Authors | Country | Sample/age | Year | Patients per week (consultation length in minutes) | Contacts per year | Contacted physi-cians per year | Referrals to specialists per year | Definition of contact In- and exclusions Definition high use | |
---|---|---|---|---|---|---|---|---|---|
1 | Seven | General practice patients age ≥ 18 (mean age: 40–48) | 1997–1998 | GE: 309 (7.6) BE: 149 (15.0) SWI: 126 (15.6) ES: 183 (7.8) NL: 189 (10.2) UK: 205 (9.4) | Not examined | Not examined | 17.9 % (ES) −5.6 % (GE) of consultations | Encounters in practice premises, plus twice the number of home visits, plus half the number of telephone contacts; high use not examined | |
2 | Koch et al. [40] | Eleven (seven reported here) | Survey among PCP | 2009 | GE: 242 (9.1) FR: 110 (22.2) IT: 171 (10.3) SWE: 53 (28.8) NL: 123 (15.0) UK: 130 (13.3) USA: 96 (22.5) | Not examined | Not examined | Not examined | “Visits”; no further specification of contact type; high use not examined |
3 | Starfield et al. [7] | USA | 5 % Medicare sample age ≥65 according to 3 comorbidity degrees | 1999 | Not examined | Lowest comorbidity degree: 3.9 (2.1 PCP, 1.8 NPCP) highest comorbidity degree: 15.6 (6.6 PCP, 9.0 NPCP) | Not examined | Not examined | PCP: geriatricians included; contacts in physician practice + ED + OPD were counted highest comorbidity degree: persons with ≥ 10 chronic conditions |
4 | Starfield et al. [42] | USA | patients aged ≥65 in Medicare managed care | 2001 | Not examined | 11.6 (2.7 PCP, 8.9 NPCP) | 4.8 (0.8 PCP, 4.0 NPCP) | Not examined | GPs and internists included (same year hospitalized patients excluded); high use not examined |
5 | National Center for Health Statistics [44] | USA | National sample aged ≥65 | 2000 | 18.1 min | 7 (all physicians in practice; 6.1; OPD + ED: 0,9) | Not examined | Not examined | High use not examined |
6 | NAMCS [62] | USA | Survey of national sample of physicians | 2008–2009 | Not examined | 3.4 (1.9 PCP, 1.5 NPCP) patient age ≥ 65: 7,4 | Not examined | Referral rate. 10.7 of visits | Visits to practices and CHCs only; telephone contacts and (nursing) home visits excluded; high use not examined |
7 | Barnett et al. [63] | USA | National sample aged ≥65 | 2009 | Not examined | 3.7 | Not examined | All physicians: 8.6 % (PCP: 9.9 %, NPCP: 7.3 %) OPD: 16.6 % | Contacts in physician practices + OPD were counted; institutionalized patients excluded; high use not examined |
8 | NIVEL [37] | Netherlands | National sample aged ≥ 15 years with ≥ 1 chronic condition | 2008 | Not examined | 2008: 9,7 (PCP: 4,6; NPCP 5,1) | Not examined | 80 % referred | GPs + GP-assistants; no further specification of contact type; high use not examined |
9 | Cardol et al. [64] | Netherlands | Primary care patients ≥65 | 2000–2002 | PCP: 10,2 min | Age ≥65: PCP 16.4 (age 65–74: PCP 11.6) | Not examined | Not examined | Visits + home visits + telephone + paperwork by GP + GP-assistants (telephone contacts account for 11 %); high use not examined |
10 | van Oostrom [38] | Netherlands | Primary care patients, age ≥65 | 2006–2008 | Not examined | ≥2 chronic conditions + age 65–74: PCP 19.6 + age ≥ 75: PCP 24.0 | Not examined | mm: 36 % referred with 0,5 referrals/year | Consultations, telephone contacts (9.8 % for mm) and home visits; high use not examined |
11 | van den Berg [65] | Netherlands | Primary care patients; all ages | 1987 & 2001 | 2001: 9.8 min | Not examined | Not examined | Not examined | Practice consultations only; high use not examined |
12 | Nie et al. [39] | Canada (Ontario) | Insured population aged ≥ 65 | 2005–2006 | Not examined | 10.3 (=6.2 PCP, 4.1 NPCP + ED); hu = 43.6 (PCP 20.7, NPCP 22.9) | Not examined | Not examined | “Office visits”; no further specification of contact type; hu-cutoff: ≥ 26 contacts (≥15 PCP visits, ≥ 11 NPCP visits, ≥ 5 ED visits) = 5,5 % of study population |
