Family Practice Advance Access originally published online on February 27, 2008
Family Practice 2008 25(2):92-97; doi:10.1093/fampra/cmn007
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Infrequent attendance in general practice after a major disaster: a problem? A longitudinal study using medical records and self-reported distress and functioning
a Netherlands Institute for Health Services Research, 3500 BN Utrecht
b Institute for Psychotrauma, van Heemstraweg West 5, 5301 PA Zaltbommel, The Netherlands
Correspondence to Gé A Donker, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands; Email: g.donker{at}nivel.nl
Received 5 July 2007; Revised 25 December 2007; Accepted 18 January 2008.
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Abstract |
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Objective. To assess the characteristics and implications for care of infrequent attendance in general practice in the aftermath of disaster.
Methods. A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires administered 3 weeks and 18 months post-disaster. The disaster (explosion of a firework depot in Enschede, The Netherlands) caused 23 deaths, about 1000 people injured and 1200 people who had to relocate. Sample included survivors (N = 922) who participated in two surveys and whose data could be linked to EMRs of GPs. A comparison of reported morbidity in ‘infrequent’ (a maximum of three times in men and four times in women in the first two post-disaster years) and ‘more frequent attenders’ (frequency determined post-disaster) in general practice examined in relation to health status (measured by diagnoses in EMRs, symptom checklist and quality of life instrument) was the main outcome measure.
Results. Infrequent attenders reported approximately three times as few contacts as more frequent attenders in the pre-disaster year (P < 0.001). Multivariate logistic regression analyses revealed that infrequent attenders were likely to be younger, less depressed, have better subjective health and physical functioning and exhibited more hostile behaviour (measured by questionnaire). Infrequent attenders were less often personally bereaved by the disaster, but more often relocated, and had a lower prevalence of psychological problems pre- and post-disaster although this increased stronger (by 10-fold).
Conclusions. Both groups showed the same type of psychological problems post-disaster, but differed in the frequency of contacting the GP.
Keywords. Attendance, disaster, general practice, mental health, symptom checklist.
Donker GA, van der Velden PG, Kerssens JJ and Yzermans CJ. Infrequent attendance in general practice after a major disaster: a problem? A longitudinal study using medical records and self-reported distress and functioning. Family Practice 2008; 25: 92–97.