Low rate of non-attenders to primary care providers in Israel - a retrospective longitudinal study

Israel Journal of Health Policy Research

Shlomo Vinker¹  Arnon D Cohen³  Sasson Nakar¹  Dana Rosen² 

[1] Department of Family Medicine, Central District, Clalit Health Services, Rehovot, Israel;Department of Family Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel;Chief Physician Office, headquarters, Clalit Health Services, 17/2 Yehoshua Bin-Nun St., Hod Hasharon, Tel Aviv 45236, Israel

关键词: Preventive services;    Health services;    Non-attender;    Primary care physician;   

Others  :  803386
DOI  :  10.1186/2045-4015-3-15

 received in 2014-01-02, accepted in 2014-04-14,  发布年份 2014

【 摘 要 】

Background

A model that combines reactive and anticipatory care within routine consultations has become recognized as a cost-effective means of providing preventive health care, challenging the need of the periodic health examination. As such, opportunistic screening may be preferable to organized screening. Provision of comprehensive preventive healthcare within the primary care system depends on regular attendance of the general population to primary care physicians (PCPs). Objectives: To assess the proportion of patients who do not visit a PCP even once during a four-year period, and to describe the characteristics of this population.

Methods

An observational study, based on electronic medical records of 421,012 individuals who were members of one district of Clalit Health Services, the largest health maintenance organization in Israel.

Results

The average annual number of visits to PCPs was 7.6 ± 8.7 to 8.3 ± 9.0 (median 5, 25%-75% interval 1–11) and 9.5 ± 10.0 to10.2 ± 10.4 (median 6, 25%-75% interval 1–14) including visits to direct access consultants) in the four years of the study. During the first year of the study 87.2% of the population visited a PCP. During the four year study period, only 1.5% did not visit a PCP even once.

In a multivariate analysis having fewer chronic diseases (for each additional chronic disease the OR, 95% CI was 0.40 (0.38¬0.42)), being a new immigrant (OR, 95% CI 2.46 (2.32¬2.62)), and being male (OR, 95% CI 1.66 (1.58¬1.75)) were the strongest predictors of being a non-attender to a PCP for four consecutive years.

Conclusions

The rate of nonattendance to PCPs in Israel is low. Other than new immigrant status, none of the characteristics identified for nonattendance suggest increased need for healthcare services.

【 授权许可】

   
2014 Rosen et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Howard-Tripp M: Should we abandon the periodic health examination?: YES. Can Fam Physician 2011, 57:158-160.
• [2]Mavriplis CA: Should we abandon the periodic health examination?: NO. Can Fam Physician 2011, 57:159-161.
• [3]Laine C: The annual physical examination: needless ritual or necessary routine. Ann Intern Med 2002, 136:701-703.
• [4]Boulware LE, Marinopoulos S, Phillips KA, Hwang CW, Maynor K, Merenstein D, Wilson RF, Barnes GJ, Bass EB, Powe NR, Daumit GL: Systematic review: the value of the periodic health evaluation. Ann Intern Med 2007, 146:289-300.
• [5]Fenton JJ, Cai Y, Weiss NS, Elmore JG, Pardee RE, Reid RJ, Baldwin LM: Delivery of cancer screening: how important is the preventive health examination? Arch Intern Med 2007, 167:580-585.
• [6]Han PKJ: Historical changes in the objectives of the periodic health examination. Ann Intern Med 1997, 127:910-917.
• [7]Watt G, O'Donnell C, Sridharan S: Building on Julian Tudor Hart's example of anticipatory care. Prim Health Care Res Dev 2011, 12:3-10.
• [8]Merenstein D, Daumit GL, Powe NR: Use and costs of nonrecommended tests during routine preventive health exams. Am J Prev Med 2006, 30:521-527.
• [9]Krogsboll LT, Jorgensen KJ, Gronhoj Larsen C, Gotzsche PC: General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012, 345:e7191.
• [10]Rennert G, Peterburg Y: Prevalence of selected chronic diseases in Israel. Isr Med Assoc J 2001, 3:404-408.
• [11]Tabenkin H, Lahad A: Clinical guidelines: the recommendations of the Israeli task force for health promotion and preventive medicine. In Israel Medical Association and the Association of Family Physicians in Israel. Israel: Hebrew; 2013. http://www.ima.org.il/Ima/FormStorage/Type1/clinical_09_preventive.pdf webcite
• [12]Bethke W: Guide to Clinical Preventive Services, 2010–2011, AHRQ Publication No. 10–05145. Rockville, MD: Agency for Healthcare Research and Quality; 2010.
• [13]Oboler SK, LaForce FM: The periodic physical examination in asymptomatic adults. Ann Intern Med 1989, 110:214-226.
• [14]Prochazka AV, Lundahl K, Pearson W, Oboler SK, Anderson RJ: Support of evidence-based guidelines for the annual physical examination: a survey of primary care providers. Arch Intern Med 2005, 165:1347-1352.
• [15]Cherrington A, Corbie-Smith G, Pathman DE: Do adults who believe in periodic health examinations receive more clinical preventive services? Prev Med 2007, 45:282-289.
• [16]Oboler SK, Prochazka AV, Gonzales R, Xu S, Anderson RJ: Public expectations and attitudes for annual physical examinations and testing. Ann Intern Med 2002, 136(9):652-659.
• [17]Schenck AP, Klabunde CN, Warren JL, Jackson E, Peacock S, Lapin P: Physician visits and colorectal cancer testing among medicare enrollees in North Carolina and South Carolina. Prev Chronic Dis 2005, 8:A112.
• [18]Thomas KJ, Nicholl JP, Fall M, Lowy A, Williams BT: Case against targeting long term non-attenders in general practice for a health check. Br J Gen Pract 1993, 43:285-289.
• [19]Dryden R, Williams B, McCowan C, Themessl-Huber M: What do we know about who does and does not attend general health checks? Findings from a narrative scoping review. BMC Publ Health 2012, 12:723. BioMed Central Full Text
• [20]Eshel N, Raz R, Chodick G, Guindy M: Characteristics of the elderly who do not visit primary care physicians. Isr J Health Policy Res 2013, 2:7. BioMed Central Full Text
• [21]Khanassov V, Vedel I, Bergman B: Are non-attenders a concern for primary care practice? Isr J Health Policy Res 2013, 2:13. BioMed Central Full Text
• [22]Tudor Hart J: The inverse care law. Lancet 1971, 297:405-412.
• [23]Lofters A, Glazier RH, Agha MM, Creatore MI, Moineddin R: Inadequacy of cervical cancer screening among urban recent immigrants: a population based study of physician and laboratory claims in Toronto, Canada. Prev Med 2007, 44:536-542.
• [24]Ngwakongnwi E, Hemmelgarn B, Quan H: Documentation of preventive screening interventions by general practitioners: a retrospective chart audit. BMC Fam Pract 2010, 11:21. BioMed Central Full Text
• [25]Yarnall KSH, Pollak KI, Ostbye T, Krause KM, Michener JL: Primary care: is there enough time for prevention? Am J Public Health 2003, 93:635-641.
• [26]Pollak KI, Krause KM, Yarnall KSH, Gradison M, Michener JL, Ostbye T: Estimated time spent on preventive services by primary care physicians. BMC Health Serv Res 2008, 8:245. BioMed Central Full Text
• [27]Zayev V, Chioborchio MD, Vinshtokc S, Perry Z, Biderman A: Characteristics of non visitors to the family physician and reasons for non attending. Israeli J Fam Pract 2009, 19(151):15-17.