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[Analysis of the claims in a specialist primary care center]
C Nebot Adell1, N Juvanet Ribot, F Orfila Pernas
1Subdivisión de Atención Primaria Barcelona, Institut Català de la Salut.
Objective:
To analyze the written claims attended at a specialists unit of a Primary Health Care Center in Nou Barris, Barcelona.
Design:
Evaluative observational study.
Setting:
Health Care District of Nou Barris, with a population of 170,849. Period of study covers claims attended between 1-6-1996 to 31-12-1998.
Participants:
220 claims registered at a specialist unit of a primary health care center.
Measurements:
Claimer's age and gender, heath care net of origin, claim's motive, claimed person or service and health care activity. Statistical analyses performed included descriptive techniques and Khi-square (chi 2) tests (alpha = 0.05).
Results:
Cumulative incidence of claims was 4.03 per 10,000 person-year in 1996, 4.70 in 1997 and 5.88 in 1998 (p = 0.0128). 220 claims were analyzed, 53.1% of them came from women. Mean age was 51.12 +/- 15.8 years. 60% of claims came from people using the traditional health care net, and 40% from reformed health care net. Mean time of response was 12.3 +/- 12.7 days. Ophthalmology was the most claimed service (18.64%), followed by "the system" (13.64%), and "the center" (13.64%). 64% of claims pointed to specialists, and don't adjusted with their health care activity (p = 0.0001). Relative risk of being claimed at the specialists unit was 2.91, compared to the rest of the primary health care centers of Nou Barris in 1998.
Conclusions:
Health care user's claims become useful to detect some difficult aspects. However, improvements in the methodology of their evaluation are needed.