| Popis: |
OBJECTIVES: To describe care activity as a function of the nature of the consultation (predictability) and the needs of the patients (clinical content). To analyse the relationship of these with the characteristics of the consultation, of the patient and of the centre DESIGN: Multi-centre, descriptive, observational study. SETTING: Primary care. Area 17 of the Health Department of the Community of Valencia, with 197 316 inhabitants and 12 health centres PARTICIPANTS: Information gathering in real time by outside observer. Stratified randomised sampling of 2051 patients who gave rise to 3008 reasons for medical consultation MAIN MEASUREMENTS: Predictable consultations (Pr): their content can be foreseen (check-ups, picking up results). Unpredictable consultations (Unp): we cannot predict their content (acute problems may arise unexpectedly). These include urgent consultations. Administrative consultations (Ad): bureaucratic tasks (prescriptions, repeat sick-notes, sick certificates). Care consultations (Car): prevention, diagnosis and treatment of the illness, or monitoring of it. Variables here are the patient, the doctor and the consultation RESULTS: 60% (1809) (95% CI, 58.69%–61.59%) of the reasons were Pr and 40% (1199) (95% CI, 36.6%–43.12%) were Unp. 50% (1509) (95% CI, 47.26%–53.06%) were Car, and 50% Ad (1499) (95% CI, 46.34%–53.39%). 40% (1189) (95% CI, 37.78%–41.28%) were Pr-Ad and only 21% (620) (95% CI, 19.16%–22.06%) were Pr-Car. 30% (889) (95% CI, 27.92%–31.18%) were Unp–Car, and 10% (310) (95% CI, 9.22%– 11.4%) Unp-Ad. 48% of patients with a single reason for attendance were Pr-Ad (577) (95% CI, 44.25%–52.05). Teaching centres and computerised ones had less Pr-Ad load. Pr-Ad consultations increased with patient´s age and with case-load. CONCLUSIONS: Almost 40% of the reasons for consultation are Pr-Ad, which implies inadequate clinical management. An intervention is needed to free up medical time consumed by bureaucratic questions, so that this time can be devoted fully to health-care tasks |
