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Damen LJ, Van Tuyl LHD, Knottnerus BJ, De Jong JD. General practitioners' perspectives on relocating care: a Dutch interview study. BMC PRIMARY CARE 2024; 25:186. [PMID: 38796424 PMCID: PMC11127345 DOI: 10.1186/s12875-024-02425-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/09/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Healthcare systems around the world are facing significant challenges because higher costs and an increase in demand for care has not been matched by a corresponding growth in the health workforce. Without reform, healthcare systems are unsustainable. Relocating care, such as from hospitals to general practices, is expected to make a key contribution to ensuring healthcare remains sustainable. Relocating care has a significant impact upon general practitioners (GPs). Therefore, we investigated which care, according to GPs, could be relocated and under which conditions. METHOD GPs were recruited through Nivel's GPs network on eHealth and innovation, located in the Netherlands. One exploratory focus group and 12 in-depth interviews were conducted. Interview transcripts were analyzed using the qualitative research principles of thematic analysis. RESULTS According to the participants, some diagnostic and follow-up care could be relocated from hospitals to GPs once certain prerequisites are fulfilled. An important condition of relocating care from the hospital to the GP is that GPs have sufficient time to take over these tasks. The types of care that can be relocated from the GP to other settings are those questions where the medical knowledge of the GP can offer nothing extra or where problems in navigating the health system cause patients to either turn to, or stay with, their GP. CONCLUSION Care should first be relocated from the GP to other settings before attempting to organize the relocation of care from the hospital to the GP. When this, and other conditions are met, some diagnostic and follow-up care can be relocated from the hospital to the GP.
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Affiliation(s)
- L J Damen
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - L H D Van Tuyl
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - B J Knottnerus
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - J D De Jong
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- CAPHRI, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands
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2
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Dros JT, van Dijk CE, Böcker KBE, Bruins Slot LCJAF, Verheij RA, Meijboom BR, Dik JW, Bos I. Healthcare utilization patterns of individuals with depression after national policy to increase the mental health workforce in primary care: a data linkage study. BMC PRIMARY CARE 2024; 25:158. [PMID: 38720260 PMCID: PMC11077842 DOI: 10.1186/s12875-024-02402-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/23/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND The deployment of the mental health nurse, an additional healthcare provider for individuals in need of mental healthcare in Dutch general practices, was expected to substitute treatments from general practitioners and providers in basic and specialized mental healthcare (psychologists, psychotherapists, psychiatrists, etc.). The goal of this study was to investigate the extent to which the degree of mental health nurse deployment in general practices is associated with healthcare utilization patterns of individuals with depression. METHODS We combined national health insurers' claims data with electronic health records from general practices. Healthcare utilization patterns of individuals with depression between 2014 and 2019 (N = 31,873) were analysed. The changes in the proportion of individuals treated after depression onset were assessed in association with the degree of mental health nurse deployment in general practices. RESULTS The proportion of individuals with depression treated by the GP, in basic and specialized mental healthcare was lower in individuals in practices with high mental health nurse deployment. While the association between mental health nurse deployment and consultation in basic mental healthcare was smaller for individuals who depleted their deductibles, the association was still significant. Treatment volume of general practitioners was also lower in practices with higher levels of mental health nurse deployment. CONCLUSION Individuals receiving care at a general practice with a higher degree of mental health nurse deployment have lower odds of being treated by mental healthcare providers in other healthcare settings. More research is needed to evaluate to what extent substitution of care from specialized mental healthcare towards general practices might be associated with waiting times for specialized mental healthcare.
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Affiliation(s)
- Jesper T Dros
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands.
- National Health Care Institute, Diemen, the Netherlands.
