Surgeries in health centres often have to deal with far more appointments than necessary. According to a study carried out in the University of Granada by the researcher Antonina Rodríguez Bayón from the Department of Forensic Medicine, Toxicology and Psychiatry, half of the appointments dealt with by family doctors in a year are set aside for 15 % of the patients in the primary health care service.
Her study represents the first random control test that shows that overall control of patients who ‘overuse’ the primary health care service could reduce these alarming figures. Moreover, this control could reduce the enormous expense that this situation causes to public funds, since these patients spend 64 % of the budget devoted to health care.
According to the researcher Rodríguez Bayón “there is no objective criterion accepted all over the world to determine these ‘overusers’ of the primary health care service; in any case, most speak of patients who have appointments too often”. This study was carried out in the health centre Centro de Salud ‘San José’ in Linares (Jaén, Andalusia), where there are 16,500 registered inhabitants who are looked after by 9 family doctors, 2 paediatricians and 8 nurses.
The study carried out in the UGR was focused on those patients belonging to the reference population who were over 14 years of age and fulfilled the definition criteria of ‘overusers’ (those patients who visit the doctor twice as much as other people of the same age range and gender did over the previous year).
Biopsychosocial intervention
Therefore, Antonina Rodríguez stresses that her study “suggests reducing use by trying to identify and act upon certain problems of patients included in this study (problems of a biomedical, mental health, social support or merely organizational nature) with positive results. This study by the UGR proves that in order to reduce this excessive use of the primary health care service it is necessary to act from a biopsychosocial perspective. According to Antonina Rodriguez Bayón, “We must include the doctor and the doctor-patient relation as part of this complex problem; looking after the patient individually against the less reasonable option of considering the ‘overuse’ problem in a homogeneous way for every patient”.
This intervention, named 7H+E (H:hypothesis, E:equipo [‘team‘ in Spanish]), consists of two parts: action by three family doctors chosen as the ‘intervention group’ who attended a workshop of 15 hours devoted to the care of ‘overusers’, and intervention with patients who filled in a form designed for those who go to the primary health care service too often. The aim of this initiative was to analyze all the clinical and organizational information.
After conducting this analysis, a series of hypotheses appeared. These hypotheses lead to a reflection about the possible causes of overuse in the primary health care service which may help to design a specific plan of action later. The study, which was funded by the University of Granada, suggests seven hypotheses as possible causes of excessive use of the health centre: clinical, psychological, social, family, cultural, administrative and doctor-patient relation reasons, “and the most common thing is that some of these reasons appear at the same time”.
In conclusion, Antonina Rodríguez Bayón stresses that the 7H+E intervention caused an important reduction in the use of doctor’s appointments by ‘overusers’ and there was a drop of 40 % in the use of the primary health care service”.
The results, six months later
In addition, this reduction was proved in a clear, unequivocal way twelve months after the intervention, “although a significant reduction in ‘overusers’ appeared six months later”.
The researcher points out that this is “the first control test of a global and successful intervention on overusers of the primary health care service, although she considers that it is necessary “to carry out new tests with larger and more heterogeneous samples of doctors and patients, that would provide new evidence and increase the external validity of the results” .
From the results of this study, Rodríguez Bayón considers that “there is a new way to find possible solutions for the problem of overuse of the primary health care service and that could make an important contribution to the reduction of costs for the health service; in addition, it may contribute to increasing the health of patients and the satisfaction of these patients and their doctors”.
Reference:
Prof. Antonina Rodríguez Bayón. Department of Forensic Medicine, Toxicology and Psychiatry in the University of Granada. Telephone Number: 953 743 056. Mobile phone number: 667 997 026. Email address: arobayon@saludalia.com
