BACKGROUND In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. METHODS The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany's national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services. RESULTS The sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases. CONCLUSIONS We observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

中文翻译：

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德国医疗保健系统的频繁就诊者：初级保健服务高利用率的决定因素。德国成人横断面健康访谈和检查调查 (DEGS) 的结果。

背景技术在德国，患者咨询全科医生的频率越来越高，这给医疗保健系统带来了沉重的负担。本研究旨在确定与德国医疗保健系统中频繁就诊初级保健相关的因素。方法 德国成人健康访谈和检查调查 (DEGS) 是德国国家健康监测的一部分，包括 18-79 岁德国人口的大量代表性样本。我们将过去 12 个月内与全科医生接触次数最多的 10% 的参与者定义为初级保健服务的常客。使用具有平均边际效应的二元逻辑回归模型来确定频繁使用初级保健服务的潜在决定因素。结果 样本由 7956 名参与者组成。社会经济地位低下、生活压力事件、与医疗护理需求相关的因素（如医学诊断的慢性病）和主观健康状况对频繁使用初级保健有显着影响。在完整模型中，非传染性疾病的数量和主观健康状况对频繁使用初级保健的影响最大。我们发现了一种交互效应，表明主观健康状况和频繁出勤之间的关联随着非传染性疾病数量的增加而消失。结论 我们观察到频繁的初级保健就诊与医疗护理需求以及主观健康相关因素之间存在很强的关联。这些发现表明，更好的护理协调可能是管理卫生服务利用并避免冗余检查和不协调的临床路径的首选方法。需要进一步的研究来阐明导致初级保健服务高利用率的调节和中介因素。