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands.
| | | | | | | | - Robert A Verheij
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
- National Health Care Institute, Diemen, the Netherlands
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands
| | - Bert R Meijboom
- Tilburg School of Social and Behavioural Sciences, Tilburg University, Tilburg, the Netherlands
| | | | - Isabelle Bos
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
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3
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Damen LJ, Van Tuyl LHD, Korevaar JC, Knottnerus BJ, De Jong JD. Citizens' perspectives on relocating care: a scoping review. BMC Health Serv Res 2024; 24:202. [PMID: 38355575 PMCID: PMC10868012 DOI: 10.1186/s12913-024-10671-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Healthcare systems around the world are facing large challenges. There are increasing demands and costs while at the same time a diminishing health workforce. Without reform, healthcare systems are unsustainable. Relocating care, for example, from hospitals to sites closer to patients' homes, is expected to make a key contribution to keeping healthcare sustainable. Given the significant impact of this initiative on citizens, we conducted a scoping review to provide insight into the factors that influence citizens' attitudes towards relocating care. METHOD A scoping review was conducted. The search was performed in the following databases: Pubmed, Embase, Cinahl, and Scopus. Articles had to include relocating healthcare and citizens' perspectives on this topic and the articles had to be about a European country with a strong primary care system. After applying the inclusion and exclusion criteria, 70 articles remained. RESULTS Factors positively influencing citizens' attitudes towards relocating care included: convenience, familiarity, accessibility, patients having more control over their disease, and privacy. Factors influencing negative attitudes included: concerns about the quality of care, familiarity, the lack of physical examination, contact with others, convenience, and privacy. Furthermore, in general, most citizens preferred to relocate care in the studies we found, especially from the hospital to care provided at home. CONCLUSION Several factors influencing the attitude of citizens towards relocating care were found. These factors are very important when determining citizens' preferences for the location of their healthcare. The majority of studies in this review reported that citizens are in favour of relocating care. In general citizens' perspectives on relocating care are very often missing in articles. It was significant that very few studies on relocation from the hospital to the general practitioner were identified.
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Affiliation(s)
- L J Damen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands.
| | - L H D Van Tuyl
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J C Korevaar
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- The Hague University of Applied Sciences, The Hague, the Netherlands
| | - B J Knottnerus
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - J D De Jong
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- CAPHRI, Maastricht University, PO Box 616, 6200 MD Maastricht, Maastricht, the Netherlands
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4
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Albada T, Berger MY, Brunninkhuis W, van Kalken D, Vermeulen KM, Damstra RJ, Holtman GA. A care substitution service in the Netherlands: impact on referral, cost, and patient satisfaction. BMC PRIMARY CARE 2023; 24:171. [PMID: 37658285 PMCID: PMC10472548 DOI: 10.1186/s12875-023-02137-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND In care substitution services, medical specialists offer brief consultations to provide general practitioners (GPs) with advice on diagnosis, treatment, or hospital referral. When GPs serve as gatekeepers to secondary care, these regional services could reduce pressures on healthcare systems. The aim is to determine the impact of implementing a care substitution service for dermatology, orthopaedics, and cardiology on the hospital referral rate, health care costs, and patient satisfaction. METHODS A before-after study was used to evaluate hospital referral rates and health care costs during a follow-up period of 1 year. The study population comprised patients with eligible International Classification of Primary Care codes for referral to the care substitution service (only dermatology, orthopaedic, cardiology indications), as pre-defined by GPs and medical specialists. We compared referral rates before and after implementation by χ2 tests and evaluated patient preference by qualitative analysis. RESULTS In total, 4,930 patients were included, 2,408 before and 2,522 after implementation. The care substitution service decreased hospital referrals during the follow-up period from 15 to 11%. The referral rate decreased most for dermatology (from 15 to 9%), resulting in a cost reduction of €10.59 per patient, while the other two specialisms experienced smaller reductions in referral rates. Patients reported being satisfied, mainly because of the null cost, improved organisation, improved care, and positive experience of the consultation. CONCLUSIONS The care substitution service showed promise for specialisms that require fewer hospital facilities, as exemplified by dermatology.
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Affiliation(s)
- Trijntje Albada
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - Marjolein Y Berger
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands
| | - Wim Brunninkhuis
- Project Group Care Substitution Service Regiopoli Sunenz Drachten, Drachten, the Netherlands
| | - Daphne van Kalken
- Project Group Care Substitution Service Regiopoli Sunenz Drachten, Drachten, the Netherlands
| | - Karin M Vermeulen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robert J Damstra
- Department of Dermatology, Phlebology and Lympho-vascular Medicine, Nij Smellinghe Hospital, Drachten, the Netherlands
| | - Gea A Holtman
- Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands.
