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How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study.

Kringos DS, van den Broeke JR, van der Lee AP, Plochg T, Stronks K - BMC Public Health (2016)

Bottom Line: And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards.The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands. d.s.kringos@amc.uva.nl.

ABSTRACT

Background: To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.

Methods: We compared expected (based on consumption patterns of a health insurers' total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006-2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.

Results: Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.

Conclusions: Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more 'comprehensive' integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.

No MeSH data available.


Trend in actual versus expected weighted number units, for total GP care and total hospital care, 2006–2011 (index:2006), in intervention district and control districts. a. Difference in actual versus expected weighted number of GP care units (2006 = index). b Difference in actual versus expected weighted number of hospital care units (2006 = index)
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Fig1: Trend in actual versus expected weighted number units, for total GP care and total hospital care, 2006–2011 (index:2006), in intervention district and control districts. a. Difference in actual versus expected weighted number of GP care units (2006 = index). b Difference in actual versus expected weighted number of hospital care units (2006 = index)

Mentions: Table 2 shows the actual and expected average health care use per 1000 insured clients, regarding total GP care and total hospital care. Residents in the intervention district are using more GP care than expected from 2007 onwards. Also in both control districts, during the whole study period, the use of GP care was higher than expected. In control district 2 the number of actual versus expected total GP care decreased over time. If we relate the use of care from 2007 onwards to the index year 2006, it becomes clear that the total GP care increased more in the intervention district than in the control districts, particularly compared to control district 2 (Fig. 1).Table 2


How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study.

Kringos DS, van den Broeke JR, van der Lee AP, Plochg T, Stronks K - BMC Public Health (2016)

Trend in actual versus expected weighted number units, for total GP care and total hospital care, 2006–2011 (index:2006), in intervention district and control districts. a. Difference in actual versus expected weighted number of GP care units (2006 = index). b Difference in actual versus expected weighted number of hospital care units (2006 = index)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940836&req=5

Fig1: Trend in actual versus expected weighted number units, for total GP care and total hospital care, 2006–2011 (index:2006), in intervention district and control districts. a. Difference in actual versus expected weighted number of GP care units (2006 = index). b Difference in actual versus expected weighted number of hospital care units (2006 = index)
Mentions: Table 2 shows the actual and expected average health care use per 1000 insured clients, regarding total GP care and total hospital care. Residents in the intervention district are using more GP care than expected from 2007 onwards. Also in both control districts, during the whole study period, the use of GP care was higher than expected. In control district 2 the number of actual versus expected total GP care decreased over time. If we relate the use of care from 2007 onwards to the index year 2006, it becomes clear that the total GP care increased more in the intervention district than in the control districts, particularly compared to control district 2 (Fig. 1).Table 2

Bottom Line: And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards.The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health, Academic Medical Center (AMC), University of Amsterdam, PO-box 22660, Amsterdam, 1100 DD, The Netherlands. d.s.kringos@amc.uva.nl.

ABSTRACT

Background: To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.

Methods: We compared expected (based on consumption patterns of a health insurers' total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006-2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.

Results: Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.

Conclusions: Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more 'comprehensive' integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems.

No MeSH data available.