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Shifting chronic disease management from hospitals to primary care inEstonian health system: analysis of national panel data

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ABSTRACT

Background: Following independence from the Soviet Union in 1991, Estonia introduced anational insurance system, consolidated the number of health care providers, andintroduced family medicine centred primary health care (PHC) to strengthen thehealth system.

Methods: Using routinely collected health billing records for 2005–2012, we examinehealth system utilisation for seven ambulatory care sensitive conditions (ACSCs)(asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and bypatient characteristics (gender, age, and number of co–morbidities). Thedata set contained 552 822 individuals. We use patient level data to testthe significance of trends, and employ multivariate regression analysis toevaluate the probability of inpatient admission while controlling for patientcharacteristics, health system supply–side variables, and PHC use.

Findings: Over the study period, utilisation of PHC increased, whilst inpatient admissionsfell. Service mix in PHC changed with increases in phone, email, nurse, andfollow–up (vs initial) consultations. Healthcare utilisation for diabetes,depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failureand asthma utilisation in outpatient and inpatient settings increased.Multivariate regression indicates higher probability of inpatient admission formales, older patient and especially those with multimorbidity, but protectiveeffect for PHC, with significantly lower hospital admission for those utilisingPHC services.

Interpretation: Our findings suggest health system reforms in Estonia have influenced the shift ofACSCs from secondary to primary care, with PHC having a protective effect inreducing hospital admissions.

No MeSH data available.


Proportion of primary health care consultations by type.
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Figure 2: Proportion of primary health care consultations by type.

Mentions: PHC consultations for ACSCs rose by 38.8%, from 728 885 in 2005 to1 011 906 in 2012. More than 90% of consultations took place in familydoctors’ offices, with the proportion decreasing from 93.9% to 85.2% of PHCconsultations during the study period. Home visits as a percentage of all PHC contactsalso declined (3.3% to 1.3%). There was a six–fold increase in the use of phoneconsultations in PHC from 20 000 calls in 2005 to 135 000 in 2012 (2.8% to13.4%), and email consultations, which have been recorded since 2010, rose to 907 in2012 (Figure 1 and Figure 2).


Shifting chronic disease management from hospitals to primary care inEstonian health system: analysis of national panel data
Proportion of primary health care consultations by type.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5017034&req=5

Figure 2: Proportion of primary health care consultations by type.
Mentions: PHC consultations for ACSCs rose by 38.8%, from 728 885 in 2005 to1 011 906 in 2012. More than 90% of consultations took place in familydoctors’ offices, with the proportion decreasing from 93.9% to 85.2% of PHCconsultations during the study period. Home visits as a percentage of all PHC contactsalso declined (3.3% to 1.3%). There was a six–fold increase in the use of phoneconsultations in PHC from 20 000 calls in 2005 to 135 000 in 2012 (2.8% to13.4%), and email consultations, which have been recorded since 2010, rose to 907 in2012 (Figure 1 and Figure 2).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Following independence from the Soviet Union in 1991, Estonia introduced anational insurance system, consolidated the number of health care providers, andintroduced family medicine centred primary health care (PHC) to strengthen thehealth system.

Methods: Using routinely collected health billing records for 2005–2012, we examinehealth system utilisation for seven ambulatory care sensitive conditions (ACSCs)(asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and bypatient characteristics (gender, age, and number of co–morbidities). Thedata set contained 552 822 individuals. We use patient level data to testthe significance of trends, and employ multivariate regression analysis toevaluate the probability of inpatient admission while controlling for patientcharacteristics, health system supply–side variables, and PHC use.

Findings: Over the study period, utilisation of PHC increased, whilst inpatient admissionsfell. Service mix in PHC changed with increases in phone, email, nurse, andfollow–up (vs initial) consultations. Healthcare utilisation for diabetes,depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failureand asthma utilisation in outpatient and inpatient settings increased.Multivariate regression indicates higher probability of inpatient admission formales, older patient and especially those with multimorbidity, but protectiveeffect for PHC, with significantly lower hospital admission for those utilisingPHC services.

Interpretation: Our findings suggest health system reforms in Estonia have influenced the shift ofACSCs from secondary to primary care, with PHC having a protective effect inreducing hospital admissions.

No MeSH data available.