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Completing the triangle — relationships between practice demography, general practitioner workload and prescribing
Author(s) -
McGavock H.,
WilsonDavis K.,
Milligan Officer E. Administrative
Publication year - 1993
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.2630020208
Subject(s) - workload , medicine , medical prescription , demography , irish , general practice , family medicine , categorical variable , nursing , statistics , management , sociology , linguistics , philosophy , economics , mathematics
The objective was to survey general practitioners' consulting workload and correlate workload with practice demography and prescribing. Two hundred and sixteen of the 345 Northern Irish practices completed a retrospective questionnaire of office consultations and home visits, November 1990. These data were amalgamated with the regional general practitioner prescribing database and statistical analyses were performed to reveal the frequency distribution of workload and to correlate workload with the number of partners, practice demography and prescribing. The consulting workload per doctor varied from 249 office consultations per month to 683. The commonest workload was 373 consultations per month. Single‐handed doctors had the largest workloads. The average length of consultation was 7.5 min a.m., 8.8 min p.m. Consulting workload correlated strongly with the number of patients over 60 ( R = 0.72), mature adults 30–44 ( R = 0.84) and children under 5 ( R = 0.86), but weakly with the number of ‘officially‐deprived’ patients ( R = 0.28). Workload could most precisely be predicted from practice demography using the equation: No. of consultations per month (for a given practice) = 1.31 (children 0–4) + 0.63 (children 10–14) + 0.004 (persons 15–59) + 0.1 (persons > 60) − 0.06 (deprived persons) + κ R = 0.9006 ( R 2 = 0.811, i.e. 81.1% of variability in workload is determined by differences in practice demography) Where k is a categorical variable of number of partners in a practice. Similarly practice demography can explain 90.0% of the total variation in monthly total prescriptions per practice and 91.3% of the variation in total monthly prescription costs. Surgery workload correlated significantly with the number and cost of prescriptions ( R = 0.35 to 0.50). This was true of specific prescribing (for proven pathology), for symptomatic prescribing and for prescribing of drugs often used less precisely than they should be (for presumptive diagnoses). On average, doctors issued 3.7 prescription items per consultation, with a net ingredient cost of £5.93 per prescription item. This study shows that general practitioner consulting workload is determined principally by the demography of the practice list and is itself a determinant of prescribing frequency and cost.