Reorganising dermatology care: predictors of the substitution of secondary care with primary care

Autor: Mariëlle E. A. L. Kroese, Marieke D. Spreeuwenberg, Dirk Ruwaard, Esther H. A. van den Bogaart, Herm Martens, Peter M. Steijlen
Přispěvatelé: Health Services Research, RS: CAPHRI - R2 - Creating Value-Based Health Care, MUMC+: MA Dermatologie (9), MUMC+: MA Dermatologie (3), Dermatologie, MUMC+: MA AIOS Dermatologie (9), RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
retrospective study
Health informatics
DISEASE
Health administration
030207 dermatology & venereal diseases
0302 clinical medicine
referral decisions
Health care
030212 general & internal medicine
Referral and Consultation
Netherlands
PROVISION
Health Policy
Nursing research
lcsh:Public aspects of medicine
Middle Aged
GENERAL-PRACTITIONERS
Primary care
INTERFACE
Female
Research Article
Adult
medicine.medical_specialty
EFFICIENCY
Referral
dermatology care
SPECIALIST CARE
Dermatology
substitution of healthcare
Secondary Care
03 medical and health sciences
primary care plus (PC+)
Ambulatory care
Outpatient care
medicine
Humans
QUALITY
Referral decision
TELEMEDICINE
Aged
Retrospective Studies
REFERRAL RATES
Primary Health Care
business.industry
Public health
Retrospective cohort study
lcsh:RA1-1270
SERVICES
HEALTH-CARE
business
Substitution
Zdroj: BMC Health Services Research, Vol 20, Iss 1, Pp 1-10 (2020)
BMC Health Services Research
BMC Health Services Research, 20(1). BioMed Central Ltd
BMC Health Services Research, 20(510)
ISSN: 1472-6963
DOI: 10.1186/s12913-020-05368-2
Popis: Background The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch ‘Blue Care’ pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision. Methods This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors. Results A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient’s diagnosis independently influenced the referral decisions following PC+. Conclusion The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.
Databáze: OpenAIRE
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