Psychosocial determinants for frequent primary health care utilisation in patients with heart failure

OBJECTIVE: Psychosocial symptoms are common in patients with heart failure. Little research, however, has been done to determine which psychosocial factors influence primary care patients' consultation frequency in the case of heart failure.

METHODS: We recruited 310 primary care patients with heart failure by analysing electronic patient records. At baseline, psychological distress (anxiety and depression; HADS), disease coping (FKV), negative affectivity and social inhibition (DS-14), disease-specific quality of life (MLHFQ) and social support (F-SozU) were measured by validated questionnaires. Severity of heart failure (according to NYHA-classification and Goldman's Specific Activity Scale) and sociodemographic characteristics were documented by self-report instruments. Nine month later, patients were contacted by telephone in order to assess GP consultation frequency. Logistic regression was done to determine whether these psychological, medical and sociodemographic factors were associated with primary care utilisation.

RESULTS: On average, patients consulted their general practitioner (GP) 8.2 times during nine months. Female subjects and patients with higher levels of perceived heart failure severity, physical problems and anxiety or depression as well as those living alone visited their GP significantly more often. In multivariate analysis, frequent attendance in general practices was predicted by physical problems and living alone. These factors explained 11.6% of the variance of frequent attendance in general practices.

CONCLUSION: Psychosocial factors of help-seeking behaviour in heart failure patients focus on mental and physical discomfort and a lonely home situation. These factors might need to be compensated by GP consultation. GPs should address the rearrangement of physical, mental, and social resources to strengthen self-reliance of patients with heart failure.