General practitioners’ consultation counts and associated factors in Swiss primary care – A retrospective observational study
Autoři:
Yael Rachamin aff001; Rahel Meier aff001; Thomas Grischott aff001; Thomas Rosemann aff001; Stefan Markun aff001
Působiště autorů:
Institute of Primary Care, University and University Hospital Zurich, Zurich, Switzerland
aff001
Vyšlo v časopise:
PLoS ONE 14(12)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0227280
Souhrn
Background
Research on individual general practitioner (GP) workload, e.g. in terms of consultation counts, is scarce. Accurate measures are desirable because GPs’ consultation counts might be related to their work satisfaction and arguably, there is a limit to the number of consultations a GP can hold per day without jeopardizing quality of care. Moreover, understanding the association of consultation counts with GP characteristics is crucial given current trends in general practice, such as the increasing proportion of female GPs, part-time work and group practices.
Aim
The aim of this study was to describe GPs’ consultation counts and efficiency and to assess associations with GP and practice variables.
Methods
In this retrospective observational study we used routine data in electronic medical records obtained from 245 Swiss GPs in 2018. We described GPs’ daily consultation counts as well as their efficiencies (i.e. total consultation counts adjusted for part-time work) and used hierarchical linear models to find associations of the GPs’ total consultation counts in 2018 with GP- and practice-level variables.
Results
The median daily consultation count was 28 over all GPs and 33 for full-time working GPs. Total consultation counts increased non-linearly with part-time status, with high part-time working GPs (60%-90% of full-time) being equally or more efficient than full-time workers. Excluding part-time status in the regression resulted in higher consultation counts for male GPs working in single practices and with older patients, whereas part-time adjusted consultation counts were unaffected by GP gender and practice type.
Conclusion
Female gender, part-time work in the range of 60%-90% of full-time, and working in group practices do not decrease GP efficiency. However, the challenge of recruiting sufficient numbers of GPs remains.
Klíčová slova:
Age groups – Electronic medical records – Employment – General practitioners – Observational studies – Patients – Primary care – Quality of care
Zdroje
1. Cohidon C, Cornuz J, Senn N. Primary care in Switzerland: evolution of physicians’ profile and activities in twenty years (1993–2012). BMC Family Practice. 2015;16(1). doi: 10.1186/s12875-015-0321-y 26292762
2. Boerma WG, van den Brink-Muinen A. Gender-related differences in the organization and provision of services among general practitioners in Europe: a signal to health care planners. Medical care. 2000;38(10):993–1002. Epub 2000/10/06. doi: 10.1097/00005650-200010000-00003 11021672.
3. Merlo P. Work Force Hausarztmedizin in der Schweiz 2015: University of Basel; 2015.
4. Merçay C. Médecins de premier recours–Situation en Suisse, tendances récentes et comparaison internationale. Neuchâtel: Observatoire suisse de la santé (Obsan), 2015.
5. Hippisley-Cox J, Vinogradova Y. Trends in Consultation Rates in General Practice 1995/1996 to 2008/2009: Analysis of the QResearch® database. QResearch®, University of Nottingham and The Health and Social Care Information Centre, 2009.
6. Hobbs FDR, Bankhead C, Mukhtar T, Stevens S, Perera-Salazar R, Holt T, et al. Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007–14. The Lancet. 2016;387(10035):2323–30. doi: 10.1016/S0140-6736(16)00620-6 27059888
7. Baird B, Charles A, Honeyman M, Maguire D, Das P. Understanding pressures in general practice. London: The King’s Fund; 2016.
8. Cassell A, Edwards D, Harshfield A, Rhodes K, Brimicombe J, Payne R, et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract. 2018;68(669):e245–e51. Epub 2018/03/14. doi: 10.3399/bjgp18X695465 29530918; PubMed Central PMCID: PMC5863678.
9. van Oostrom SH, Picavet HSJ, de Bruin SR, Stirbu I, Korevaar JC, Schellevis FG, et al. Multimorbidity of chronic diseases and health care utilization in general practice. BMC Family Practice. 2014;15(1):61. doi: 10.1186/1471-2296-15-61 24708798
10. Harrison C, Henderson J, Miller G, Britt H. Predicting patient use of general practice services in Australia: models developed using national cross-sectional survey data. BMC Family Practice. 2019;20(1):28. Epub 2019/02/16. doi: 10.1186/s12875-019-0914-y 30764778; PubMed Central PMCID: PMC6376650.
11. Mukhtar TK, Bankhead C, Stevens S, Perera R, Holt TA, Salisbury C, et al. Factors associated with consultation rates in general practice in England, 2013–2014: a cross-sectional study. Br J Gen Pract. 2018;68(670):e370–e7. Epub 2018/04/25. doi: 10.3399/bjgp18X695981 29686130; PubMed Central PMCID: PMC5916084.
12. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. Epub 2012/05/15. doi: 10.1016/S0140-6736(12)60240-2 22579043.
13. Pedersen KM, Andersen JS, Søndergaard J. General Practice and Primary Health Care in Denmark. The Journal of the American Board of Family Medicine. 2012;25(Suppl 1):S34–S8. doi: 10.3122/jabfm.2012.02.110216 %J The Journal of the American Board of Family Medicine. 22403249
14. Kraft E, Hersperger M. Daten und Demographie–informativ und spannend. Schweizerische Ärztezeitung. 2009.
15. Lenoir AL, Richelle L, Ketterer F, Fraipont B, Cayn M, Duchesnes C, et al. Young general practitioners' professional activities: a survey in the French-speaking part of Belgium. Acta clinica Belgica. 2017;72(6):399–404. Epub 2017/03/21. doi: 10.1080/17843286.2017.1302624 28317474.
