A new formula for managing family doctors’ patient list in Portugal

In Portugal, family doctors work with a well-defined list of patients to whom they provide healthcare throughout their lives. Several studies showed that larger list sizes are associa- ted with poorer health outcomes and compromise the quality of care. A significant increase in the average list size has been observed in recent years due to the Portuguese unfavorable socioeconomic context and the lack of family doctors. In 2017, the Portuguese Association of General and Fa- mily Medicine (APMGF) developed technical and scientific research that ultimately typified a set of different clinical practice contexts. It considers the geographic and socioeconomic characteristics and a set of population-based indicators, adjusting the list size according to the population’s specific needs. Such adjustments ensure health care services with better quality, safety, efficacy, and personalized to their features. In this paper, a brief review is made on this topic, focusing on the work developed by APMGF and its main results.

Key words:
Primary Health Care; List Sizes; Family Doctor

Authorship

Tiago Maricoto

Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, PortugalUniversidade da Beira InteriorPortugalCovilhã, PortugalFaculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal

Associação Portuguesa de Medicina Geral e Familiar, Covilhã, PortugalAssociação Portuguesa de Medicina Geral e FamiliarPortugalCovilhã, PortugalAssociação Portuguesa de Medicina Geral e Familiar, Covilhã, Portugal

Unidade de Saúde Familiar Aveiro-Aradas, Centro de Saúde de Aveiro. Portugal. Faculdade de Ciências da Saúde, Universidade da Beira Interior. Av. Infante D. Henrique, 6200-506 Covilhã. Associação Portuguesa de Medicina Geral e Familiar. Covilhã Portugal. tiago.maricoto@gmail.comCentro de Saúde de AveiroPortugalCovilhã, PortugalUnidade de Saúde Familiar Aveiro-Aradas, Centro de Saúde de Aveiro. Portugal. Faculdade de Ciências da Saúde, Universidade da Beira Interior. Av. Infante D. Henrique, 6200-506 Covilhã. Associação Portuguesa de Medicina Geral e Familiar. Covilhã Portugal. tiago.maricoto@gmail.com

https://orcid.org/0000-0002-4201-9565

Rui Nogueira

Associação Portuguesa de Medicina Geral e Familiar, Coimbra, PortugalAssociação Portuguesa de Medicina Geral e FamiliarPortugalCoimbra, PortugalAssociação Portuguesa de Medicina Geral e Familiar, Coimbra, Portugal

Unidade de Saúde Familiar Norton de Matos, Coimbra. Associação Portuguesa de Medicina Geral e Familiar. Coimbra Portugal.Unidade de Saúde Familiar Norton de MatosPortugalCoimbra, PortugalUnidade de Saúde Familiar Norton de Matos, Coimbra. Associação Portuguesa de Medicina Geral e Familiar. Coimbra Portugal.

https://orcid.org/0000-0002-2490-7219

Collaborations

All authors have contributed to all stages of this manuscript elaboration. T Maricoto elaborated the first draft, and both he and R Nogueira revised it.

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (8)

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Figure 1
Average dimension on list size according to administrative region (a), or according to the unit's type of organizational model (b), in Portugal by 2017. Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. Data reports the situation by august 2017, which was the up-to-date on the monography release.

Thumbnail

Figure 2
Results of a pilot study, conducted on a random sample of about 800 patients from a clinical list, relating the number of appointments performed by each patient and his/her age. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Thumbnail

Figure 3
Mathematical formula for combining the variables that composes the demand index (chart on the top) and linear correlation between the index and the numberof appointments/inhabit./year (chart on the bottom). From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Thumbnail

Figure 4
Variables identified by health professionals as being the most relevant to define the complexity of the exercise. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Thumbnail

Figure 5
Combination of the complexity index and the demand index determines the municipal global index (dimensional reduction approach) (left), and the classification of municipalities into six categories of municipal global index (right). Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. This graph represents a matrix of such two distinct indexes (left), and a final combination resulting from the average weight of both (right).

Thumbnail

Figure 6
Estimated average patients list according to the standardized workload (defined by number of doctor appointments per year, with highlight at 4000 appointments per year per doctor) in each of the six exercise site categories. Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. Detailed information regarding methods may be accessed on original monography.

Thumbnail

Figure 7
Adjustment proposed by APMGF to DecreeLaw No. 266/2012, which establishes the elative “weight” that each patient has according to age (called Weighted Unit). The original Decree-Law No. 266/2012 only contemplates the first line, while in this proposal a correction of the values is made according to the category of the place of exercise. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Thumbnail

Figure 8
Projection of the adjusted weighted units new formula implementation. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Figure 1 Average dimension on list size according to administrative region (a), or according to the unit's type of organizational model (b), in Portugal by 2017. Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. Data reports the situation by august 2017, which was the up-to-date on the monography release.

Figure 2 Results of a pilot study, conducted on a random sample of about 800 patients from a clinical list, relating the number of appointments performed by each patient and his/her age. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Figure 3 Mathematical formula for combining the variables that composes the demand index (chart on the top) and linear correlation between the index and the numberof appointments/inhabit./year (chart on the bottom). From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Figure 4 Variables identified by health professionals as being the most relevant to define the complexity of the exercise. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Figure 5 Combination of the complexity index and the demand index determines the municipal global index (dimensional reduction approach) (left), and the classification of municipalities into six categories of municipal global index (right). Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. This graph represents a matrix of such two distinct indexes (left), and a final combination resulting from the average weight of both (right).

Figure 6 Estimated average patients list according to the standardized workload (defined by number of doctor appointments per year, with highlight at 4000 appointments per year per doctor) in each of the six exercise site categories. Adapted from APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017.. Detailed information regarding methods may be accessed on original monography.

Figure 7 Adjustment proposed by APMGF to DecreeLaw No. 266/2012, which establishes the elative “weight” that each patient has according to age (called Weighted Unit). The original Decree-Law No. 266/2012 only contemplates the first line, while in this proposal a correction of the values is made according to the category of the place of exercise. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

Figure 8 Projection of the adjusted weighted units new formula implementation. From APMGF²⁴24 Associaçao Portuguesa de Medicina Geral de Família (APMGF). Uma Nova Métrica Para a Lista de Utentes. Lisboa: APMGF; 2017..

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A new formula for managing family doctors’ patient list in Portugal

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[1] Collaborations

All authors have contributed to all stages of this manuscript elaboration. T Maricoto elaborated the first draft, and both he and R Nogueira revised it.