A consultation-level intervention to improve care of frequently attending patients: a cluster randomised controlled feasibility trial

Background
Frequent attenders (FAs) receive considerable NHS resources without necessarily gaining benefit and may even be harmed.

Aim
Assess the feasibility of a consultation-level intervention to improve care and address service use of FAs.

Design and setting
Cluster randomised controlled feasibility trial with mixed-methods process evaluation in six practices in England.

Method
All practices screened their top 3% attenders over the previous 12 months for eligibility. Following randomisation, intervention patients were matched with named General Practitioners (GPs) trained to use the BATHE technique during consultations. Telephone consultations were encouraged. Feasibility outcomes assessed were recruitment, retention, data collection and completeness, implementation fidelity and acceptability.

Results
599/1328 (45.1%) FAs were eligible. Four practices were randomised to the intervention (n=451) and two to usual care (n=148). 96 (23.7%) patients were recruited to complete questionnaires. Retention and completeness of data were good, 76% of those agreeing to complete questionnaires did so at the 12 month assessment point. 35 GPs were trained and delivered BATHE one or more times to 50.1% patients (n=577 consultations). There were minimal increases in continuity and telephone consultations. Patients were positive about the intervention but noticed little change in their care. Despite valuing BATHE, low adherence to training was indicated and GPs used it less than anticipated.

Conclusion
It was feasible to identify FAs and collect trial data. GPs were keen to engage and there was evidence that the BATHE technique was taken into practice. Optimising training is likely to improve fidelity. The intervention was low cost and low risk.