Impact of medical and non-medical Factors on Quality and Costs in Primary Care : A Conscious Look at Subconcious Processes

Abstract: Background / IntroductionPhysicians and patients may be influenced by more than just the medical facts of the situation at hand. The physician is a part of the sociocultural environment and is under influence of this. The physician could be afraid of making mistakes and thus choose the safest option. In addition, economic considerations may apply. The perceived continuity or quality of the communication may also influence medical decision-making. Patients may not think about what allergens they are exposed to. Differences in socioeconomy or perceived morbidity may influence the patient's or their family’s desire to see the doctor or to use medications like antibiotics.Material and MethodsIn Paper 1, referrals from two Primary Healthcare centers in Norway were compared to each other and to the other referrals that were received by the local hospital. In Paper 2, Influenza-Like Illness (ILI) for children 2-12 years old was monitored for 7 years, and costs of treatment and parental absence due to ill children were calculated using real numbers. In Paper 3, the number of antibiotic prescriptions was compared to the patient’s socioeconomic background, to investigate possible inequalities. Paper 4 compares asthma and atopy incidence to the number of antibiotic prescriptions, to investigate if asthma patients are more often treated with antibiotics than nonasthma patients are. The analyses are based on regional healthcare data and the prospective ABIS study.ResultsPaper 1 showed that locum doctors and regular General Practitioners had the same referral rates, but the locum doctors had a distribution of diagnoses that differed significantly from the regular GPs and from the other referrals.Paper 2 showed that parental absence due to children with ILI follows the seasonal influenza pattern closely. The main burden of consultations and costs is carried by Primary Care.Paper 3 showed that parent-reported infectious morbidity at age 5, is associated with a higher number of antibiotic prescriptions in later childhood (5-14 years). Family income is a factor, where children from Q1 (wealthiest) receive significantly fewer antibiotics than children from Q3-Q5.Paper 4 found that asthma/ fur allergy at age 5 was associated with more antibiotic prescriptions in later childhood, but that wide-spectrum antibiotics are rarely used. Doctors seem to adhere to national and regional guidelines.ConclusionsPrimary care physicians seem to be affected by their grade of continuity and length of employment in their referral diagnosis distribution. Influenza-like illness in children carries a substantial cost in terms of loss of production, healthcare encounters, and personal suffering for vulnerable individuals. Parents’ perceptions of morbidity seem to influence antibiotic demand in children, along with socioeconomic factors. Children with asthma or airway allergies seem to receive more antibiotic prescriptions, possibly due to increased infectious vulnerability or to allergic exposure unknown to the doctor.