Limits...
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 ambulatory hospital care, 2006–2011 (index:2006), in intervention district and control districts. Difference in actual versus expected ambulatory hospital care (2006 = index)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Trend in actual versus expected weighted number units, for ambulatory hospital care, 2006–2011 (index:2006), in intervention district and control districts. Difference in actual versus expected ambulatory hospital care (2006 = index)

Mentions: All districts show an increase in ambulatory care from 2009 and onwards, but this remains clearly lower than expected in the intervention district, in all years (Table 4). In control district 1 ambulatory care use is only above the expected level in 2011, while in control district 2 it is well above the expected level during the whole study period. As a result, the difference between the actual and expected levels of the intervention district and the two districts increased over time (Fig. 3). Looking at clinical care, all districts show a reduction in the difference between actual and expected average use, though the numbers are small and do not seem to differ much across districts (Table 4). While the differences with the control districts are small, the intervention district shows the largest negative difference between actual and expected use of clinical care from 2009 and onwards. The number of 1-day hospitalizations of residents in all districts is above expectation, with small differences between districts. The intervention district shows the largest decrease between actual and expected use of 1-day hospitalizations.Table 4


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 ambulatory hospital care, 2006–2011 (index:2006), in intervention district and control districts. Difference in actual versus expected ambulatory hospital care (2006 = index)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Trend in actual versus expected weighted number units, for ambulatory hospital care, 2006–2011 (index:2006), in intervention district and control districts. Difference in actual versus expected ambulatory hospital care (2006 = index)
Mentions: All districts show an increase in ambulatory care from 2009 and onwards, but this remains clearly lower than expected in the intervention district, in all years (Table 4). In control district 1 ambulatory care use is only above the expected level in 2011, while in control district 2 it is well above the expected level during the whole study period. As a result, the difference between the actual and expected levels of the intervention district and the two districts increased over time (Fig. 3). Looking at clinical care, all districts show a reduction in the difference between actual and expected average use, though the numbers are small and do not seem to differ much across districts (Table 4). While the differences with the control districts are small, the intervention district shows the largest negative difference between actual and expected use of clinical care from 2009 and onwards. The number of 1-day hospitalizations of residents in all districts is above expectation, with small differences between districts. The intervention district shows the largest decrease between actual and expected use of 1-day hospitalizations.Table 4

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.