare. BMJ Open. 2015;5(10):e008975.","journal-title":"BMJ Open"},{"issue":"1","key":"1575_CR10","doi-asserted-by":"publisher","first-page":"24","DOI":"10.5534\/wjmh.180103","volume":"38","author":"B Park","year":"2020","unstructured":"Park B, Lee YJ. Upcoming aging society and Men's health: focus on clinical implications of exercise and lifestyle modification. World J Mens Health. 2020;38(1):24\u201331.","journal-title":"World J Mens Health"},{"issue":"1","key":"1575_CR11","doi-asserted-by":"publisher","first-page":"20","DOI":"10.5847\/wjem.j.1920-8642.2018.01.003","volume":"9","author":"Y Shen","year":"2018","unstructured":"Shen Y, Tay YC, Teo EWK, Liu N, Lam SW, Ong MEH. Association between the elderly frequent attender to the emergency department and 30-day mortality: a retrospective study over 10 years. World J Emerg Med. 2018;9(1):20\u20135.","journal-title":"World J Emerg Med"},{"issue":"1","key":"1575_CR12","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s12875-017-0700-7","volume":"18","author":"FD Welzel","year":"2017","unstructured":"Welzel FD, Stein J, Hajek A, K\u00f6nig HH, Riedel-Heller SG. Frequent attenders in late life in primary care: a systematic review of European studies. BMC Fam Pract. 2017;18(1):104.","journal-title":"BMC Fam Pract"},{"issue":"1","key":"1575_CR13","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1186\/s12913-018-3487-x","volume":"18","author":"A Hajek","year":"2018","unstructured":"Hajek A, K\u00f6nig HH. Which factors lead to frequent attendance in the outpatient sector among individuals in the second half of life? Evidence from a population-based longitudinal study in Germany. BMC Health Serv Res. 2018;18(1):673.","journal-title":"BMC Health Serv Res"},{"issue":"10204","key":"1575_CR14","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/S0140-6736(19)32136-1","volume":"394","author":"W Yip","year":"2019","unstructured":"Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, et al. Ten years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394(10204):1192\u2013204.","journal-title":"Lancet"},{"issue":"10239","key":"1575_CR15","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1016\/S0140-6736(20)30122-7","volume":"395","author":"X Li","year":"2020","unstructured":"Li X, Krumholz HM, Yip W, Cheng KK, De Maeseneer J, Meng Q, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802\u201312.","journal-title":"Lancet"},{"key":"1575_CR16","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1186\/1471-2296-9-21","volume":"9","author":"FT Smits","year":"2008","unstructured":"Smits FT, Mohrs JJ, Beem EE, Bindels PJ, van Weert HC. Defining frequent attendance in general practice. BMC Fam Pract. 2008;9:21.","journal-title":"BMC Fam Pract"},{"key":"1575_CR17","doi-asserted-by":"publisher","first-page":"162","DOI":"10.1186\/1471-2296-14-162","volume":"14","author":"J Hauswaldt","year":"2013","unstructured":"Hauswaldt J, Himmel W, Hummers-Pradier E. The inter-contact interval: a new measure to define frequent attenders in primary care. BMC Fam Pract. 2013;14:162.","journal-title":"BMC Fam Pract"},{"issue":"3","key":"1575_CR18","first-page":"232","volume":"18","author":"N Li","year":"2019","unstructured":"Li N, Shou J, Li Y, Han X. Characteristics of elderly frequent clinic attenders in a Shanghai community health service center. Chin J Gen Practition. 2019;18(3):232\u20135.","journal-title":"Chin J Gen Practition"},{"issue":"7","key":"1575_CR19","doi-asserted-by":"publisher","first-page":"8","DOI":"10.25270\/owm.2018.7.817","volume":"64","author":"H Xian","year":"2018","unstructured":"Xian H, Zhang Y, Yang Y, Zhang X, Wang X. A descriptive, cross-sectional study among Chinese patients to identify factors that affect psychosocial adjustment to an Enterostomy. Ostomy Wound Manage. 2018;64(7):8\u201317.","journal-title":"Ostomy Wound Manage"},{"issue":"3\u20134","key":"1575_CR20","first-page":"35","volume":"10","author":"S Afshinmajd","year":"2011","unstructured":"Afshinmajd S, Davati A, Akbari F. The effects of body mass index on the treatment of the patients with migraine headaches. Iran J Neurol. 2011;10(3\u20134):35\u20138.","journal-title":"Iran J Neurol"},{"issue":"1","key":"1575_CR21","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.genhosppsych.2014.09.009","volume":"37","author":"L Manea","year":"2015","unstructured":"Manea L, Gilbody S, McMillan D. A diagnostic meta-analysis of the patient health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry. 2015;37(1):67\u201375.","journal-title":"Gen Hosp Psychiatry"},{"key":"1575_CR22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.yebeh.2014.04.005","volume":"35","author":"JG Seo","year":"2014","unstructured":"Seo JG, Cho YW, Lee SJ, Lee JJ, Kim JE, Moon HJ, et al. Validation of the generalized anxiety disorder-7 in people with epilepsy: a MEPSY study. Epilepsy Behav. 2014;35:59\u201363.","journal-title":"Epilepsy Behav"},{"issue":"2","key":"1575_CR23","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.puhe.2004.03.007","volume":"119","author":"P Vedsted","year":"2005","unstructured":"Vedsted P, Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health. 2005;119(2):118\u201337.","journal-title":"Public Health"},{"issue":"1","key":"1575_CR24","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1186\/s12889-018-5230-2","volume":"18","author":"AA Pasgaard","year":"2018","unstructured":"Pasgaard AA, M\u00e6hlisen MH, Overgaard C, Ejlskov L, Torp-Pedersen C, B\u00f8ggild H. Social capital and frequent attenders in general practice: a register-based cohort study. BMC Public Health. 