First Contact with the Health System: a Survey Study in Northern Portugal

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Nov 9

PMID 37945304

Authors

Monica Granja

Luis Alves

Sofia Correia

Affiliations

Soon will be listed here.

Abstract

Objective: The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics.

Design: Cross-sectional survey.

Setting: Primary care department of a local health unit in northern Portugal.

Participants: Random sample of 4286 persons, retrieved from all registered adults.

Outcomes: Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression.

Results: There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1-4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08).

Conclusions: The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection.

Citing Articles

Contacts with health services for COVID-19-related reasons during the first wave of the pandemic in Portugal: a longitudinal study.

Granja M, Correia D, Alves L, Severo M, Lucas R, Correia S BMJ Public Health. 2025; 2(2):e000979.

PMID: 40018524 PMC: 11816515. DOI: 10.1136/bmjph-2024-000979.

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