Table 4 Studies on physicians’ work load in ambulatory medical care, length of consultations, number of contacts and contacted physicians per year, referral frequency to specialist care with special reference to high use among the (multimorbid) elderly
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) |