Factors affecting the selection of doctor of first contact in the Western Region of Melbourne: An interview study of parents of sick children

An interview study investigating attitudinal and other factors influencing the selection of primary medical care (PMC) is described. It focuses on parents of sick children, excluding those with trauma or medical/surgical emergencies, and was conducted in part of the Western Region (WR) of Melbourne in late 1983, the period immediately prior to the introduction of Medicare. It is based on a cross‐sectional survey of in‐hours attenders of eight general practices (GP), the Western Region Community Health Centre (WRCHC), the general clinic of the casualty departments at the Western General Hospital (WGH), and the Royal Children's Hospital (RCH), a teaching hospital outside the region. The most commonly stated reasons for attendance at services generally were ‘closeness to home/work’, ‘recommendation’ and ‘good service’. ‘Cheap/economic reasons’ were given less frequently overall than the above reasons. There were however some differences in reasons given by attenders at different places of care. ‘Cheap/economic reasons’ was offered significantly more often and ‘recommendation’ significantly less often by WGH attenders compared with other attenders. ‘Specialists available’ and ‘dissatisfaction with other doctors’ was offered significantly more frequently and ‘close to home’ and ‘no other doctor’ significantly less frequently by RCH attenders than other attenders. Health insurance status did not differ significantly at the different places of care. Attenders of the RCH were significantly more knowledgeable about community health centres than GP or WGH attenders. Non‐GP attenders had more often used other than their current place of care for treatment in the recent past than GP attenders had. It is concluded that non‐economic as well as economic factors are important in the selection of PMC. A pluralist model recognizing the legitimacy of different PMC arrangements including multiple use of services best reflects community usage of PMC services. This is likely to be even more true under Medicare. The further development of specialist paediatric services at the WGH is necessary both for improved local service delivery and ongoing paediatric education of local doctors in the WR.