Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel

• Published in: The European journal of general practice Vol. 27; no. 1; pp. 294 - 302
• Main Authors: Hammerman, Oded, Halperin, Daniel, Tsalihin, Daniel, Greenberg, Dan, Kushnir, Talma, Ezra, Yacov
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.01.2021; Taylor & Francis Ltd; Taylor & Francis Group
• Subjects: Cost of Illness; Demographics; Electronic health records; Frequent attenders; Health services utilization; healthcare utilisation; Humans; Israel; Medical records; Medically Unexplained Symptoms; Original; Primary care; Primary Health Care; primary healthcare; Retrospective Studies; somatisation; Israel; medically unexplained symptoms; primary healthcare; Frequent attenders; somatisation; healthcare utilisation
• ISSN: 1381-4788; 1751-1402
• DOI: 10.1080/13814788.2021.1985997

Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat. This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns. For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be'er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA. Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, p<.001) and costlier (ILS27693 vs. ILS9075, p<.001) than FA/MUS. Average costs for FA/MUS were over four times higher than Non-FA (ILS9075 vs. ILS2035, p<.001). The largest disparities between FA/OI and FA/MUS were in hospitalisations (ILS6998 vs. ILS2033) and surgical procedures (ILS8143 vs. ILS3175). Regarding laboratory tests, differences were smaller between groups of FA but significantly different between FA and Non-FA. FA/MUS are more costly than Non-FA and exhibit unique healthcare utilisation and costs patterns. FA/OI had more severe illnesses necessitating hospitalisations and surgical interventions, while FA/MUS had more investigations and tests, attempting to find an explanation for their symptoms.