Continuity and longitudinality of general practice in four European countries

Abstract

Background: The goal was to compare continuity and longitudinality of general practice in four European countries with public salary earner models. Methods: Descriptive and prospective study. 63 publicly remunerated general practitioners/family doctors registered all (direct/indirect) contact with their patients over a period of one week in public and state primary assistance centres in Spain, Finland, Portugal and Sweden. Results: 92% of the contacts were held in the doctor’s surgery; 75% were direct; the average number of visits per week, per doctor was 103. In 42% of cases, the main health problem was chronic and in 31% acute. In 63% of the visits, the patient had already been examined in relation to the same problem and 79% for a different problem. In 66% of cases, doctors knew a relative of the patients examined. Conclusions: The surveyed countries show a variable degree of continuity and longitudinality in general practice (from high to low: Portugal, Spain, Sweden and Finland). In Spain, visits are short and repeated prescription systems rare; in Portugal, waiting lists are used, thereby impeding assistance for acute problems; in Finland, there are no patient lists, which de-personalises assistance; finally, in Sweden, there are also waiting lists and a wider usage of indirect consultation (mainly by telephone).