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Wackers E, van Dulmen S, Berden B, Kremer J, Stadhouders N, Jeurissen P. Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands. Int J Health Policy Manag 2023; 12:7243. [PMID: 37579390 PMCID: PMC10425645 DOI: 10.34172/ijhpm.2023.7243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Hospital strategies aimed at increasing quality of care and simultaneously reducing costs show potential to improve healthcare, but knowledge on real-world effectiveness is limited. In 2014, two Dutch hospitals introduced such quality-driven strategies. Our aim was to evaluate contexts, mechanisms, and outcomes of both strategies using multiple perspectives. METHODS We conducted a mixed methods evaluation. Four streams of data were collected and analysed: (1) semi-structured interviewing of 62 stakeholders, such as medical doctors, nurses, managers, general practitioners (GPs), and consultants; (2) financial statements of both organisations and other hospitals in the Netherlands (counterfactual); (3) national database of quality indicators, and patient-reported experiences; and (4) existing material on strategy development and effects. RESULTS Both strategies resulted in a relative decrease in volume of care within the hospital, while quality of care has not been affected negatively. One hospital failed to cut operating costs sufficiently, resulting in declining profit margins. We identified six main mechanisms that impacted these outcomes: (1) Quality-improvement projects spur change and commitment; (2) increased coordination between hospital and primary care leads to substitution of care; (3) insufficient use of data and support hinder quality improvement; (4) scaling down hospital facilities is required to convert volume reductions to cost savings; (5) shared savings through global budgets lead to shared efforts between payer and hospital; and (6) financial security for physicians facilitates shift towards quality-driven care. CONCLUSION This integrated analysis of mixed data sources demonstrated that the institution-wide nature of the strategies has induced a shift from a focus on production towards quality of care. Longer-term (financial) sustainability of hospital strategies aimed at decelerating production growth requires significant efforts in reducing fixed costs. This strategy poses financial risks for the hospital if operating costs are insufficiently reduced or if payer alignment is compromised.
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Affiliation(s)
- Erik Wackers
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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6
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Auener SL, Jeurissen PPT, Lok DJA, van Duijn HJ, van Pol PEJ, Westert GP, van Dulmen SA. Use of regional transmural agreements to support the right care in the right place for patients with chronic heart failure-a qualitative study. Neth Heart J 2023; 31:109-116. [PMID: 36507945 PMCID: PMC9742644 DOI: 10.1007/s12471-022-01740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a major challenge for healthcare systems. As these patients' needs vary over time in intensity and complexity, the coordination of care between primary and secondary care is critical for them to receive the right care in the right place. To support the continuum of care needed, Dutch regional transmural agreements (RTAs) between healthcare providers have been developed. However, little is known about how the stakeholders have experienced the development and use of these RTAs. The aim of this study was to gain insight into how stakeholders have experienced the development and use of RTAs for CHF and explore which factors affected this. METHODS We interviewed 25 stakeholders from 9 Dutch regions based on the Measurement Instrument for Determinants of Innovations framework. Interview recordings were transcribed verbatim and analysed through open thematic coding. RESULTS In most cases, the RTA development was considered relatively easy. However, the participants noted that sustainable use of the RTAs faced different complexities and influencing factors. These barriers concerned the following themes: education of primary care providers, referral process, patients' willingness, relationships between healthcare providers, reimbursement by health insurance companies, electronic health record (EHR) systems and outcomes. CONCLUSION Some complexities, such as reimbursement and EHR systems, are likely to benefit from specialised support or a national approach. On a regional level, interregional learning can improve stakeholders' experiences. Future research should focus on quantitative effects of RTAs on outcomes and potential financing models for projects that aim to transition care from one setting to another.
