The digital revolution of general practitioners and their patients

The research addresses an important issue: how are doctor-patient interactions changing, and what are the implications of these changes? Traditionally, the service model relied on in-person visits, where patients would visit the GP’s office for all their medical needs. However, the combination of a declining number of GPs—expected to drop further in the coming years before hopefully rising again—and the growing demands of an aging, chronically ill population has rendered the old paradigm unsustainable. Today, an Italian GP manages an average of 1,300 patients, compared to 1,100 ten years ago and 1,000 twenty years ago. Moreover, over half of GPs are “massimalisti,” meaning they manage more than the theoretical maximum of 1,500 patients.

For the first time, our study systematically and quantitatively analyzes the evolving modes of interaction between doctors and patients. Which channels are preferred? What is the actual volume of contacts a GP handles daily? And, most importantly, how do the different modes of access—physical or digital—vary depending on the characteristics of both doctors and patients? The research aims to answer these questions, providing a map of the ongoing changes.

For a chapter in the OASI Report 2024 (in Italian), we collected data on over 22,000 interactions in three Italian regions—Lombardy, Emilia-Romagna, and Campania—by involving 78 GPs. Using a detailed questionnaire, doctors tracked all incoming contacts for five consecutive days, noting the contact mode, purpose, and patient characteristics. This investigation offers a clear snapshot of how general practice is evolving.

The results show that each GP manages an average of 45 contacts per day, with an additional 30 or more handled by secretarial staff, with the number sometimes exceeding 100 daily contacts. Notably, the share of remote interactions is substantial: 69% in Lecco, 66% in Romagna, and 57% in Naples. Among remote channels, email and phone are the most used, while in-person visits remain limited to scheduled appointments or urgent needs.

A particularly relevant finding concerns doctors' ability to manage this transformation despite organizational limitations. In Naples, for instance, 89% of doctors have limited or no administrative support, yet they handle a significant volume of contacts thanks to remote tools like the telephone. In Romagna and Lombardy, more structured secretarial support allows for smoother operations but does not eliminate the pressure on medical staff.

From the patients’ perspective, most interactions involve requests for prescriptions, information, and appointments (over 40% of contacts). Chronic disease consultations are also often managed remotely, indicating that general practice is quickly adapting to new tools to ensure continuity of care.

The transition to technology adoption has been a bottom-up revolution, and the trend does not appear to vary based on the characteristics of either GPs or their patients.

So far, digitalization has been a tool for managing increasing workloads, but moving forward, it must be seen as an opportunity to improve efficiency and quality by capitalizing on the already established habits among patients and doctors in using these tools. It is therefore essential to support GPs in choosing channels that balance workloads, avoiding overload caused by tools like WhatsApp, which create expectations of immediate responses and increase pressure on doctors.

On the other hand, failing to leverage this familiarity with digital tools to strengthen the GP's role as a clinical coordinator for increasingly chronically ill patients would be a missed opportunity. These patients often require care that can be delivered in a territorial rather than a hospital setting.

For example, integrating clinical decision support systems (CDSS) could standardize prescriptions and improve treatment adherence. These tools, if co-designed with doctors, would make prescriptions not only more uniform but also easier for the healthcare system to process. A shared strategy between GPs and healthcare companies could include creating pre-packaged care plans for chronic patients, reducing random access and optimizing resources.

For such a scenario to become a reality, better integration of the information systems used by GPs is necessary. As highlighted in a recent Lancet article that garnered significant media attention, the system is fragmented. This finding is confirmed by another study of ours, which reveals that Lombardy’s GPs must use 11 different public software programs, which rarely communicate with each other.

Giulia Broccolo, Francesca Guerra, Francesco Longo, Angelica Zazzera, “Changes in General Medicine Service Models,” in OASI Report 2024, pp. 447–468.

Read other articles in the OASI Report 2024 series:

Ricci, Longo - Tell me the truth about the Italian NHS: Four steps toward sustainable universality

Bobini, Compagni, Rotolo - Sustainability in healthcare: A new model for the future

Boscolo, Cinelli, Guerra, Petracca, Petralia, Pinelli - Se non ora, quando? PNRR e digitalizzazione del Servizio Sanitario Nazionale