Analysis of the Increase in the Complexity of Care in Family Medicine

Abstract Objective: To analyze how the complexity of consultation among family physicians has evolved between 2019 and 2022. Methods: Cross-sectional, prospective, multicenter, observational study. 31 health centers in Catalonia, Spain. Ninety physicians were selected by convenience sampling, and 26 repeated in each year of the study. Descriptive study in 3 cuts in years 2019, 2021, 2022. Continuous variables expressed in means and standard deviations and categorical variables in frequencies and percentages. In bivariate comparisons of categorical variables the chi-squared test was used, for continuous variables in two groups T-students test was used, and for comparison in three groups analysis of variance was used. Statistical test were performed with bilateral contrast and statistical significance of p-value<0.05. Results: 17,473 visits and 23,998 reasons for consultation in a total of 599 days. From 2019 to 2022 the mean number of total visits per day increased from 27.8±5.0 to 31.5±8.4 (p-value= 0.042). The mean number of reasons per consultation increased from 39.2±8.6 to 44.8±16.3 (p-value=0.040). Psychosocial pathology increased from 3.15% to 4.49% (p-value<0.001). The unscheduled medical management time increased from 13.4 ± 16.6 to 20.7 ± 19.3 minutes (p-value<0.001). Complex visits increased from 33.2% in 2019 to 37.5% in 2022 (p-value<0.001), mostly due to emotional and communicative complexity. Face-to-face visits were the most that presented the highest complexity. Conclusions: The overall complexity of consultations, which affects more than one-third of total visits, has increased by 12.9% since 2019, especially in face-to-face visits. Clinical, emotional, and communicative complexity have increased significantly.