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Affiliation(s)
- Stefan L. Auener
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Patrick P. T. Jeurissen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Dirk J. A. Lok
- grid.413649.d0000 0004 0396 5908Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | | | - Petra E. J. van Pol
- grid.440209.b0000 0004 0501 8269Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert P. Westert
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Simone A. van Dulmen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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Bray L, Krogh TB, Østergaard D. Simulation-based training for continuing professional development within a primary care context: a systematic review. EDUCATION FOR PRIMARY CARE 2023; 34:64-73. [PMID: 36730551 DOI: 10.1080/14739879.2022.2161424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Given the increasing complexity of tasks transferred to primary care, discipline-specific educational opportunities are required for those working within this context. Simulation-based training (SBT) is widely applied within a hospital setting, underpinned by extensive research. However, little is known about the transfer of simulations' utility to primary care. This systematic review sought to determine which SBT approaches are adopted for continuing professional development within primary care and appraise their impact. METHODS Medline, Embase, CINAHL and Web of Science databases were searched, with additional articles obtained through secondary searching. Eligible studies employed and evaluated a simulation-based educational intervention for fully qualified healthcare professionals, working within primary care. Included studies were quality assessed using the Mixed Methods Appraisal Tool (v18) and their findings narratively synthesised. RESULTS Forty-nine studies were included, sampling 4,601 primary care health professionals. Studies primarily adopted a quantitative design and demonstrated variable quality. Simulation approaches comprised standardised patients (n = 21), role-play (n = 14), virtual (n = 6), manikin (n = 5) and mixed manikin/standardised patients (n = 3). Efficacy was evaluated across Kirkpatrick levels and demonstrated a positive impact for knowledge-, skills- and attitude-based outcomes, though this was limited in select studies. DISCUSSION SBT has been adopted in the education of the spectrum of health professionals working within primary care, with the most common approach being standardised patients. Simulation delivers an acceptable and effective educational method, demonstrating a positive impact across various learning objectives. Further research assessing the impact at an organisational- and patient-level is required.
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Affiliation(s)
- Lucy Bray
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
| | - Tobias Browall Krogh
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark
| | - Doris Østergaard
- Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR and Education, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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van den Bogaart EHA, Spreeuwenberg MD, Kroese MEAL, van Hoof SJM, Hameleers N, Ruwaard D. Patients' perspectives on a new delivery model in primary care: A propensity score matched analysis of patient-reported outcomes in a Dutch cohort study. J Eval Clin Pract 2021; 27:344-355. [PMID: 32701197 PMCID: PMC7983912 DOI: 10.1111/jep.13426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/11/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Primary Care Plus (PC+) focuses on the substitution of hospital-based medical care to the primary care setting without moving hospital facilities. The aim of this study was to examine whether population health and experience of care in PC+ could be maintained. Therefore, health-related quality of life (HRQoL) and experienced quality of care from a patient perspective were compared between patients referred to PC+ and to hospital-based outpatient care (HBOC). METHODS This cohort study included patients from a Dutch region, visiting PC+ or HBOC between December 2014 and April 2018. With patient questionnaires (T0, T1 and T2), the HRQoL and experience of care were measured. One-to-two nearest neighbour calliper propensity score matching (PSM) was used to control for potential selection bias. Outcomes were compared using marginal linear models and Pearson chi-square tests. RESULTS One thousand one hundred thirteen PC+ patients were matched to 606 HBOC patients with well-balanced baseline characteristics (SMDs <0.1). Regarding HRQoL outcomes, no significant interaction terms between time and group were found (P > .05), indicating no difference in HRQoL development between the groups over time. Regarding experienced quality of care, no differences were found between PC+ and HBOC patients. Only travel time was significantly shorter in the HBOC group (P ≤ .001). CONCLUSION Results show equal effects on HRQoL outcomes over time between the groups. Regarding experienced quality of care, only differences in travel time were found. Taken as a whole, population health and quality of care were maintained with PC+ and future research should focus more on cost-related outcomes.
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Affiliation(s)
- Esther H. A. van den Bogaart
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
- Research Center for Technology in CareZuyd University of Applied SciencesHeerlenThe Netherlands
| | - Mariëlle E. A. L. Kroese
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Sofie J. M. van Hoof
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Niels Hameleers
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research Care and Public Health Research Institute (CAPHRI) Faculty of Health Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
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Abstract
Introduction Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility. The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners. Methods Scientific databases and reference list were searched. Hits were screened on title/abstract and full text. Studies published between 1990-2018 with any study design were included. Risk of bias assessment was performed using QualSyst tool. Results Search resulted in 5.848 hits, 15 studies were included. Studies investigated nurse practitioners only. Primary care plus was at least equally effective as hospital care (patient-related outcomes). The number of admission/referral rates was significantly reduced in favor of primary care plus. Barriers to implement primary care plus included obtaining equipment, structural funding, direct access to patient-data. Facilitators included multidisciplinary collaboration, medical specialist support, protocols. Conclusions and Discussion Quality of care within primary care plus delivered by nurse practitioners appears to be guaranteed, at patient-level and professional-level, with better access to healthcare and fewer referrals to hospital. Most studies were of restricted methodological quality. Findings should be interpreted with caution.