2018;18(1):310.","journal-title":"BMC Public Health"},{"issue":"12","key":"1575_CR25","doi-asserted-by":"publisher","first-page":"2629","DOI":"10.1007\/s40520-020-01495-2","volume":"32","author":"E Buczak-Stec","year":"2020","unstructured":"Buczak-Stec E, Hajek A, van den Bussche H, Eisele M, Wiese B, Mamone S, et al. Frequent attendance in primary care in the oldest old: evidence from the AgeCoDe-AgeQualiDe study. Aging Clin Exp Res. 2020;32(12):2629\u201338.","journal-title":"Aging Clin Exp Res"},{"issue":"7","key":"1575_CR26","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1016\/j.pec.2016.02.009","volume":"99","author":"A Dinkel","year":"2016","unstructured":"Dinkel A, Schneider A, Schmutzer G, Br\u00e4hler E, H\u00e4user W. Family physician-patient relationship and frequent attendance of primary and specialist health care: results from a German population-based cohort study. Patient Educ Couns. 2016;99(7):1213\u20139.","journal-title":"Patient Educ Couns"},{"key":"1575_CR27","doi-asserted-by":"crossref","unstructured":"Hadwiger M, K\u00f6nig HH, Hajek A. Determinants of Frequent Attendance of Outpatient Physicians: A Longitudinal Analysis Using the German Socio-Economic Panel (GSOEP). Int J Environ Res Public Health. 2019;16(9):1553.","DOI":"10.3390\/ijerph16091553"},{"issue":"6","key":"1575_CR28","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1016\/j.jpsychores.2015.10.007","volume":"79","author":"C Pymont","year":"2015","unstructured":"Pymont C, Butterworth P. Changing circumstances drive changing attendance: a longitudinal cohort study of time varying predictors of frequent attendance in primary health care. J Psychosom Res. 2015;79(6):498\u2013505.","journal-title":"J Psychosom Res"},{"key":"1575_CR29","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/1471-2296-13-39","volume":"13","author":"R Morriss","year":"2012","unstructured":"Morriss R, Kai J, Atha C, Avery A, Bayes S, Franklin M, et al. Persistent frequent attenders in primary care: costs, reasons for attendance, organisation of care and potential for cognitive behavioural therapeutic intervention. BMC Fam Pract. 2012;13:39.","journal-title":"BMC Fam Pract"},{"key":"1575_CR30","doi-asserted-by":"publisher","first-page":"96","DOI":"10.3390\/healthcare8020096","volume":"8","author":"S-C Kang","year":"2020","unstructured":"Kang S-C, Lin C-C, Tsai C-C, Lu Y-H, Huang C-F, Chen Y-C. Characteristics of frequent attenders compared with non-frequent attenders in primary care: study of remote communities in Taiwan. Healthcare. 2020;8:96.","journal-title":"Healthcare"},{"issue":"2","key":"1575_CR31","doi-asserted-by":"publisher","first-page":"71","DOI":"10.3109\/13814788.2016.1161751","volume":"22","author":"D Haroun","year":"2016","unstructured":"Haroun D, Smits F, van Etten-Jamaludin F, Schene A, van Weert H, Ter Riet G. The effects of interventions on quality of life, morbidity and consultation frequency in frequent attenders in primary care: a systematic review. Eur J Gen Pract. 2016;22(2):71\u201382.","journal-title":"Eur J Gen Pract"},{"issue":"9","key":"1575_CR32","doi-asserted-by":"publisher","first-page":"e028295","DOI":"10.1136\/bmjopen-2018-028295","volume":"9","author":"F Jadhakhan","year":"2019","unstructured":"Jadhakhan F, Lindner OC, Blakemore A, Guthrie E. Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis. BMJ Open. 2019;9(9):e028295.","journal-title":"BMJ Open"},{"issue":"2","key":"1575_CR33","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.genhosppsych.2005.10.007","volume":"28","author":"M Menchetti","year":"2006","unstructured":"Menchetti M, Cevenini N, De Ronchi D, Quartesan R, Berardi D. Depression and frequent attendance in elderly primary care patients. Gen Hosp Psychiatry. 2006;28(2):119\u201324.","journal-title":"Gen Hosp Psychiatry"},{"issue":"9","key":"1575_CR34","doi-asserted-by":"publisher","first-page":"e80","DOI":"10.1002\/hsr2.80","volume":"1","author":"Y Str\u00f6mbom","year":"2018","unstructured":"Str\u00f6mbom Y, Karlsson J, Fredrikson M, Melin L, Magnusson P. Cognitive behavioral therapy for frequent attenders in primary care. Health Sci Rep. 2018;1(9):e80.","journal-title":"Health Sci Rep"}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01575-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12875-021-01575-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-021-01575-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,12]],"date-time":"2021-11-12T18:03:10Z","timestamp":1636740190000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-021-01575-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,12]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1575"],"URL":"https:\/\/doi.org\/10.1186\/s12875-021-01575-w","relation":{},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,12]]},"assertion":[{"value":"22 February 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 November 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The research was approved by the ethics committee of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China<b>.<\/b> All patients signed the informed consent. This study was conducted in accordance with the tenets of the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"221"}}