[Variability of physician changing requests in primary care of Insalud:a preliminary study]

The study consisted of two phases. The first phase involved analysis of the variability in the rates of changing doctor recorded in the Areas of Insalud in the first two years after Royal Decree 1575/93 came into effect, pinpointing some of the factors that might explain this variability. The second phase describes the profile of the citizens who voluntarily changed their General Practitioner in a Health Area, and the possible reasons for doing so.

A simple correlation is made between the accumulated rates of G.P. change in the Areas (voluntarily and owing to a change of address) and certain variables that were presumably associated with this, together with a systematic sampling of the voluntary changes recorded in Area 5 Madrid, for the first three-monthly period in 1994, and a description of the characteristics of both the patients involved and their former doctors.

The two-yearly rates of voluntary change in Areas (1.73-18.87 changes for every 100 cards) are correlated with the following variables: lower ageing of the population, number of inhabitants/doctor, frequency of visits, proportion of evening surgeries and population concentration on the Area. These last three variables are also correlated with the rates of change of address in the Areas (0.62-7.35 changes for every 100 cards). By contrast, no correlation was to be found between the two rates of change, neither was there any correlation between them and the extension of the cover through Primary Aid Teams. Those who requested to change doctors in the Area studied, were differentiated from the rest of the population in the Area because of their age (there was a larger number of elderly people and less adults than were expected) and zone of residence (more urban and less rural). Most of the patients did not change the model but did change their surgery visiting hours (the tended to change to the evening surgery), but these latter differences where not statistically significant.

The rate for changing one's G.P. in the Areas, bears no relationship to the setting up of Health Centres, but rather with factors that are present in the urban Areas (population concentration and an increase in the offers of assistance), which were conducive to the use of the new legislation by citizens, especially those who are users of the services.