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Martens H, Steijlen PM, Ruwaard D. Reorganising dermatology care: predictors of the substitution of secondary care with primary care. BMC Health Serv Res 2020; 20:510. [PMID: 32503509 PMCID: PMC7275501 DOI: 10.1186/s12913-020-05368-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/26/2020] [Indexed: 01/18/2023] Open
Abstract
Background The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands.,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Herm Martens
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Peter M Steijlen
- Department of Dermatology and GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229, GT, The Netherlands
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11
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van den Bogaart EHA, Spreeuwenberg MD, Kroese MEAL, van den Boogaart MW, Boymans TAEJ, Ruwaard D. Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting. PLoS One 2020; 15:e0227863. [PMID: 31971964 PMCID: PMC6977750 DOI: 10.1371/journal.pone.0227863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/31/2019] [Indexed: 12/05/2022] Open
Abstract
Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81-0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient's diagnosis and the period (p ≤ 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.
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Affiliation(s)
- Esther H. A. van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Mariëlle E. A. L. Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mark W. van den Boogaart
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tim A. E. J. Boymans
- Department of Orthopaedic Surgery, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Ravensbergen W, Drewes Y, Hilderink H, Verschuuren M, Gussekloo J, Vonk R. Combined impact of future trends on healthcare utilisation of older people: A Delphi study. Health Policy 2019; 123:947-954. [DOI: 10.1016/j.healthpol.2019.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/22/2019] [Accepted: 07/07/2019] [Indexed: 11/30/2022]
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van Hoof SJM, Quanjel TCC, Kroese MEAL, Spreeuwenberg MD, Ruwaard D. Substitution of outpatient hospital care with specialist care in the primary care setting: A systematic review on quality of care, health and costs. PLoS One 2019; 14:e0219957. [PMID: 31369567 PMCID: PMC6675042 DOI: 10.1371/journal.pone.0219957] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/03/2019] [Indexed: 01/17/2023] Open
Abstract
RATIONALE, AIMS AND OBJECTIVE Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting. METHOD The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible. RESULTS A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers. CONCLUSIONS Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design.
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Affiliation(s)
- Sofie J. M. van Hoof
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Mariëlle E. A. L. Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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14
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Smeele P, Kroese MEAL, Spreeuwenberg MD, Ruwaard D. Substitution of hospital care with Primary Care Plus: differences in referral patterns according to specialty, specialist and diagnosis group. BMC FAMILY PRACTICE 2019; 20:81. [PMID: 31185921 PMCID: PMC6560871 DOI: 10.1186/s12875-019-0961-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 05/06/2019] [Indexed: 01/17/2023]
Abstract
Background Primary Care Plus (PC+) is an intervention where patients consult specialists in a primary care setting outside the hospital. Two facilities have been founded in the city of Maastricht, the Netherlands. Main aim is to achieve substitution of hospital care with primary care and hence reduce costs. The objective of this study is to evaluate referral patterns per specialty, specialist and diagnosis group, as input for deliberations to optimise substitution. Methods Prospectively collected referral data after PC+ consultations between November 2014 and March 2016 was analysed for eight participating specialties. Primary outcomes were differences in referral patterns per specialty, specialist and diagnosis group. Absolute counts and percentages were recorded for categorical variables, means and standard deviations for continuous variables. Statistical analyses were performed using IBM SPSS Statistics 23 (SPSS Inc., Chicago, IL). Results In total 4536 patients were seen in PC+; 3132 (69.0%) were referred back to the general practitioner (GP), whereas 1275 (28.1%) were referred to secondary care. Referral information of 130 (2.9%) patients was unknown. Large differences in referral numbers to secondary care after PC+ consultation were found between specialties (from 8.6% (gynaecology) to 43.8% (orthopaedic surgery)), specialists (14.5 to 65.2%) and diagnosis groups (11.1 to 93.4%). Conclusions Wide variation in referral numbers to secondary care between specialties, specialists and diagnosis groups exists after PC+ consultations. This data indicates that deliberation and further research is needed in order to optimize substitution initiatives like PC+.
