Determinants of frequent use of open consultations: a study on patient demographics, chronic conditions, and utilization patterns in primary care

Abstract

In Portugal, open consultations (OCs) in primary health care address urgent medical needs, constituting 40–50% of family doctor activity. Frequent attenders (FAs), often presenting nonacute issues, significantly contribute to health care overuse. This study aimed to identify factors associated with frequent OC use in a primary health care unit during 2022. A retrospective cross-sectional analysis was conducted on 4,269 adult patients, with frequent attendance defined as four or more consultations (≥90th percentile). Sociodemographic and clinical factors, including age, sex, employment, chronic conditions, and multimorbidity, were examined using binomial logistic regression. FAs (n = 570, 13.4%) accounted for 36.2% of all consultations. Significant associated variables included female sex (OR = 1.417), economic insufficiency (OR = 1.323), and multimorbidity (OR = 1.678). Conditions such as musculoskeletal (OR = 2.146), psychological (OR = 2.040), and neurological (OR = 1.550) disorders were strongly linked to frequent attendance. While FAs represent a minority of patients, their disproportionate use of OC services underscores the need for targeted interventions, such as individualized care plans and resource optimization, to balance demand and availability. These findings highlight critical areas for policy and practice to enhance health care efficiency.