Nathan Talya A, Cohen Arnon D, Vinker Shlomo
The Department of Family Medicine, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clalit Health Services, Tel Aviv; 3) Medical Division, Leumit Health Services, Tel Aviv, Israel.
Isr J Health Policy Res. 2017 Aug 10;6(1):35. doi: 10.1186/s13584-017-0159-y.
Most of the research on primary care workload has focused on the number of visits or the average duration of visits to a primary care physician (PCP) and their effect on the quality of medical care. However, the accumulated annual visit duration has yet to be examined. This measure could also have implications for the allocation of resources among health plans and across regions. In this study we aimed to define and characterize the concept of "Accumulated Annual Duration of Time" (AADT) spent with a PCP. METHOD: A cross-sectional study based on a national random sample of 77,247 adults aged 20 and over. The study's variables included annual number of visits and AADT with a PCP, demographic characteristics and chronic diseases. The time period was the entire year of 2012.
For patients older than 20 years, the average annual number of visits to a PCP was 8.8 ± 9.1, and the median 6 ± 10 IQR (Interquartile Range). The mean AADT was 65.8 ± 75.7 min, and the median AADT was 43 ± 75 IQR minutes. The main characteristics of patients with a higher annual number of visits and a higher AADT with a PCP were: female, older in age, a higher Charlson index and a low socio-economic status. Chronic diseases were also found to increase the number of annual visits to a PCP as well as the AADT, patients with chronic heart failure had highest AADT in comparison to others (23.1 ± 15.5 vs. 8.6 ± 8.9 visits; and 165.3 ± 128.8 vs. 64.5 ± 74 min). It was also found that the relationship between AADT and age was very similar to the relationship between visits and age.
While facing the ongoing increase in a PCP's work load and shortening of visit length, the concept of AADT provides a new measure to compare between different healthcare systems that allocate different time frames for a single primary care visit. For Israel, the analysis of the AADT data provides support for continued use of the number of visits in the capitation formula, as a reliable and readily-accessible indicator of primary care usage.
大多数关于初级保健工作量的研究都集中在就诊次数、就诊初级保健医生（PCP）的平均时长及其对医疗质量的影响上。然而，年度累计就诊时长尚未得到研究。这一指标对于健康计划之间以及不同地区的资源分配也可能具有重要意义。在本研究中，我们旨在定义并描述与初级保健医生相处的“年度累计时长”（AADT）这一概念。
一项基于全国77247名20岁及以上成年人随机样本的横断面研究。该研究的变量包括每年就诊次数、与初级保健医生相处的AADT、人口统计学特征和慢性病情况。研究时间段为2012年全年。
对于20岁以上的患者，每年就诊初级保健医生的平均次数为8.8±9.1次，中位数为6±10次（四分位间距）。平均AADT为65.8±75.7分钟，中位数AADT为43±75分钟（四分位间距）。每年就诊次数较多且与初级保健医生相处的AADT较高的患者的主要特征为：女性、年龄较大、查尔森指数较高且社会经济地位较低。还发现慢性病会增加每年就诊初级保健医生的次数以及AADT，与其他患者相比，慢性心力衰竭患者的AADT最高（分别为23.1±15.5次与8.6±8.9次就诊；165.3±128.8分钟与64.5±74分钟）。还发现AADT与年龄之间的关系与就诊次数和年龄之间的关系非常相似。
在面对初级保健医生工作量不断增加以及就诊时长缩短的情况下，AADT这一概念为比较不同医疗系统提供了一种新的指标，这些医疗系统为单次初级保健就诊分配了不同的时长。对于以色列而言，对AADT数据的分析为在人头费公式中继续使用就诊次数提供了支持，将其作为初级保健利用情况的可靠且易于获取的指标。