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Affiliation(s)
- Paul Smeele
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
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Quanjel TCC, Spreeuwenberg MD, Struijs JN, Baan CA, Ruwaard D. Substituting hospital-based outpatient cardiology care: The impact on quality, health and costs. PLoS One 2019; 14:e0217923. [PMID: 31150520 PMCID: PMC6544378 DOI: 10.1371/journal.pone.0217923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many Western countries face the challenge of providing high-quality care while keeping the healthcare system accessible and affordable. In an attempt to deal with this challenge a new healthcare delivery model called primary care plus (PC+) was introduced in the Netherlands. Within the PC+ model, medical specialists perform consultations in a primary care setting. PC+ aims to support the general practitioners in gatekeeping and prevent unnecessary referrals to hospital care. The aim of this study was to examine the effects of a cardiology PC+ intervention on the Triple Aim outcomes, which were operationalized by patient-perceived quality of care, health-related quality of life (HRQoL) outcomes, and healthcare costs per patient. METHODS This is a quantitative study with a longitudinal observational design. The study population consisted of patients, with non-acute and low-complexity cardiology-related health complaints, who were referred to the PC+ centre (intervention group) or hospital-based outpatient care (control group; care-as-usual). Patient-perceived quality of care and HRQoL (EQ-5D-5L, EQ-VAS and SF-12) were measured through questionnaires at three different time points. Healthcare costs per patient were obtained from administrative healthcare data and patients were followed for nine months. Chi-square tests, independent t-tests and multilevel linear models were used to analyse the data. RESULTS The patient-perceived quality of care was significantly higher within the intervention group for 26 out of 27 items. HRQoL outcomes did significantly increase in both groups (P <0.05) but there was no significant interaction between group and time. At baseline and also at three, six and nine months' follow-up the healthcare costs per patient were significantly lower for patients in the intervention group (P<0.001). CONCLUSIONS While this study showed no improvements on HRQoL outcomes, PC+ seemed to be promising as it results in improved quality of care as experienced by patients and lower healthcare costs per patient.
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Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department for Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Caroline A. Baan
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Noels EC, Wakkee M, van den Bos RR, Bindels PJE, Nijsten T, Lugtenberg M. Substitution of low-risk skin cancer hospital care towards primary care: A qualitative study on views of general practitioners and dermatologists. PLoS One 2019; 14:e0213595. [PMID: 30889211 PMCID: PMC6424446 DOI: 10.1371/journal.pone.0213595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/25/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Rising healthcare expenditures places the potential for substitution of hospital care towards primary care high on the political agenda. As low-risk basal cell carcinoma (BCC) care is one of the potential targets for substitution of hospital care towards primary care the objective of this study is to gain insight in the views of healthcare professionals regarding substitution of skin cancer care, and to identify perceived barriers and potential strategies to facilitate substitution. METHODS A qualitative study was conducted consisting of 40 interviews with dermatologists and GPs and three focus groups with 18 selected GPs with noted willingness regarding substitution of skin cancer care. The interviews and focus groups focused on general views, perceived barriers and potential strategies to facilitate substitution of skin cancer care, using predefined topic lists. All sessions were audio-taped, transcribed verbatim and analyzed using the program AtlasTi. RESULTS GPs were generally positive regarding substitution of skin care whereas dermatologists expressed more concerns. Lack of trust in GPs to adequately perform skin cancer care and a preference of patients for dermatologists are reported as barriers by dermatologists. The main barriers reported by GPs were a lack of confidence in own skills to perform skin cancer care, a lack of trust from both patients and dermatologists and limited time and financial compensation. Facilitating strategies suggested by both groups mainly focused on improving GPs' education and improving the collaboration between primary and secondary care. GPs additionally suggested efforts from dermatologists to increase their own and patients' trust in GPs, and time and financial compensation. The selected group of GPs suggested practical solutions to facilitate substitution focusing on changes in organizational structure including horizontal referring, outreach models and practice size reduction. CONCLUSIONS GPs and, to lesser extent, dermatologists are positive regarding substitution of low-risk BCC care, though report substantial barriers that need to be addressed before substitution can be further implemented. Aside from essential strategies such as improving GPs' skin cancer education and time and financial compensation, rearranging the organizational structure in primary care and between primary and secondary care may facilitate effective and safe substitution of low-risk BCC care.
