Distribution of medical and nursing consultations in primary care: Portugal Trend and Seasonality

Cátia Dias, Rita Felix, Pedro Damião

Background:
There are diseases with a seasonal distribution, if the amplitude of the impact of these diseases is important in the total number of consultations throughout the year, there is an opportunity for improvement in management of appointments.

Research questions:
The aim of this study is to assess the temporal evolution and distribution of direct and indirect medical and nursing contacts in mainland Portugal, between 2016 and 2019.

Method:
Descriptive observational study, with data collected from the National Health Service’s Transparency Portal, processed and combined with the R (3.4.2) for the production of distribution graphs. A linear model for a short temporal series (Jan/2014-Dec/2019, monthly resolution) was created with a trend component and a seasonal component (the seasonal pattern was approximated by fourier terms).

Results:
There is a seazonal distribution in person medical consultations, the model shows a periodic component [coef fourier (df, 2)S1-12=67842,02, p=0.011]. Nursing contacts, both face-to-face [coef fourier (df, 2)S1-12=-66179.87, p=0.031; coef fourier (df, 2)C1-12=70315.40, p=0.031; coef fourier (df, 2)S2-12=-1272272.24, p<0.001 ] and non-face-to-face [coef fourier (df, 2)S1-12=10515.29, p<0.001 ] contacts, show periodic phenomena.

Conclusions:
There is evidence of periodic phenomena in face-to-face medical consultations, but not in the indirect ones.
Nursing contacts, both face-to-face and non-face-to-face contacts, show periodic phenomena, with a potential management opportunity to be investigated.

Points for discussion:
Which are the temporal evolution and distribution of direct and indirect contacts in primary care?

How we can improve the consultation offer?