Primary care consultations: are they all by the doctor?

Objectives: To find out the proportion of primary healthcare consultations that could be attended by another professional other than the doctor. Design: multicentre cross-sectional study. Location: Primary healthcare, west-gipuzkoa region, with 17 health centres taking part. Participants: Reasons for consultation dealt with by 38 doctors over 5 days. Main measurements: Age, sex, frequency, category, initiative, reason for consultation and ideal Level of healthcare. Results: A total of 4,377 patients who generated 5,592 consultations were included. The average frequency was 10 visits/year. The large majority (93.1%) of consultations took place in the centre, 5.4% by telephone and 1.5% were home visits. A total of 74.4% of the consultations were requested, 17.2% arranged by the doctor, 6.4% arranged by protocol, 2% at the request of other professionals, and 8% were urgent. The reasons were; 71.5% (95% CI: 69.8-73.2) were medical clinical, 7.2% (6.2-8.2) minor symptoms, 18.4% (17.1-19.5) bureaucratic, and 2.9% (2.3-3.3) for information. The consultations for medical reasons accounted for 80.5% (79.3-81.7) and 19.5% (18.3-20.7) were for non-medical reasons. Non-medical reasons made up 29.3% of the telephone consultations, 20.2% of the consultations in the centre, and 2.4% of the home visits, as well as 16.7% of the urgent consultations. The ideal level of healthcare was considered to be doctor 80.7%, 13.2% nursing and 2.8% administrative. In the consultations for minor symptoms, nursing was considered the ideal level in 65.3% of cases. Conclusions: One out of every 5 consultations could be dealt with by a professional other than the doctor, which in 5 hours of consultations would allow 1 hour to be gained which could be used for other activities. (C) 2010 Elsevier Espana, S.L. All rights reserved.