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

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.


Related in: MedlinePlus

Average number of visits in primary, outpatient and inpatient care, by condition,2005 and 2012. Asth – asthma; COPD – chronic obstructivepulmonary disease; Depr – depression; Diab – diabetes;HF – heart failure; Hyp – hypertension; IHD – ischemicheart disease.
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Figure 4: Average number of visits in primary, outpatient and inpatient care, by condition,2005 and 2012. Asth – asthma; COPD – chronic obstructivepulmonary disease; Depr – depression; Diab – diabetes;HF – heart failure; Hyp – hypertension; IHD – ischemicheart disease.

Mentions: The average number of visits to PHC and hospitals rose with increasing age andmulti–morbidity, with the highest inpatient admission rate observed for patientsthat had four or more ACS conditions in a given year, and in particular for those aged55 and above. (Figure 3, Table 2, and Figure S2 in OnlineSupplementary Document(OnlineSupplementary Document)). Healthcare utilisation varied bycondition: patients that had at least one health contact in a given year with a primarydiagnosis of diabetes or hypertension utilised PHC services more frequently thanpatients with other diagnoses. Average number of outpatient visits was higher forpatients with diabetes, COPD, asthma and depression, and rose significantly for patientswith COPD in 2012, whereas patients with IHD or COPD had more frequent inpatientadmissions (Figure 4).


Shifting chronic disease management from hospitals to primary care inEstonian health system: analysis of national panel data
Average number of visits in primary, outpatient and inpatient care, by condition,2005 and 2012. Asth – asthma; COPD – chronic obstructivepulmonary disease; Depr – depression; Diab – diabetes;HF – heart failure; Hyp – hypertension; IHD – ischemicheart disease.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Average number of visits in primary, outpatient and inpatient care, by condition,2005 and 2012. Asth – asthma; COPD – chronic obstructivepulmonary disease; Depr – depression; Diab – diabetes;HF – heart failure; Hyp – hypertension; IHD – ischemicheart disease.
Mentions: The average number of visits to PHC and hospitals rose with increasing age andmulti–morbidity, with the highest inpatient admission rate observed for patientsthat had four or more ACS conditions in a given year, and in particular for those aged55 and above. (Figure 3, Table 2, and Figure S2 in OnlineSupplementary Document(OnlineSupplementary Document)). Healthcare utilisation varied bycondition: patients that had at least one health contact in a given year with a primarydiagnosis of diabetes or hypertension utilised PHC services more frequently thanpatients with other diagnoses. Average number of outpatient visits was higher forpatients with diabetes, COPD, asthma and depression, and rose significantly for patientswith COPD in 2012, whereas patients with IHD or COPD had more frequent inpatientadmissions (Figure 4).

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.


Related in: MedlinePlus