[New model of professional self-management in primary care]

To analyse the benefits of a new organisational model in Primary Care based on the empowerment of professional management compared to standard model (team led by medical director). To improve the quality of care, and patient and professional satisfaction.

In February 2009 six family physician (FP) and four administrative staff met to create a self-management group to care for the 10,281 population assigned to them. The total catchment population of the Primary Care (PC) centre was 32,318. Additionally, between March and December 2010 three FP, seven nurses and two administrative staff, were included in the self-management group making the total population served by the self-management group of 16,368, compared to 15,950 patients seen using the standard model. The model gave priority to self-demand management, professional self-coverage, to reduce clinic bureaucracy, greater efficiency and participation in research and teaching.

1) Milestone in Pilot Phase (December-2008 to December-2009): increase in attended population, reduction in clinic visits, significant reduction in delay to be visited by a doctor; significant reduction of complementary tests (x-rays, laboratory tests); increase in use of generic drugs and reduction of expensive and new drugs without added value, and active participation in teaching and clinical trials. 2) Consolidation Phase (December-2010, compared to other professionals working in a standard model in the same centre): self-management group reported a lower percentage of clinic visits and a higher percentage of visits resolved through telephoning the clinic. Furthermore, the self-management group achieved better financial results than the control group (additional medical tests, pharmacy budget). The self-management group had improved job satisfaction compared to control group (measured by Professional Questionnaire QoL-35).

The new model has increased professional satisfaction and may improve results in some health indicators (accessibility, efficiency, pharmacy budget) compared with the usual clinical practice.