Analysis of the increase in the complexity of care in family medicine

对家庭医学护理复杂性增加的分析

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Abstract

OBJECTIVE: To analyze how the complexity of consultation among family physicians has evolved between 2019 and 2022. METHODS: This was a cross-sectional, multicenter, observational study conducted across 30 healthcare centers in Catalonia, Spain. A total of 90 physicians were selected through convenience sampling, with 26 of them participating in all study years. The study followed a descriptive design with three data collection points in 2019, 2021, and 2022. Continuous variables were expressed as means and standard deviations, while categorical variables were summarized using frequencies and percentages. For bivariate comparisons, the chi-squared test was applied to categorical variables; the Student's T-Test was used for comparisons between two groups of continuous variables; and analysis of variance was employed when comparing three groups. All statistical tests were two-tailed, and statistical significance was set at p < 0.05. RESULTS: 17,473 visits and 23,998 reasons for consultation in a total of 599 days. From 2019 to 2022 the mean number of total visits per day increased from 27.8 ± 5.0 to 31.5 ± 8.4 (p-value = 0.042). The mean number of reasons per consultation increased from 39.2 ± 8.6 to 44.8 ± 16.3 (p-value = 0.040). Psychosocial pathology increased from 3.15 to 4.49% (p-value < 0.001). The unscheduled medical management time increased from 13.4 ± 16.6 to 20.7 ± 19.3 min (p-value < 0.001). Complex visits increased from 33.2% in 2019 to 37.5% in 2022 (p-value < 0.001), mostly due to emotional and communicative complexity. Face-to-face visits were the most that presented the highest complexity. CONCLUSIONS: The overall complexity of consultations, which affects more than one-third of total visits, has increased by 12.9% since 2019, especially in face-to-face visits. Clinical, emotional, and communicative complexity have increased significantly.

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