13 | Demers [26] | Canada (Quebec) | Insured general population | 1991 | Not examined | 5.5 (PCP 3.6, NPCP 1.9) | 3 (PCP 2, NPCP 1) | Not examined | “Encounters” not further specified; hu-cutoff: contacts with > 20 physicians (=0.06 % of patients) |
14 | Reid et al. [66] | Canada (Brit. Columbia) | General population ≥ 18 years | 1996–1997 | Not examined | hu: 50.3, nhu: 9.0 | hu: 9, nhu: 2.7 | Not examined | “Encounters” not further specified; ED-visits excluded; hu-cutoff: most costly 5 % of users of fee-reimbursed services |
15 | Broemeling et al. [67] | Canada (Brit. Columbia) | Insured general population ≥ 18 years | 2000–2001 | Not examined | ≥1chronic condition: 11.5 (8,5 PCP + 3.0 NPCP) maximum hu: 28.1 (19.3 PCP + 8.8 NPCP) | Not examined | Not examined | “Visits”; no further specification of contact type; hu-cutoff: 5 % of total population, 11.6 % of persons with chronic conditions |
16 | Britt et al. [68] | Australia | Survey among GPs | 2009–2010 | 15,3 min | Not examined | 8.4 % of encounters with GP | Not examined | Consultations, home visits, nursing home visits included; high use not examined |
17 | Busato et al. [69] | Switzerland | Primary care sample age ≥ 40 | 2004 | Not examined | 3.0 (PCP only) | Not examined | Not examined | Specialist consultations & ED visits excluded; high use not examined |
18 | Bähler et al. [34] | Switzerland | Helsana Group insurants age ≥ 65 | 2013 | Not examined | All physicians: 13.1 (mm: 15.7, nmm: 4.4) PCPs: 6.1 (mm: 7.4, nmm: 1.9) NPCP: 4.3 (mm: 5.1, nmm: 1.8) | All physicians: 2.9 (mm: 3.3, nmm: 1.5) PCP: 1.1 (mm: 1.2, nmm: 0.6) NPCP: 1.8 (mm: 2.1, nmm: 0.9) | Not examined | Consultations, home visits, OPD contacts, phone contacts (all physicians: 5.7 %) included; nursing home visits excluded mm : ≥ 2 chronic conditions; high use not examined |
19 | OBSAN [35] | Switzerland | Population sample age ≥ 65 | 2012 | Not examined | 8.0 (PCP: 4.2, NPCP: 3.8) | Not examined | Not examined | Visits (“Besuch einer Praxis”) included; no further specification of contact type; high use not examined |
20 | Neal et al. [36] | United Kingdom | Sample from 4 primary care practice | 1991–1995 | Not examined | 10.7 | Not examined | Not examined | Visits and outpatient contacts; no further specification of contact type; high use not examined |
21 | Salisbury et al. [70] | United Kingdom | Primary care sample age ≥ 18 | 2005–2008 | Not examined | mm: 9.4, nmm: 3.8 | Not examined | Not examined | |
22 | Bellón et al. [71] | Spain (Andalousia) | 208 hu age ≥ 15 in one health center | 2001 | Not examined | 21.8–22.5 | Not examined | Not examined | ED/OPD-contacts excluded; no further specification of contact type hu cut-off: 14.7 for females, 13.8 for men |
23 | Luciano al. [72] | Spain (Catalonia) | GP sample age ≥ 65 with ≥ 3 chronic conditions | 2005–2006 | Not examined | 23,1 (age ≥ 65: 22.4) | Not examined | Not examined | ED/OPD-contacts excluded; no further specification of contact type hu:10 % highest users = consultation frequency > 12 |
24 | Bergh et al. [73] | Sweden | 1 health center sample age ≥ 65 | 1997–1998 | Not examined | GP-contacts: 1.2–1.4 (hu: 5, nhu: 1) | Not examined | Not examined | hu: 10 % highest users |
25 | Moth et al. [74] | Denmark | Primary care sample age ≥ 40 | 2009 | (>2/3 of contacts <15 min | Not examined | Not examined | Not examined | Contacts = face-to-face, phone, email and home visits (telephone + mail-contacts 39.1 %); high use not examined |
26 | Drees [75] | France | PCP-population | 2002 | (PCP 15 min, NPCP 15–30 min) | Not examined | Not examined | Not examined | Practice consultations and home visits, no ED/OPD contacts; high use not examined |
27 | Health Insurance Authority [76] | Austria | “Care intensive” patients (cip); no age limit | 2006–2007 | Not examined | All physicians: cip: 39.6, ncip: 7 (PCP: cip: 30, ncip: 5; NPCP: cip: 9.6, ncip: 2) | Not examined | Not examined | No specification of contact type cip: numbers of contacts & services + hospital days (=7 % of population) |