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Affiliation(s)
- E. C. Noels
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M. Wakkee
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - R. R. van den Bos
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - P. J. E. Bindels
- Department of General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T. Nijsten
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - M. Lugtenberg
- Department of Dermatology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Quanjel TCC, Struijs JN, Spreeuwenberg MD, Baan CA, Ruwaard D. Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands. BMC FAMILY PRACTICE 2018; 19:55. [PMID: 29743021 PMCID: PMC5941471 DOI: 10.1186/s12875-018-0734-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/18/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. METHODS This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. RESULTS In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. CONCLUSIONS To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. TRIAL REGISTRATION NUMBER NTR6629 (Data registered: 25-08-2017) (registered retrospectively).
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Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marieke D. Spreeuwenberg
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Caroline A. Baan
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Quanjel TCC, Winkens A, Spreeuwenberg MD, Struijs JN, Winkens RAG, Baan CA, Ruwaard D. Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care? Scand J Prim Health Care 2018; 36:99-106. [PMID: 29376458 PMCID: PMC5901446 DOI: 10.1080/02813432.2018.1426147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention. DESIGN A retrospective interrupted times series study. SETTING Two multidisciplinary general practitioner (GP) practices. INTERVENTION An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings. SUBJECTS The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting. MAIN OUTCOME MEASURES The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period. RESULTS It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period. CONCLUSIONS This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting. Key Points An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.
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Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anne Winkens
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department for Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ron A. G. Winkens
- Diagnostic Centre, Maastricht University Medical Centre (Maastricht UMC+), Maastricht, The Netherlands
| | - Caroline A. Baan
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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19
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Karam M, Brault I, Van Durme T, Macq J. Comparing interprofessional and interorganizational collaboration in healthcare: A systematic review of the qualitative research. Int J Nurs Stud 2017; 79:70-83. [PMID: 29202313 DOI: 10.1016/j.ijnurstu.2017.11.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 10/11/2017] [Accepted: 11/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Interprofessional and interorganizational collaboration have become important components of a well-functioning healthcare system, all the more so given limited financial resources, aging populations, and comorbid chronic diseases. The nursing role in working alongside other healthcare professionals is critical. By their leadership, nurses can create a culture that encourages values and role models that favour collaborative work within a team context. OBJECTIVES To clarify the specific features of conceptual frameworks of interprofessional and interorganizational collaboration in the healthcare field. This review, accordingly, offers insights into the key challenges facing policymakers, managers, healthcare professionals, and nurse leaders in planning, implementing, or evaluating interprofessional collaboration. DESIGN This systematic review of qualitative research is based on the Joanna Briggs Institute's methodology for conducting synthesis. DATA SOURCES Cochrane, JBI, CINAHL, Embase, Medline, Scopus, Academic Search Premier, Sociological Abstract, PsycInfo, and ProQuest were searched, using terms such as professionals, organizations, collaboration, and frameworks. METHODS Qualitative studies of all research design types describing a conceptual framework of interprofessional or interorganizational collaboration in the healthcare field were included. They had to be written in French or English and published in the ten years between 2004 and 2014. RESULTS Sixteen qualitative articles were included in the synthesis. Several concepts were found to be common to interprofessional and interorganizational collaboration, such as communication, trust, respect, mutual acquaintanceship, power, patient-centredness, task characteristics, and environment. Other concepts are of particular importance either to interorganizational collaboration, such as the need for formalization and the need for professional role clarification, or to interprofessional collaboration, such as the role of individuals and team identity. Promoting interorganizational collaboration was found to face greater challenges, such as achieving a sense of belonging among professionals when differences exist between corporate cultures, geographical distance, the multitude of processes, and formal paths of communication. CONCLUSIONS This review sets a direction to follow for implementing changes that meet the challenge of a changing healthcare system and the transition towards non-institutional care. It also shows that collaboration between nurses and healthcare professionals from different healthcare organizations is still poorly explored. This is a major limitation in the existing scientific literature, especially given the potential role that could be played by nurses in enhancing interorganizational collaboration.
