Primary care consultations: are they all by the doctor?

Abstract

Objectives

To find out the proportion of primary healthcare consultations that could be attended by another professional other than the doctor.

Design

multicentre cross-sectional study.

Location

Primary healthcare, west-gipuzkoa region, with 17 health centres taking part.

Participants

Reasons for consultation dealt with by 38 doctors over 5 days.

Main measurements

Age, sex, frequency, category, initiative, reason for consultation and ideal level of healthcare.

Results

A total of 4,377 patients who generated 5,592 consultations were included. The average frequency was 10 visits/year. The large majority (93.1%) of consultations took place in the centre, 5.4% by telephone and 1.5% were home visits.

A total of 74.4% of the consultations were requested, 17.2% arranged by the doctor, 6.4% arranged by protocol, 2% at the request of other professionals, and 8% were urgent.

The reasons were; 71.5% (95% CI: 69.8-73.2) were medical clinical, 7.2% (6.2-8.2) minor symptoms, 18.4% (17.1-19.5) bureaucratic, and 2.9% (2.3-3.3) for information.

The consultations for medical reasons accounted for 80.5% (79.3-81.7) and 19.5% (18.3-20.7) were for non-medical reasons. Non-medical reasons made up 29.3% of the telephone consultations, 20.2% of the consultations in the centre, and 2.4% of the home visits, as well as 16.7% of the urgent consultations.

The ideal level of healthcare was considered to be doctor 80.7%, 13.2% nursing and 2.8% administrative. In the consultations for minor symptoms, nursing was considered the ideal level in 65.3% of cases.

Conclusions

One out of every 5 consultations could be dealt with by a professional other than the doctor, which in 5hours of consultations would allow 1 hour to be gained which could be used for other activities.