Characteristics and economic burden of frequent attenders with medically unexplained symptoms in primary care in Israel.

BACKGROUND: Frequent Attenders with Medically Unexplained Symptoms (FA/MUS) are common in primary care, though challenging to identify and treat. OBJECTIVES: This study sought to compare FA/MUS to FA with organic illnesses (FA/OI) and the general clinic population (Non-FA) to understand their demographic characteristics and healthcare utilisation patterns. METHODS: For this retrospective, observational study, Electronic Medical Records (EMR) were obtained from Clalit Health Services, regarding the population of a sizeable primary care clinic in Be'er-Sheva, Israel. Electronic medical records were screened to identify the top 5% of FA. FA were stratified based on whether they had OI. FA without OI were then corroborated as having MUS by their physicians. Demographics, healthcare utilisation and costs were analysed for FA/OI, FA/MUS and Non-FA. RESULTS: Out of 594 FA, 305 (53.6%) were FA/OI and 264 (46.4%) were FA/MUS. FA/OI were older (69.1 vs. 56.4 years, p<.001) and costlier (ILS27693 vs. ILS9075, p<.001) than FA/MUS. Average costs for FA/MUS were over four times higher than Non-FA (ILS9075 vs. ILS2035, p<.001). The largest disparities between FA/OI and FA/MUS were in hospitalisations (ILS6998 vs. ILS2033) and surgical procedures (ILS8143 vs. ILS3175). Regarding laboratory tests, differences were smaller between groups of FA but significantly different between FA and Non-FA. CONCLUSION: FA/MUS are more costly than Non-FA and exhibit unique healthcare utilisation and costs patterns. FA/OI had more severe illnesses necessitating hospitalisations and surgical interventions, while FA/MUS had more investigations and tests, attempting to find an explanation for their symptoms.

[How patients choose their new family physician and what do they know about him?].

BACKGROUND: A change of residence is the main reason for choosing a new family physician. Patients entering a new clinic need to choose a new family physician. AIMS: To explore the factors influencing new patients' choice of physician. This study examined the importance of the physician's demographic and personal characteristics, the knowledge patients have of their physician and compared these factors between new immigrants, up to five years in Israel, and veteran residents. METHODS: The study population was comprised of a random sample of new patients registered in two family medicine clinics in Beer Sheba, in the two years prior to the commencement of the study. The patients were interviewed by phone using a structured questionnaire in Hebrew or Russian. RESULTS: A total of 166 patients participated in the study. Only 45% of the new patients fulfilled their right to choose their new family physician. About two thirds of the patients consulted either their relatives or the clinic's staff in choosing their family physician. About 78% were satisfied with their family physician. Professionalism and patience were the most important qualities noted by patients as important characteristics of their family physician. Eighty percent of the patients knew their family physician's full name and half knew his country of birth. Only a few knew that their physician performs surgical procedures, treats psychological problems and provides personal or family crisis intervention. Unlike the new immigrants, veteran residents were more aware of the comprehensive approach of the family physician. Veteran residents considered professionalism, patience and availability to be more important qualities in a family physician. These findings were statistically significant. In comparison, new immigrants noted speaking their mother language and mannerisms as being more important. CONCLUSIONS: The majority of patients are satisfied with their family physician, however, more efforts should be made to educate the public, especially new immigrants, in the wide range of medical problems that can be consulted and treated by the family physician in Israel.