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J Eval Clin Pract. 2010 Oct;16(5):1002-8. doi: 10.1111/j.1365-2753.2010.01532.x.

Trends in the perceived complexity of primary health care: a secondary analysis.

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Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.



If the complexity of the patient's medical problems increases or the complexity of the interactions between the doctor and the patient, the staff or the health care system increase, then complexity of patient care will increase. This study examined trends in patient complexity, and identified doctor, practice and improvement strategy characteristics associated with perceived complexity.


This secondary analysis used data from three Community Tracking Surveys with 22,134 primary care doctors completing surveys about themselves, their practice setting, practice improvement strategies and complexity of care in three consecutive 2-year time periods (1996-1997, 1998-1999, 2000-2001). Data were analysed using hierarchical logistic regression.


The proportion of primary care doctors who perceived that complexity of care had increased over the past 2 years rose from 31.5% to 35.9%. Perceived complexity of patient care was consistently related to being in solo practice and the belief that they could not frequently obtain high-quality services and referrals for patients. As availability of services increased, complexity decreased whereas as use of practice improvement strategies increased, complexity also increased.


Understanding that we cannot determine whether respondents understood care as 'complicated' or 'complex', potential consequences of this increase in complexity include an increase in medical errors and referral rates along with decreased quality of patient care and career satisfaction.

[Indexed for MEDLINE]

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