[The demand for care and systems of access in primary health care]

The aim of the investigation was to assess variations in the demand for medical care in the primary care centre of Ciudad Badia (Barcelona, Spain). The records of attendance were analysed over a period of seven years. During this period, some changes were made which affected the way the centre was used by patients, such as the creation of systems which required notice of medical and nursing appointments, the reduction of spontaneous attendance, and the introduction of a card for medication for the chronically sick. These changes were accompanied initially by a decrease, then a stabilisation, and afterwards a slight increase in total number of visits. All visits (with notice) rose from 5.3% in 1983 to 45.2% in 1989. Similarly, nursing visits (with notice) increased from 4% to 9.5 of total activity. Emergency visits in the same period rose from 3.4% to 8%. It is concluded that changes that were introduced raised the level of commitment of the staff to medical work-both preventive and therapeutic, as well as the improvement of the organisation of attendance at the centre and a higher satisfaction of users of the centre and the medical staff.