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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 different types of GP care, 2006–2011 (index:2006), in intervention district and control districts. a Difference in actual versus expected number of regular GP consultations (2006 = index). b Difference in actual versus expected number of long GP consultations (2006 = index)
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Fig2: Trend in actual versus expected weighted number units, for different types of GP care, 2006–2011 (index:2006), in intervention district and control districts. a Difference in actual versus expected number of regular GP consultations (2006 = index). b Difference in actual versus expected number of long GP consultations (2006 = index)

Mentions: The divergent trends in total GP care between the intervention district and the control districts appears to conceal different patterns for different types of GP use (Table 3). Regarding regular GP consultations, only residents in the intervention district had less consultations than expected (Table 3). The usage increased since 2007 but remained lower than expected during the study period. Compared to the control districts, the intervention district showed a higher increase in actual use versus expected use with regard to regular and long consultations, GP home visits and evening, night and weekend consultations. This was particularly so in comparison with district 2. As a result, for these types of GP care, we found divergent trends in the difference between actual and expected for the intervention district and control districts (Fig. 2). There were no noticeable differences between districts regarding telephone consultation (Table 3).Table 3


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 different types of GP care, 2006–2011 (index:2006), in intervention district and control districts. a Difference in actual versus expected number of regular GP consultations (2006 = index). b Difference in actual versus expected number of long GP consultations (2006 = index)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Trend in actual versus expected weighted number units, for different types of GP care, 2006–2011 (index:2006), in intervention district and control districts. a Difference in actual versus expected number of regular GP consultations (2006 = index). b Difference in actual versus expected number of long GP consultations (2006 = index)
Mentions: The divergent trends in total GP care between the intervention district and the control districts appears to conceal different patterns for different types of GP use (Table 3). Regarding regular GP consultations, only residents in the intervention district had less consultations than expected (Table 3). The usage increased since 2007 but remained lower than expected during the study period. Compared to the control districts, the intervention district showed a higher increase in actual use versus expected use with regard to regular and long consultations, GP home visits and evening, night and weekend consultations. This was particularly so in comparison with district 2. As a result, for these types of GP care, we found divergent trends in the difference between actual and expected for the intervention district and control districts (Fig. 2). There were no noticeable differences between districts regarding telephone consultation (Table 3).Table 3

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.