16. Hedden L, Barer ML, McGrail K, Law M, Bourgeault IL. In British Columbia, The Supply Of Primary Care Physicians Grew, But Their Rate Of Clinical Activity Declined. Health Aff (Millwood). 2017;36(11):1904–11. Epub 2017/11/16. doi: 10.1377/hlthaff.2017.0014 29137511.
17. Hostettler S, Kraft E. FMH-Ärztestatistik 2018. Schweizerische Ärztezeitung. 2019;100(12):411–6.
18. Djalali S, Meier T, Hasler S, Rosemann T, Tandjung R. Primary care in Switzerland gains strength. Fam Pract. 2015;32(3):348–53. doi: 10.1093/fampra/cmv005 25714346
19. Federal Act on Research involving Human Beings 2014 [21.08.2019]. Available from: https://www.admin.ch/opc/en/classified-compilation/20061313/index.html.
20. Raumgliederungen: Federal Statistical Office; [cited 2019 23.07.2019]. Available from: https://www.bfs.admin.ch/bfs/de/home/grundlagen/raumgliederungen.html.
21. R Core Team. R: A language and environment for statistical computing. In: R Foundation for Statistical Computing, editor. Vienna, Austria2018.
22. Tandjung R, Hanhart A, Bartschi F, Keller R, Steinhauer A, Rosemann T, et al. Referral rates in Swiss primary care with a special emphasis on reasons for encounter. Swiss Med Wkly. 2015;145:w14244. doi: 10.4414/smw.2015.14244 26709751
23. Stevens S, Bankhead C, Mukhtar T, Perera-Salazar R, Holt TA, Salisbury C, et al. Patient-level and practice-level factors associated with consultation duration: a cross-sectional analysis of over one million consultations in English primary care. 2017;7(11):e018261. doi: 10.1136/bmjopen-2017-018261 29150473
24. Deveugele M, Derese A, van den Brink-Muinen A, Bensing J, De Maeseneer J. Consultation length in general practice: cross sectional study in six European countries. Bmj. 2002;325(7362):472. Epub 2002/08/31. doi: 10.1136/bmj.325.7362.472 12202329; PubMed Central PMCID: PMC119444.
25. Fairchild DG, McLoughlin KS, Gharib S, Horsky J, Portnow M, Richter J, et al. Productivity, quality, and patient satisfaction: comparison of part-time and full-time primary care physicians. Journal of general internal medicine. 2001;16(10):663–7. Epub 2001/10/27. doi: 10.1111/j.1525-1497.2001.01111.x 11679033; PubMed Central PMCID: PMC1495282.
26. Bühren A, Eckert J. „Feminisierung “der Ärzteschaft: Überschätzter Effekt. Dtsch Arztebl. 2011;108:A-1168/B–968/C-968.
27. Hedden L, Barer ML, Cardiff K, McGrail KM, Law MR, Bourgeault IL. The implications of the feminization of the primary care physician workforce on service supply: a systematic review. Human resources for health. 2014;12:32. Epub 2014/06/06. doi: 10.1186/1478-4491-12-32 24898264; PubMed Central PMCID: PMC4057816.
28. Pericin I, Mansfield G, Larkin J, Collins C. Future career intentions of recent GP graduates in Ireland: a trend analysis study. BJGP open. 2018;2(1):bjgpopen18X101409. Epub 2018/12/20. doi: 10.3399/bjgpopen18X101409 30564707; PubMed Central PMCID: PMC6181082.
29. van Hassel D, van der Velden L, de Bakker D, Batenburg RJHRfH. Age-related differences in working hours among male and female GPs: an SMS-based time use study. 2017;15(1):84. doi: 10.1186/s12960-017-0258-4
30. McKinstry B, Colthart I, Elliott K, Hunter C. The feminization of the medical work force, implications for Scottish primary care: a survey of Scottish general practitioners. BMC Health Serv Res. 2006;6:56. Epub 2006/05/12. doi: 10.1186/1472-6963-6-56 16686957; PubMed Central PMCID: PMC1475570.
31. Gisler LB, Bachofner M, Moser-Bucher CN, Scherz N, Streit S. From practice employee to (co-)owner: young GPs predict their future careers: a cross-sectional survey. BMC Family Practice. 2017;18(1):12. Epub 2017/02/06. doi: 10.1186/s12875-017-0591-7 28148245; PubMed Central PMCID: PMC5289023.
32. van Hassel D, van der Velden L, de Bakker D, Batenburg R. Age-related differences in working hours among male and female GPs: an SMS-based time use study. Human resources for health. 2017;15(1):84. doi: 10.1186/s12960-017-0258-4 29258573
33. Steinhaeuser J, Joos S, Szecsenyi J, Miksch A. A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey. BMC Family Practice. 2011;12:112. Epub 2011/10/13. doi: 10.1186/1471-2296-12-112 21988900; PubMed Central PMCID: PMC3209467.
34. Canbek A. Es gibt keinen Ärztemangel aufgrund «Feminisierung der Medizin». Schweiz Ärzteztg. 2019;100(10):353–6 Epub 06.03.2019. https://doi.org/10.4414/saez.2019.17570.
35. Federal Statistical Office. (Projektübersicht) Gesundheitsversorgungsstatistik–Ambulante Statistiken im Projekt MARS. 2017.
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PLOS One
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