[Potentially avoidable visits to the physician's office: an exploratory observational study].

Abstract

In order to harmonize supply and demand in the outpatient sector, current figures are needed on the number of visits to physicians' offices and their rationale. Since the introduction of partially flat-rate remuneration in the outpatient sector in 2008, only uncertain estimates are possible on the basis of billing data.On the basis of direct observation in physicians' offices, the number and reasons for visits to the physician's office are to be recorded and their potential avoidability estimated.In 11 GP practices (4 practices), general specialist practices (6 practices) and specialized specialist practices (1 practice), all visits to the physician's office in a given week were documented with regard to the reason for and type of contact as well as the age and gender of the patients. To this number, the practices added the patients' utilization of the services in the entire quarter and previous quarter as well as the total number of all cases seen in the practice per quarter. Frequencies and differences in relation to practice types, age groups and gender were analyzed descriptively and using Chi² tests.A total of 3266 practice contacts (57% by women, 43% by men) were recorded. There were 2.9 visits to GPs and 1.9 visits to specialists per patient per quarter. In the case of GPs, 40% of patients aged<60 years visited the practice because of an acute illness, while the leading reason for patients aged 60+was to collect a referral or prescription (50%). The most prominent reason for visits to a specialist was the monitoring of chronic illnesses for younger patients (36%) and older patients (51%). Explicit contact with a GP was made by 58% of those under 60 and 32% of those over 59, while 70 and 73%, respectively of such patients saw a specialist. Extrapolated, every citizen had 16.9 contacts with a physician's office per year.The explorative study provides indications of the extent of avoidable contacts with physicians' offices, in that half of the contacts with over 59-year-olds were only to collect prescriptions, findings etc. and 41% of contacts with specialists were routine check-ups, the necessary frequency of which is unclear.