Skip Navigation



Family Practice Advance Access published online on April 6, 2005
Family Practice, doi:10.1093/fampra/cmi023
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
22/3/347    most recent
cmi023v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Love, T.
Right arrow Articles by Burton, C.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Love, T.
Right arrow Articles by Burton, C.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author (2005). Published by Oxford University Press. All rights reserved.
Received October 28, 2004
Revised December 30, 2004

Article

General practice as a complex system: a novel analysis of consultation data

Tom Love 1* and Chris Burton 2

1 Department of General Practice, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington, New Zealand; Health Informatics Centre, University of Dundee, Dundee DD2 4AD, UK
2 Community Health Sciences--General Practice, University of Edinburgh, 20 West Richmond Street, Edinburgh EH8 9DX, UK

* To whom correspondence should be addressed.
Tom Love, E-mail: t.love{at}chs.dundee.ac.uk


  Abstract

Background. Complex systems have specific properties of robustness and self organization which arise from interacting components within the overall system and which govern the system's behaviour. These are typically associated with a power law distribution of event sizes. Commentators have suggested that health systems are complex, but there has been limited quantitative investigation of this issue.

Objectives. To test the hypothesis that consultation patterns in primary care follow a power law distribution typical of a complex system.

Methods. Analysis of 142 050 episodes of non-pathological back pain in routinely collected New Zealand national data. Calculation of the distribution of the duration and number of GP consultations for each illness episode. Secondary analysis of a published UK dataset of consultation rates for 44 000 patients in four general practices.

Results. Number of consultations per episode of back pain demonstrated excellent fit with a power law in the full dataset (r2 = 0.96) and all but one subgroups (r2 = 0.90-0.99). The number of consultations per patient from four UK practices was suggestive of a power law distribution (r2 = 0.88-0.93).

Conclusions. Consultation patterns in general practice show measurable properties of a complex system. The consistency of the distribution across different population groups suggests that attempts to manage consultation patterns should focus on the whole system of patients, rather than upon individuals or subgroups of the patient population.

Keywords: Behavioural sciences; complex systems; consultations; health service management; primary health care.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Epidemiol. Community HealthHome page
D. Rickles, P. Hawe, and A. Shiell
A simple guide to chaos and complexity
J Epidemiol Community Health, November 1, 2007; 61(11): 933 - 937.
[Abstract] [Full Text] [PDF]

Home page
 Fam PractHome page
D. Kernick
Wanted--new methodologies for health service research. Is complexity theory the answer?
Fam. Pract., June 1, 2006; 23(3): 385 - 390.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.