[Clinical management of consultations: clinical content and predictability (SyN-PC Study)]

Aten Primaria. 2004 Feb 15;33(2):69-77. doi: 10.1016/s0212-6567(04)79354-3.
[Article in Spanish]

Abstract

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 197316 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.

Objetivo: Describir la actividad asistencial en función de la naturaleza de la consulta (previsibilidad) y las necesidades de los pacientes (contenido clínico). Analizar la relación con las características de la consulta, del paciente y del centro

Diseño: Estudio observacional descriptivo multicéntrico

Emplazamiento: Atención primaria. Área 17 de la Conselleria de Sanidad de la Comunidad Valenciana. Población de 197.316 habitantes. Trece centros de salud

Participantes: Recogida de información en tiempo real por un observador externo. Muestreo aleatorio estratificado de 2.051 pacientes que ocasionaron 3.008 motivos de consulta médica

Mediciones principales: Consulta previsible (Pr): se puede prever su contenido (revisiones, recogida de resultados). Consulta imprevisible (Ip): no podemos prever su contenido (problemas agudos) y surgen inesperadamente. Engloba la consulta urgente. Consulta administrativa (Ad): tareas burocráticas (recetas, partes de confirmación, certificados). Consulta asistencial (As): prevenir, diagnosticar y tratar la enfermedad, o realizar seguimiento de ésta. Variables del paciente, el centro y la consulta

Resultados: El 60% (n = 1.809; IC del 95%, 58,69–61,59%) de los motivos fueron previsibles y el 40% (n = 1.199; IC del 95%, 36,6–43,12%), imprevisibles. El 50% (n = 1.509; IC del 95%, 47,26–53,06%) fueron consultas asistenciales y el 50% (n = 1.499; IC del 95%, 46,34–53,39%), administrativas. El 40% (n = 1.189; IC del 95%, 37,78–41,28%) fueron previsibles-administrativas y tan sólo un 21% (n = 620; IC del 95%, 19,16– 22,06%) resultaron de carácter previsible-asistencial. El 30% (n = 889; IC del 95%, 27,92–31,18%) fueron de carácter imprevisible–asistencial y el 10% (n = 310; IC del 95%, 9,22– 11,4%), imprevisibles-administrativas. En los pacientes con un único motivo, el 48% (n = 577; IC del 95%, 44,25–52,05%) fueron consultas previsibles-administrativas. Los centros docentes o informatizados tienen menos carga de consultas previsibles-administrativas. Éstas aumentan con la edad del paciente y con la presión asistencial

Conclusiones: Casi un 40% de los motivos de consulta son previsibles-administrativos, lo que implica una gestión clínica inadecuada. Sería necesaria una intervención que permitiera liberar tiempo médico consumido en asuntos burocráticos para dedicarlo a la tarea asistencial propiamente dicha

Publication types

  • Comparative Study
  • English Abstract
  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Efficiency, Organizational
  • Female
  • Humans
  • Male
  • Middle Aged
  • Office Management
  • Office Visits / statistics & numerical data*
  • Primary Health Care*
  • Referral and Consultation / statistics & numerical data*