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Subsequent consultation as a cause of overuse in a family medicine clinic



Subsequent consultation as a cause of overuse in a family medicine clinic



Revista Medica del Instituto Mexicano del Seguro Social 36(5): 377-382



In family medicine subsequent consultation may be a condition of overuse (excessive demand) of medical care because of the number persons assigned to the family doctor, poor resolution of the original complain or overdemanding patients. Overuse was detected in a Family Medicine Clinic and a cross-sectional review of 290 randomly selected medical records of subsequent consultation during the previous year was performed in order to estimate the prevalence and associated features of subsequent consultation. The justification of subsequence was estimated with a standardized clinical record review form for family medicine. Only 26 % of all medical consultation were considered unjustified. Unjustified subsequences were associated with chronic and degenerative (CD) diseases in 23.88 %, acute infections (AI) in 21.62 %, healthy child control (HCC) in 14.86 %, prenatal care (PC) in 13.15 % and trauma (T) in 9.21 %. For justified subsequences the causes were CD in 46.15 %, HCC in 15.89 %, PC in 10.75 %, AI in 8.78 % and T in 6.07 %. Chronic and degenerative diseases were significantly (p < 0.05) more frequent as cause of justified subsequences and acute infections were significantly (p < 0.05) more frequent as causes of unjustified subsequences. Unjustified subsequences were related to poor resolution of the original complaint due to diagnostic or therapeutic decisions, lack of referral to the specialist nurse or patient related causes. Only three characteristics of the patients were significantly different (p < 0.05): age > 50 years old, pensioners and beneficiaries, and education as high school or higher; all of them were related to justified subsequent consultations. Subsequent consultations in this clinic are mainly because of CD, and PC and HCC that were not referred to the specialist nurse. In accordance with those results group care was proposed for CD and supervision of the family doctor for timely referral of HCC and PC cases to the specialist nurse.

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