Federica Arnone
DISPEA, Politecnico di Torino
Luglio 2010
Appendix 3. The role of the family doctor in a LHA
3.1. Introduction
This paper is focused on the figure of the family doctor. The purpose of this study is to provide a
description of the activity of family doctors and of their influence on the performance of the entire
network. The case study refers to physicians working in the LHA of Asti, but the same analysis can be
generalized to other LHAs.
The role of the family doctor is of fundamental importance within the service network of a LHA.
Family doctors provide primary cares in a continuous and comprehensive way for all patients, address
patients to specialist physicians, follow-up their diagnostic or therapeutic paths, manage the treatment of
chronic diseases. They also play an essential role in providing preventive cares. Moreover, they deeply
influence patient behavior. Consequently, their activity has an important impact on the population health
status and on the costs for the entire network. In other words, family doctors monitor the patient health
status by prescribing diagnostic and therapeutic elementary services. In our dataset, referring to the year
2007, the activity of family doctors is tracked in the form of prescribed elementary services.
The first part of this paper provides some general information concerning family doctors and their
patient features. Then, the second part describes the activity of family doctors in terms of typologies of
healthcare services prescribed. In particular, the way they address the population to specialist physicians
and to laboratory analysis and diagnostic imaging centers has been investigated.
3.2. General information concerning family doctors







Number of family doctors: 172.
Number of pediatricians: 15.
Average number of patients per family doctor: 744.
Average number of patients per pediatrician: 449.
Average number of patients per physician (family doctors and pediatricians): 716. Physicians have
been grouped into 8 classes on the basis of the average number of patients. The relative
frequencies are reported in Figure 1.
Estimated percentage of patients that have not had any interactions with the National Healthcare
System: 34%.
Average number of healthcare services prescribed per physician (family doctors and pediatricians):
7470. Physicians have been grouped into 7 classes on the basis of the number of prescriptions done
during the period of time considered. The relative frequencies are reported in Figure 2.
1
Number of patients per physician
Percentage of physicians
25%
20%
15%
10%
5%
0%
<10
patients
10÷100
patients
100÷300
patients
300÷500
patients
500÷800
patients
800÷1000 1000÷1300 1300÷1700
patients
patients
patients
Number of patients
Figure 1. Number of patients per physician
Number of prescriptions per physician
Percentage of physicians
25%
20%
15%
10%
5%
0%
<100
prescript.
100÷1000
prescript.
1000÷5000
prescript.
5000÷10000
prescript.
1000÷15000 15000÷20000 20000÷30000
prescript.
prescript.
prescript.
Number of prescriptions
Figure 2. Number of prescriptions per physician
2
3
3.3. Patient features


Average age of patients (per pediatrician): 6 years.
Average age of patients (per family doctor): 58 years. Physicians have been grouped into 6 classes
on the basis of the age of their patients. The relative frequencies are reported in Figure 3.
Average age of patients per physician
Percentage of physicians
60%
Average age: 58 years
50%
40%
30%
20%
10%
0%
<40 years
40÷50 years
50÷60 years
60÷70 years
70÷80 years
>80 years
Patient age
Figure 3. Average age of patients per physician


Municipality of residence: the 15% of patients resides in the town of Asti, the 2% resides in the
municipality of Nizza Monferrato, while another 2% resides in the municipality of Canelli. On the
contrary, the 0,7% of patients resides outside the territory under the jurisdiction of the LHA of Asti.
Thus, the average number of patients not residing in a municipalities localized in the territory under
the jurisdiction of the LHA of Asti per physician is 6.
Medical exemption: patients with medical exemptions for chronic diseases represent the 10% of
the total (patients that have had at least one interaction with the system). The main 5 exemptions
reported in Figure 4 account for the 89% of the total medical exemptions for chronic diseases.
4
Percentage of medical exemptions
Main medical exemptions for chronic diseases
30%
25%
20%
15%
10%
5%
0%
048-cancer
013-diabetes
031-hypertension
002-circulatory
system diseases
019-glaucoma
Medical exemption codes
Figure 4. Main medical exemptions for chronic diseases
3.4. Typologies of ambulatory healthcare services prescribed

The main 5 typologies of ambulatory healthcare services prescribed are depicted in Figure 5. While
the remaining medical specialties, if individually considered, account for less than 5%. Individual
contributions are reported in Table 6.
5
Main typologies of healthcare services prescribed
Quantity of prescriptions
30%
25%
20%
15%
10%
5%
0%
cardiology
ophthalmology
obstetrics and
gynecology
rehabilitation
neurology
Medical specialties
Figure 5. Main typologies of healthcare services prescribed
26%
17%
11%
9%
6%
4%
4%
3%
cardiology
ophthalmology
obstetrics and gynecology
rehabilitation
neurology
dietetics
oncology
otolaryngology
Healthcare services prescribed
3% gastroenterology
2% pneumology
2% psychiatry
2% orthopedics and traumat.
2% urology
2% dermatology
2% odontostomatology
2% radiation treatment
1%
1%
1%
0%
0%
0%
0%
100%
general surgery
allergology
cardiovascular surgery
nephrology
anesthesia
plastic surgery
child neuropsichiatry
total
Figure 6. Healthcare services prescribed
3.5. Physical examinations

