Patient psychosocial factors and primary care consultation: a cohort study.

BACKGROUND

The combined influence of psychological distress, family dysfunction and social support on primary care consultation (PCC) remains unclear. OBJECTIVE. To build an explanatory model of PCC concerning users' psychosocial factors.

METHODS

We undertook a multicentre, prospective cohort study of a random sample of 1141 persons assigned to 113 GPs, belonging to 11 urban health centres in four Spanish cities (Seville, Malaga, Jaen and Granada), of whom 955 (84%) were interviewed in their homes. They were followed up for 1 year and then contacted again. After the second interview, 70 (7.3%) patients were excluded; accordingly, we measured the number of PCC of 885 valid patients using their medical charts.

RESULTS

A multilevel analysis was developed. The null model with three levels showed that 93.29% of the variability was explained by the patients, 1.56% by the GPs and 5.15% by the health centres. We selected a two-level model (patients and health centres) with random effects. The variables used in the multilevel analysis explained 48% of PCC, 36% at the patient level and 12% at the health centre level. Poor mental health (GHQ-28, partial correlation coefficient=0.28) and family dysfunction (Family APGAR index, partial correlation coefficient=0.26) were the most predictive variables, whereas social support (Duke-UNC-11, partial correlation coefficient=-0.14) lost significance in the multivariate analysis. Chronic illness seemed less relevant in our study, and only two predisposing factors were included in the equation: age and satisfaction with their doctor.

CONCLUSIONS

Mental health and family function were the most important psychosocial factors predicting PCC. More comprehensive identification of psychosocial factors may enhance our understanding of PCC.