Table 3

Predominant health problems from the qualitative analysis of “revolving door” patients with typical examples of patient profiles
Predominant health code “patient script” % of patients Patient profile examples
Substance misuse and psychiatric illness 18% Female patient in her 50s, 300 admissions. Shifting psychiatry diagnoses; depression, anxiety, with personality disorder, self harm and alcohol dependency. Drug misuse treatment episodes for opiate dependency, and additional physical health problems, long term neurological condition and epilepsy. Missed 3/23 outpatient appointments. Removed 5 times from GP lists.
Drug dependency problems 15% Male patient in his 40s, 20 admissions. Opiate dependent with drug misuse treatment episodes, admissions with recurrent cutaneous abscesses, chronic hepatitis C infection and occasionally asthma. Missed 11/14 outpatient appointments. Removed 22 times from GP lists.
Psychiatric illness and physical illness 10% Male patient in his 40s, 80 admissions. Sporadic diagnosis of conduct disorder, evidence of self harm, and was alcohol dependent. Many admissions due to disability after major trauma. Missed 1/3 outpatient appointments. Removed 4 times from GP lists.
Substance misuse and physical illness 6% Male patient in his 50s, 9 admissions. History of malignant disease and was alcohol dependent with physical complications of alcohol dependency. Had no outpatient appointments. Removed 10 times from GP lists.
Alcohol related harm 7% Female patient in her 60s, 60 admissions. Alcohol dependent and who had alcohol related brain injury, seizures and alcoholic liver disease. Missed 2/13 outpatient appointments. Removed 4 times from GP lists.
Psychiatric illness 6% Male patient in his 30s, 65 admissions. Several admissions with diagnosis of paranoid schizophrenia, various personality disorder diagnoses, admissions following medicines and opiate overdoses, drug dependence and alcohol dependence and some physical consequences of drug use starting to become apparent. Missed 12/24 outpatient appointments. Removed 8 times from GP lists.
Injuries 5% Male patient in his 30s, 10 admissions. Contusions of the thorax, lower back and pelvis, pneumothorax, scalp wound injury, open wounds of abdomen lower back and pelvis, drug dependency, evidence of self harm and asthma. Missed 16/38 outpatient appointments. Removed 4 times from GP lists.
Physical illness 4% Female patient in 20s, 5 admissions. She had nausea and vomiting, biochemical and coagulation problems. The underlying diagnosis was unclear. Missed 5/6 outpatient appointments including psychiatry appointments. Removed 5 times from GP lists.
No clinical code possible 29% Male patient in his 30s, 10 admissions. Open wound to forearm and no other recorded information on other admissions. 5 outpatient appointments in oral surgery, orthopaedics and ENT with 1/5 missed appointments. Removed 5 times from GP lists.

Williamson et al.

Williamson et al. BMC Family Practice 2012 13:95   doi:10.1186/1471-2296-13-95

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