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Affiliation(s)
- Marlène Karam
- Catholic University of Louvain, Faculty of Public Health, Institute of Health and Society, Clos-Chapelle-aux-Champs, 30, PO Box B1.30.01, 1200 Brussels, Belgium.
| | | | - Thérèse Van Durme
- Catholic University of Louvain, Faculty of Public Health, Institute of Health and Society, Clos-Chapelle-aux-Champs, 30, PO Box B1.30.01, 1200 Brussels, Belgium.
| | - Jean Macq
- Catholic University of Louvain, Faculty of Public Health, Institute of Health and Society, Clos-Chapelle-aux-Champs, 30, PO Box B1.30.01, 1200 Brussels, Belgium.
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20
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Ahmadi K, Prickaerts E, Smeets J, Joosten V, Kelleners-Smeets N, Dinant G. Current approach of skin lesions suspected of malignancy in general practice in the Netherlands: a quantitative overview. J Eur Acad Dermatol Venereol 2017; 32:236-241. [DOI: 10.1111/jdv.14484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/19/2017] [Indexed: 12/11/2022]
Affiliation(s)
- K. Ahmadi
- Department of Family Medicine; Maastricht University Medical Centre; Maastricht The Netherlands
| | - E. Prickaerts
- Department of Dermatology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - J.G.E. Smeets
- Department of Family Medicine; Maastricht University Medical Centre; Maastricht The Netherlands
- General Practice; Health Care Centre Heer; Maastricht The Netherlands
| | - V.H.M.J. Joosten
- Department of Dermatology; Maastricht University Medical Centre; Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht The Netherlands
| | - N.W.J. Kelleners-Smeets
- Department of Dermatology; Maastricht University Medical Centre; Maastricht The Netherlands
- GROW Research Institute for Oncology and Developmental Biology; Maastricht The Netherlands
| | - G.J. Dinant
- Department of Family Medicine; Maastricht University Medical Centre; Maastricht The Netherlands
- CAPHRI School for Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
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van Hoof SJM, Spreeuwenberg MD, Kroese MEAL, Steevens J, Meerlo RJ, Hanraets MMH, Ruwaard D. Substitution of outpatient care with primary care: a feasibility study on the experiences among general practitioners, medical specialists and patients. BMC FAMILY PRACTICE 2016; 17:108. [PMID: 27506455 PMCID: PMC4979105 DOI: 10.1186/s12875-016-0498-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 07/21/2016] [Indexed: 01/17/2023]
Abstract
Background Reinforcing the gatekeeping role of general practitioners (GPs) by embedding specialist knowledge into primary care is seen as a possibility for stimulating a more sustainable healthcare system and avoiding unnecessary referrals to outpatient care. An intervention called Primary Care Plus (PC+) was developed to achieve these goals. The objective of this study is to gain insight into: (1) the content and added value of PC+ consultations according to stakeholders, and (2) patient satisfaction with PC+ compared to outpatient care. Methods A feasibility study was conducted in the southern part of the Netherlands between April 2013 and January 2014. Data was collected using GP, medical specialist and patient questionnaires. Patient characteristics and medical specialty data were collected through the data system of a GP referral department. Results GPs indicated that they would have referred 85.4 % of their PC+ patients to outpatient care in the hypothetical case that PC+ was not available. Medical specialists indicated that about one fifth of the patients needed follow-up in outpatient care and 75.9 % of the consultations were of added value to patient care. The patient satisfaction results appear to be in favour of PC+. Conclusion PC+ seems to be a feasible intervention to be implemented on a larger scale, because it has the potential to prevent unnecessary hospital referrals. PC+ will be evaluated on a larger scale regarding the effects on health outcomes, quality of care and costs (Triple Aim principle).
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Affiliation(s)
- Sofie J M van Hoof
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. .,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jessie Steevens
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Ronald J Meerlo
- Primary Care Organisation Care In Development ZIO, Wilhelminasingel 81, 6221 BG, Maastricht, The Netherlands
| | - Monique M H Hanraets
- Department of Patient and Care, Academic Hospital Maastricht azM, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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