SOCIOECONOMIC DETERMINANTS OF RATES OF CONSULTATION IN GENERAL-PRACTICE BASED ON 4TH NATIONAL MORBIDITY SURVEY OF GENERAL PRACTICES

Objective-To identify the socioeconomic determinants of consultation r ates in general practice. Design-Analysis of data from the fourth nati onal morbidity survey of general practices (MSGP4) including sociodemo graphic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take acc ount of both individual patient data and small area statistics to rela te socioeconomic and health status factors directly to a measure of ge neral practitioner workload. Results-Higher rates of consultations wer e found in patients who were classified as permanently sick, unemploye d (especially those who became unemployed during the study year), livi ng in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (gi rls only), and living in urban areas, especially those living relative ly near the practice. When characteristics of individual patients are known and controlled for the role of ''indices of deprivation'' is con siderably reduced. The effect of individual sociodemographic character istics were shown to vary between different areas. Conclusions-Demogra phic and socioeconomic factors can act as powerful predictors of consu ltation patterns. Though it will always be necessary to retain some lo cal planning discretion, the sets of coefficients estimated for indivi dual level factors, area level characteristics, and for practice group ings may be sufficient to provide an indicative level of demand for ge neral medical services. Although the problems in using socioeconomic d ata from individual patients would be substantial, these results are r elevant to the development of a resource allocation formula for genera l practice.