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Estudio exploratorio de los asistentes frecuentes en la práctica general para comprender mejor por qué los pacientes

Samira Nur¹, James Coultas¹, Louise Jones²

¹North West London Training Scheme.

The British journal of general practice : the journal of the Royal College of General Practitioners

|June 20, 2024

Antecedentes:

Los asistentes frecuentes (definidos como el 10% superior de los usuarios de servicios sanitarios o aquellos que realizan ≥10 visitas al año) representan entre el 30 y el 50% de las consultas de medicina general. Esto tiene implicaciones significativas en cuanto a los recursos.

Aim:

Para comprender las características de los pacientes frecuentes (≥18 años) en una consulta de medicina general en las afueras de Londres (lista de 5.876 pacientes; índice de privación 5)^th decil) y razones para asistir.

MéTodo:

Se llevó a cabo una revisión retrospectiva de las notas clínicas mediante SystmOne de personas que acudieron en $\geq$10 ocasiones a consultar a un profesional de la salud entre marzo de 2022 y febrero de 2023. Los datos se extrajeron manualmente: edad, género, motivo y tipo de consulta, diagnósticos, derivaciones, índice de comorbilidad de Charlson (CCI) y mortalidad al año. Un médico de familia senior revisó las notas de los pacientes con $\geq$30 contactos.

Resultados:

544 personas (9,3%) asistieron a ≥10 citas. De estas, cinco interactuaron con un médico de cabecera en ≥50 ocasiones (Grupo 1; edad media: 74,6 años / mujeres: 4 / CCI: 5,0), ocho en ≥40 ocasiones (Grupo 2; 69,6 años / 6,0 / 5,5) y 35 en ≥30 ocasiones (Grupo 3; 70 años / 27 / 4,7). Cuarenta y ocho personas representaron 882 citas, el 29% presenciales y el 71% telefónicas. La frecuencia aumentó con la edad y el CCI. Los pacientes del grupo 3 se sometieron a más exploraciones (6,0 / 6,0 / 10,0). No hubo diferencias en el número medio de médicos consultados (6,4 / 7,1 / 7,4) ni en las derivaciones (5,0 / 4,0 / 5,0) entre los tres grupos. Los asistentes frecuentes tendieron a dividirse en dos grupos: personas con enfermedades crónicas, típicamente asociadas a la ansiedad y a necesidades complejas, y personas con afecciones de salud mental persistentes. La codificación resultó dificultosa debido a la complejidad.

ConclusióN:

Los asistentes frecuentes acudieron debido a su complejidad médica o a trastornos de salud mental, más que por síntomas médicamente inexplicables. La mayoría de las interacciones con un médico de familia son comprensibles.

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