[The general practitioner as physician of first contact with health problems]

An aim of this study was to determine the extent to which general practitioners (GPs) are their patients' physicians of first contact (PFCs) for specific health problems. It was also designed to explain the differences between physicians who treat these problems, and those who do not, by the type of problem presented, the characteristics of the physician, and the characteristics of the environment in which the physician works. The study is based on data collected in a nationwide mail survey in 1993 among 677 GPs working in 1 or more of Israel's 4 health insurance funds. They were asked if they were their patients' PFC for 27 health problems. There was great variation in the responses to this question according to the type of health problem presented. Thus for problems such as abdominal pain or chest pain, 85% of the GPs reported being the PFC, compared with only 50% for problems of suicidal thoughts or alcohol dependence. Multivariate analysis revealed that those more likely to report being their patients' PFC for the majority of problems presented were specialists in family medicine (p < 0.001), physicians under the age of 55 (p < 0.01) and rural physicians (p < 0.05). Our findings support the model which proposes that characteristics of the physician, the type of problem presented, and characteristics of the environment influence the likelihood of the GP being the patient's PFC. The findings have implications for GP training programs designed to enable GPs to cope with the wide range of problems encountered in general practice and to provide high quality care at reasonable cost.