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Fig.1 Doctors strike, Hospital 12 de Octubre, Madrid.
"The days I end with 40 patients many times, as I go with delay, I don't take my, my rest, or eat, I don't pee sometimes, sometimes I forget to pee (laughs).”
Itziar, Family Doctor, 29, Valecia.
The Primary Care Centers (PCCs) of the public health system in Spain are at their capacities limit, the number of daily patients pushes Family Doctors (FDs) to reduce the time per consultation average around 10 minutes and even less in some municipalities.
This situation of extreme saturation has become a problem national scale and doctors protest the consequences on their working conditions, state of health and the risks it causes in the patients health.
How could we reduce the number of daily patients per consultation in the spanish public health family medicine system to improve doctors labor conditions and reduce the health risks of patients?
Know at a municipal scale the average number of daily patients of one FD in Spain.
Find out what is the average number of daily patients that the FDs consider maximum to improve their working conditions and provide a diagnosis with which they feel satisfied.
Know how and how much the number of daily patients consultations for a FD can affect negative to the doctors health and diagnosis quality.
Find out why there are so many daily patients per FD in the municipalities where the number average exceeds the maximum according to the FD.
Learn about other similar cases and find out how the problem is solved.
Find out what are the five most common reasons for consultation and the five reasons for consultation that exceed the most time.
Fig.2 CIVIO / Pressure Consultant assistance in primary care, María Alvarez and Angela Bernardo, 2022.
1-1 doctor interviews and video-interviews were be the biggest source of qualitative information.
SHADOWING & GUERRILLA INTERVIEWS
Patient centered in health centers, the idea is to obtain information in the context when the experience is most recent.
DESKTOP RESEARCH AND EXPERT INTERVIEWS
Mainly as support to specific questions,
doubts, technical details and for complement and reinforce the data obtained from the interviews.
Focused on FD, pretend to respond quantitatively the objective Nº2 with a large volume of data.
Profiles were defined as family doctors with crossed extreme variables of age, capacity to deal with stress, location in urban municipalities with more than 350,000 people and rural municipalities of less than 10,000, localities wealthy and humble and in localities of the three main climates of Spain.
Profiles share the same geographic variables than FD. Demographics are the same but with a new age group, retirees. Capacity to manage stress was discarded for not being related with their problems.
"It may happen that you have forgotten some evidence of something that he said that you told him that were you going to ask for, and you haven't done it for interruptions or by, pressure or because of anxiety, you know?
Itziar, Family Doctor, 29, Valecia.
"Every consultation is different and each patient is different, then
counting that there will be some that exceeded the time and some that are shorter I think that the minimum should be 20 minutes
minimum and ideally, half an hour"
Ana Family Doctor, 28, Barcelona
"I have been called up to 3 times
by administrators and I, I lose the thread a bit, sometimes when talking with a patient of a depression, a cancer, someone who is crying telling you important information"
Toni Family Doctor, 55, Barcelona.
"Now it's chaos because an appointment is requested, it is
difficult to make an appointment, there are long terms, closeness
in attention before has been lost
Enrique Patient, 63, Olba.
Management of emergency triage in each health center is different and in many cases inefficient.
The management and organization of the days assigned to doctors to assist the various types of health care in each health center is different and in many cases inefficient.
Telephone or email assistance are powerful tools to desaturate the system if used correctly, otherwise they saturate it more.
Patients ignorance about what is an emergency or when they should or should not go to the doctor and the related consequences increases the number of daily patients.
Ideally FDs need triple the time (30 minutes) on average per daily patient to work in working conditions that do not affect their health or put their patients at risk.
The mean number of daily patients per current FD affects negatively the doctors health both mentally and physically.
The current mean number of daily patients per FD poses a risk to the health of the patient.
The current times per consultation as well as the allocation of dates for visits worsen confidence in the public system and are negatively affecting the doctor-pacient relationship.
Zip code and migration are two important variables to consider in user screening.
Insights 1, 2, 3, 4 and 8 are considered opportunity precursors. Questions will be drawn from these, research routes and some clear problems to evolve to a creative stage. For now we will keep them in our opportunity and problem backlog and and we will reopen them when we have dived deeper around all the research objectives. With all the insights and opportunities we will have an interesting medium-high level map to understand the problem and be able to analyze and move forward with the research and project.
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