Striking variations in consultation rates with general practice reveal family influence

BACKGROUND: The reasons why patients decide to consult a general practitioner vary enormously. While there may be individual reasons for this variation, the family context has a significant and unique influence upon the frequency of individuals' visits. The objective of this study was to explore which family factors can explain the differences between strikingly high, and correspondingly low, family consultation rates in families with children aged up to 21. METHODS: Data were used from the second Dutch national survey of general practice. This survey extracted from the medical records of 96 practices in the Netherlands, information on all consultations with patients during 2001. We defined, through multilevel analysis, two groups of families. These had respectively, predominantly high, and low, contact frequencies due to a significant family influence upon the frequency of the individual's first contacts. Binomial logistic regression analyses were used to analyse which of the family factors, related to shared circumstances and socialisation conditions, can explain the differences in consultation rates between the two groups of families. RESULTS: In almost 3% of all families, individual consultation rates decrease significantly due to family influence. In 11% of the families, individual consultation rates significantly increase due to family influence. While taking into account the health status of family members, family factors can explain family consultation rates. These factors include circumstances such as their economic status and number of children, as well as socialisation conditions such as specific health knowledge and family beliefs. The chance of significant low frequencies of contact due to family influences increases significantly with factors such as, paid employment of parents in the health care sector, low expectations of general practitioners' care for minor ailments and a western cultural background. CONCLUSION: Family circumstances can easily be identified and will add to the understanding of the health complaints of the individual patient in the consulting room. Family circumstances related to health risks often cannot be changed but they can illuminate the reasons for a visit, and mould strategies for prevention, treatment or recovery. Health beliefs, on the other hand, may be influenced by providing specific knowledge

Increased primary healthcare utilisation among women with a history of breast cancer

<p>Little is known about the current role of the general practitioner (GP) in breast cancer follow-up care. This study explores primary healthcare use in the period after completion of primary breast cancer treatment.</p><p>A total of 336 women with a history of early-stage breast cancer treated with curative intent were identified in the primary care database of the Registration Network Groningen (RNG) (1998-2007) and matched with a reference population of 983 women without breast cancer on birth year and GP.</p><p>Over the entire follow-up period (starting 1 year post-diagnosis), the median numbers of face-to-face contacts, drug prescriptions, and referrals in the patient group were significantly higher than those in the reference group: 4.0 vs. 3.2/year, 12.3 vs. 8.4/year, and 0.4 vs. 0.3/year, Mann-Whitney (M-W) test p <0.001 for all differences. At least one annual face-to-face contact was observed for 96.7 % of patients and 92.9 % of women from the reference population (Chi-square test p = 0.011). More patients than women from the reference population had face-to-face contacts for reasons related to breast cancer or were prescribed hormone antagonists and aromatase inhibitors to treat breast cancer. The main predictor of higher rates of face-to-face contacts and drug prescriptions was a higher age at diagnosis.</p><p>This study shows increased primary healthcare utilisation among women with a history of breast cancer, especially among the elderly. When follow-up is transferred to the primary care setting, new responsibilities of GPs might be incorporated into existing primary healthcare delivery.</p>