Physical examinations represent the 9% of the total prescribed healthcare services, as shown in
Figure 7. The 7% consists of psychiatric or psychological counselings, the 3% of gynecological
examinations, the 2% of neurological examinations, while the 1% consist of ophthalmology
examinations. The remaining 87% is represented by general physical examinations.
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Healthcare services prescribed: physical examinations
9%
91%
Physical examinations
Other healthcare services
Figure 7. Healthcare services prescribed: physical examinations

Average number of physical examinations prescribed per physician: 787.
3.6. Laboratory analysis and diagnostic imaging

Laboratory analysis tests represent a large amount of the total prescribed healthcare services,
equal to the 82%, while diagnostic imaging tests represent the 5%, as shown in Figure 8.
Healthcare services prescribed:
laboratory analysis and diagnostic imaging tests
13%
5%
82%
Diagnostic imaging tests
Other healthcare services
Laboratory analysis tests
Figure 8. Healthcare services prescribed: laboratory analysis and diagnostic imaging tests
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
Average number of laboratory analysis tests prescribed per physician: 7080. Physicians have been
grouped into 5 classes on the basis of number of laboratory analysis tests prescribed. The relative
frequencies are reported in Figure 9.
Laboratory analysis tests prescribed
Percentage of physicians
35%
30%
25%
20%
15%
10%
5%
0%
>15000 prescript.
15000÷10000
prescript.
10000÷5000
prescript.
5000÷1000
prescript.
<1000 prescript.
Number of prescriptions
Figure 9. Laboratory analysis tests prescribed

Average number of diagnostic imaging tests prescribed per physician: 444. Physicians have been
grouped into 6 classes on the basis of the number of diagnostic imaging tests prescribed. The
relative frequencies are reported in Figure 10.
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Diagnostic imaging tests prescribed
Percentage of physicians
35%
30%
25%
20%
15%
10%
5%
0%
>1000
prescript.
1000÷750
prescript.
750÷500
prescript.
500÷250
prescript.
250÷100
prescript.
<100 prescript.
Number of prescriptions
Figure 10. Diagnostic imaging tests prescribed
3.7. Admissions at the emergency department

Average number of patients per physician admitted at the emergency department of the hospital,
following the family doctor suggestion, regardless of the assigned triage color: 5. Patients have
been divided into 4 groups depending on the severity of their conditions at the arrival at the
emergency department. Results are depicted in Figure 11. Subsequently, just white and green
codes have been analyzed. Physicians have been grouped into 7 classes on the basis of the number
of patients that they have transferred to the emergency department of the hospital. The relative
frequencies are reported in Figure 12.
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Admissions at the emergency department grouped by assigned triage color
Percentage of patients
70%
60%
50%
40%
30%
20%
10%
0%
white
green
yellow
red
Triage color
Figure 11. Admissions at the emergency department grouped by assigned triage color
Patients transferred to the emergency department per physician
(triage color: white or green)
45%
Percentage of physicians
40%
35%
30%
25%
20%
15%
10%
5%
0%
>10 patients 10÷8 patients 8÷6 patients 6÷4 patients 4÷2 patients
1 patient
0 patients
Number of patients transferred to the emergency department
Figure 12. Patients transferred at the emergency department per physician
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3.8. Methodology of analysis
The number of family doctors and pediatricians has been calculated considering the physicians that
have prescribed at least one healthcare service during the period of time considered. We assume that the
number of prescriptions done corresponds exactly to the number of healthcare services rendered. This
assumption is necessary since the policy of data management of a LHA do not require to record each
prescription issued by the family doctor.
In order to distinguish between family doctors and pediatricians, the average age of patients have
been taken into consideration.
The number of patients per physician has been calculated on the basis of the patients with at least
one prescription and that have actually received the healthcare service prescribed.
The estimated percentage of patients that have not had any interactions with National Healthcare
System has been evaluated considering a population of about 205000 persons.
Laboratory analysis and diagnostic imaging have been excluded from the calculation of the number
of prescriptions done per physician.
Referring to the analysis of the main typologies of healthcare services prescribed, ambulatory
healthcare services have been investigated. Initially, laboratory analysis and diagnostic imaging tests have
been excluded. Subsequently they have been analyzed separately.
As regards to the emergency admissions at the hospital, only records where is clearly indicated that
patients have been transferred to the hospital by the family doctor have been considered.
With regards to hospital admissions, it is not possible to track the activity of family doctors (the
identification codes recorded refer to specialists physicians).
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