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BMC Primary Care
Published in: BMC Primary Care 1/2016

Open Access 01-12-2016 | Research article

Substitution of outpatient care with primary care: a feasibility study on the experiences among general practitioners, medical specialists and patients

Authors: Sofie J. M. van Hoof, Marieke D. Spreeuwenberg, Mariëlle E. A. L. Kroese, Jessie Steevens, Ronald J. Meerlo, Monique M. H. Hanraets, Dirk Ruwaard

Published in: BMC Primary Care | Issue 1/2016

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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).
Literature
1.
Przywara B. Projecting future health care expenditure at European level: drivers, methodology and main results: Directorate General Economic and Monetary Affairs (DG ECFIN), European Commission. 2010.
2.
3.
4.
Rijksoverheid. Naar beter betaalbare zorg. In: Ministerie van Volksgezondheid Welzijn en Sport. Rapport Taskforce Beheersing Zorguitgaven. Den Haag: Rijksoverheid; 2012 [in Dutch].
5.
O'Donnell CA. Variation in GP referral rates: what can we learn from the literature? Fam Pract. 2000;17(6):462–71.CrossRefPubMed
6.
Smith SM, O’Kelly S, O’Dowd T. GPs’ and pharmacists’ experiences of managing multimorbidity: a ‘Pandora’s box’. Br J Gen Pract. 2010;60(576):e285–94.CrossRefPubMedCentral
7.
Saltman RB, Rico A, Boerma W. Primary care in the driver’s seat? Organizational reform in European primary care. McGraw Hill Education: Open University Press; 2006.
8.
Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015; 350(h176).
9.
Nolte E, Knai C, Hofmarcher M, Conklin A, Erler A, Elissen A, et al. Overcoming fragmentation in health care: chronic care in Austria, Germany and The Netherlands. Health Econ Policy L. 2012;7(01):125–46.CrossRef
10.
Leiba A, Martonovits G, Magnezi R, Goldberg A, Carroll J, Benedek P, et al. Evaluation of a specialist outreach clinic in a primary healthcare setting: the effect of easy access to specialists. Clin Manag. 2002;11(3):131–6.
11.
12.
Bond M, Bowling A, Abery A, McClay M, Dickinson E. Evaluation of outreach clinics held by specialists in general practice in England. J Epidemiol Commun H. 2000;54(2):149–56.CrossRef
13.
Bowling A, Bond M. A national evaluation of specialists' clinics in primary care settings. Brit J Gen Pract. 2001;51(465):264–9.
14.
Bowling A, Stramer K, Dickinson E, Windsor J, Bond M. Evaluation of specialists' outreach clinics in general practice in England: process and acceptability to patients, specialists, and general practitioners. J Epidemiol Commun H. 1997;51(1):52–61.CrossRef
15.
Gruen R, Weeramanthri T, Knight S, Bailie R. Specialist outreach clinics in primary care and rural hospital settings (Cochrane Review). Community eye health/International Centre for Eye Health. 2006;19(58):31.PubMedPubMedCentral
16.
Schulpen G, Vierhout W, Van der Heijde D, Landewe R, Winkens R, Van der Linden S. Joint consultation of general practitioner and rheumatologist: does it matter? Ann Rheum Dis. 2003;62(2):159–61.CrossRefPubMedPubMedCentral
17.
Vlek J, Vierhout W, Knottnerus J, Schmitz J, Winter J, Wesselingh-Megens A, et al. A randomised controlled trial of joint consultations with general practitioners and cardiologists in primary care. Brit J Gen Pract. 2003;53(487):108–12.
18.
Powell J. Systematic review of outreach clinics in primary care in the UK. J Health Serv Res Po. 2002;7(3):177–83.CrossRef
19.
Welch HG, Schwarts L, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. Boston: Beacon; 2011.
20.
Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affair. 2008;27(3):759–69.CrossRef
21.
Ministerie van Volksgezondheid, Welzijn en Sport. Onderhandelingsresultaten Schippers met ziekenhuizen, medisch specialisten, zelfstandige behandelcentra, GGZ en huisartsen. [Negotiation results of Minister Schippers with hospitals, medical specialists, independent treatment centres,mental health care and GPs.]. Ministerie van Volksgezondheid, Welzijn en Sport.’s-Gravenhage 2013. [in Dutch].
22.
Van Hoof SJM, Kroese MEAL, Spreeuwenberg MD, Elissen AMJ, Meerlo RJ, Hanraets MMH, et al. Substitution of hospital care with primary care: defining the conditions of Primary Care Plus. Int J Integr Care. 2016;16(1):1–11.CrossRef
23.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluation complex interventions: the new Medical Research Council guidance. Brit Med J. 2008;337:1655.CrossRef
24.
Schulpen G, Meerlo R, van Uden C, Dekkers T, van Hees A, Maes J. Blauwe Zorg. Regio-experiment voor duurzame zorg in Maastricht en Heuvelland. Maastricht: ZIO, VGZ and Huis voor de Zorg; 2012 [in Dutch].
25.
Donselaar GC, de Boer D, van der Hoek L, Krol MW, Rademakers J, Delnoij DMJ. Ervaringen van verzekerden met de zorg en de zorgverzekeraars. CQ-index Zorg en Zorgverzekering, meting 2011. Nivel. 2011. [in Dutch]
26.
Greenfield S, Nelson EC, Zubkoff M, Manning W, Rogers W, Kravitz RL, et al. Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA. 1992;267(12):1624–30.CrossRefPubMed
27.
Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the Chronic Care Model in the new millennium. Health Affair. 2009;28(1):75–85.CrossRef
28.
Smith SM, Allwright S, O’Dowd T. Effectiveness of shared care across the interface between primary and specialty care in chronic disease management. Cochrane Db Syst Rev. 2007;3.
29.
Mattke S, Seid M, Ma S. Evidence for the effect of disease management: is $1 billion a year a good investment? Am J Manag Care. 2007;13(12):670.PubMed
30.
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet. 2003;362(9391):1225–30.CrossRefPubMed
31.
Gill L, White L. A critical review of patient satisfaction. Leadersh Health Serv. 2009;22(1):8–19.CrossRef
32.
Metadata
Title
Substitution of outpatient care with primary care: a feasibility study on the experiences among general practitioners, medical specialists and patients
Authors
Sofie J. M. van Hoof
Marieke D. Spreeuwenberg
Mariëlle E. A. L. Kroese
Jessie Steevens
Ronald J. Meerlo
Monique M. H. Hanraets
Dirk Ruwaard
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2016
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-016-0498-8

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