Review of salaried physician visits in a rural remote community - Bella Coola Valley

Introduction: The current study quantifies visits to salaried physicians working in a geographically remote health care facility in British Columbia in 2001. Methods: A retrospective chart review was conducted of patients residing in the Bella Coola Valley and attending the Bella Coola General Hospital/Medical Clinic (BCGH/Medical Clinic) in 2001. Visits to family physicians at this clinic, visits to the BCGH emergency department, hospital admissions, smoking rates and chronic disease prevalence rates were quantified. Results: An estimated 2378 patients made 7747 BCGH/Medical Clinic family physician visits, and 4474 "other" visits in 2001. These "other" visits included emergency department visits (n = 1736), hospital admissions (n = 245) and prescription visits (n = 2252). Twenty-six percent (n = 622) of the population did not see a family physician at all in 2001, and 15% of the population accounted for 52% of all visits. Women had a higher number of visits than men; pregnant women had a higher number of visits than non-pregnant women, and the Aboriginal population saw family physicians more often than did non-Aboriginal people (p < 0.001). Those who had a chronic illness (e.g., diabetes) saw family physicians more frequently than did people who did not have that particular chronic illness (p < 0.01). The Aboriginal population used the BCGH/Medical Clinic and emergency department more frequently than did the non-Aboriginal population. BCGH/Medical Clinic physicians had an average of 75 patient visits per week. An additional 22 "visits" per week were for writing prescription refills with the patient not present. Conclusion: Older people, people with chronic disease, women and Aboriginal peoples more frequently visited the family physicians. Salaried physicians working in geographically isolated communities appeared to behave in ways that minimized contact (e.g., used the phone, wrote prescriptions without patient being present) and maximized time efficiency for both themselves and their patients.