Low rate of non-attenders to primary care providers in Israel - a retrospective longitudinal study

Background: A model that combines reactive and anticipatory care within routine consultations has become recognized as a cost-effective means of providing preventive health care, challenging the need of the periodic health examination. As such, opportunistic screening may be preferable to organized screening. Provision of comprehensive preventive healthcare within the primary care system depends on regular attendance of the general population to primary care physicians (PCPs). Objectives: To assess the proportion of patients who do not visit a PCP even once during a four-year period, and to describe the characteristics of this population. Methods: An observational study, based on electronic medical records of 421,012 individuals who were members of one district of Clalit Health Services, the largest health maintenance organization in Israel. Results: The average annual number of visits to PCPs was 7.6 +/- 8.7 to 8.3 +/- 9.0 (median 5, 25%-75% interval 1-11) and 9.5 +/- 10.0 to 10.2 +/- 10.4 (median 6, 25%-75% interval 1-14) including visits to direct access consultants) in the four years of the study. During the first year of the study 87.2% of the population visited a PCP. During the four year study period, only 1.5% did not visit a PCP even once. In a multivariate analysis having fewer chronic diseases (for each additional chronic disease the OR, 95% CI was 0.40 (0.380-0.42)), being a new immigrant (OR, 95% CI 2.46 (2.32-2.62)), and being male (OR, 95% CI 1.66 (1.58-1.75)) were the strongest predictors of being a non-attender to a PCP for four consecutive years. Conclusions: The rate of nonattendance to PCPs in Israel is low. Other than new immigrant status, none of the characteristics identified for nonattendance suggest increased need for healthcare services.