[Patient complaints in primary care in a Spanish region (2018-2024): A quantitative analysis]

To analyze longitudinal trends, reasons and geographic variability of patient complaints in primary care (2018-2024) within a Spanish regional health service, providing management-relevant quality indicators.

Observational, retrospective ecological study (unit: healthcare area/year).

Primary care in a Spanish regional health service; 14 healthcare areas.

All formally registered complaints during 2018-2024 (census).

Annual complaint counts; prevalence per 1,000 health cards; rate per 1 000 primary-care encounters; out-of-time responses (2021-2024) and patient-safety-related complaints (2021-2024); complaint-reason distribution (2021-2024).

A total of 47,279 complaints were analysed. Population size was stable (∼1.95 million cards/year). Prevalence rose from 2,47‰ (2018) to 6,21‰ (2021) and decreased to 2,76‰ (2024), temporal trend analysis showed an upward trend (Mann-Kendall, τ=0.619; P=.021). In 2021, incidence was 2,54 times that of 2018 (IRR=2.54; 95% CI: 2,45-2,62). The rate of patient safety complaints was 13.06%. In 2021-2024, four categories accounted for 82% of complaints: organization (55,42%), staff attitude (9,49%), appointments (9.22%) and dissatisfaction with care (7,91%). The median activity-adjusted rate was 0.14/1 000 encounters (∼1 complaint per 7 000 encounters), with significant between-area heterogeneity (P<.0001).

Primary-care complaints displayed significant changes, thematic concentration and substantial territorial variability, complaints may serve as a complementary indicator for monitoring perceived quality, as they are easy to obtain, incur no additional cost, and may help to prioritise organisational interventions in primary care.