Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Oct 14;26(1):311.
doi: 10.1186/s12875-025-02939-2.

Analysis of the increase in the complexity of care in family medicine

Juan José Montero-Alía  1 , Gemma Seda-Gombau  2 , María Victoria Zamora-Sánchez  3 , María Del Mar Rodríguez-Álvarez  4 , Estíbaliz López-Torrent  5 , Pere Torán-Montserrat  6
Affiliations
Observational Study

Analysis of the increase in the complexity of care in family medicine

Juan José Montero-Alía et al. BMC Prim Care. .

Abstract

Objective: To analyze how the complexity of consultation among family physicians has evolved between 2019 and 2022.

Methods: This was a cross-sectional, multicenter, observational study conducted across 30 healthcare centers in Catalonia, Spain. A total of 90 physicians were selected through convenience sampling, with 26 of them participating in all study years. The study followed a descriptive design with three data collection points in 2019, 2021, and 2022. Continuous variables were expressed as means and standard deviations, while categorical variables were summarized using frequencies and percentages. For bivariate comparisons, the chi-squared test was applied to categorical variables; the Student's T-Test was used for comparisons between two groups of continuous variables; and analysis of variance was employed when comparing three groups. All statistical tests were two-tailed, and statistical significance was set at p < 0.05.

Results: 17,473 visits and 23,998 reasons for consultation in a total of 599 days. From 2019 to 2022 the mean number of total visits per day increased from 27.8 ± 5.0 to 31.5 ± 8.4 (p-value = 0.042). The mean number of reasons per consultation increased from 39.2 ± 8.6 to 44.8 ± 16.3 (p-value = 0.040). Psychosocial pathology increased from 3.15 to 4.49% (p-value < 0.001). The unscheduled medical management time increased from 13.4 ± 16.6 to 20.7 ± 19.3 min (p-value < 0.001). Complex visits increased from 33.2% in 2019 to 37.5% in 2022 (p-value < 0.001), mostly due to emotional and communicative complexity. Face-to-face visits were the most that presented the highest complexity.

Conclusions: The overall complexity of consultations, which affects more than one-third of total visits, has increased by 12.9% since 2019, especially in face-to-face visits. Clinical, emotional, and communicative complexity have increased significantly.

Keywords: Clinical complexity; Complexity of care; Emotional complexity; Family medicine; Reasons for consultation; Telematic consultation; Virtual consultation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Research have been performed in accordance with the Declaration of Helsinki and have been approved by the ethics committee Consorci Sanitari del Maresme and IDIAP Jordi Gol: Código CEIC CSM: 50/16; Código CEIC IDIAP: P16/186. Consent for publication: Consent to Participate and Consent to Publish were obtained from all participants or, if participants are under 18, from a parent and/or legal guardian. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Distribution of total consultations, reasons for consultation, on-site consultations and non-face-to-face consultations per day in the month of May 2019, 2021 and 2022
See this image and copyright information in PMC

References

    1. Beard JR, Officer A, de Carvalho IA, Sadana R, Pot AM, Michel JP, et al. The world report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54. - PMC - PubMed
    1. Josi R, De Pietro C. Skill mix in Swiss primary care group practices - a nationwide online survey. BMC Fam Pract. 2019;20(1): 39. - PMC - PubMed
    1. Moore M, Gibbons C, Cheng N, Coffman M, Petterson S, Bazemore A. Complexity of ambulatory care visits of patients with diabetes as reflected by diagnoses per visit. Prim Care Diabetes. 2016;10(4):281–6. - PubMed
    1. Landon BE, Bayram C, Harrison C. Primary care visits in the USA and Australia 2000–2016. J Gen Intern Med. 2023;38(3):675–82. - PMC - PubMed
    1. Gerber T, Giezendanner S, Zeller A. Measuring workload of Swiss general practice: a five-yearly questionnaire-based survey on general practitioners’ self-reported working activities (2005–2020). Swiss Med Wkly. 2022;152:w30196. - PubMed

Publication types

LinkOut - more resources