Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

Abstract

Objectives Frequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater morbidity and adverse socioeconomic circumstances. Our study aimed to describe the sociodemographic profile, clinical presentation, and healthcare utilisation patterns of adolescent FAs at polyclinics in Singapore and to determine the factors associated with adolescent FA.Design Retrospective electronic database analysis.Setting A cluster of eight state-subsidised public primary care clinics (polyclinics).Participants Multiethnic Asian adolescents aged 10–19 years who attended the eight polyclinics in 2021. FAs were defined as the top 10% of clinic attendees in terms of annual visit frequency.Results In 2021, 34 645 adolescents attended the polyclinics for 75 902 visits. Visits were for acute (52.8%), chronic (26.2%) and preventive (27.7%) care. FAs attended ≥4 visits annually, accounting for 14.4% of adolescents and 42.5% of total attendances. Compared with non-FAs, FAs were older (OR 1.16, 95% CI 1.15 to 1.18, p<0.001), more likely to be of non-Chinese ethnicity, and have received financial aid (OR 1.68, 95% CI 1.58 to 1.79, p<0.001). FAs had more underlying psychiatric conditions (p<0.001) but presented less frequently with psychiatric complaints (p<0.001). FAs were more likely to be referred to emergency departments (p<0.001) and psychiatry clinics (p<0.001), to be prescribed potentially addictive medication (p<0.001), and had longer annual medical leave certification (7 days (IQR=4–11) vs 3 days (IQR=1–3, p<0.001)).Conclusion Adolescent FA was associated with increasing age, non-Chinese ethnicity and lower socioeconomic status. Despite having more underlying psychiatric conditions, adolescent FAs presented more frequently with acute physical complaints instead of psychiatric symptoms. Adolescent FAs had longer annual medical leave certification and greater healthcare utilisation indicated by more clinic visits and referrals to emergency departments and psychiatry clinics.