How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study

Abstract

BackgroundTo 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.MethodsWe 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.ResultsOur 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.ConclusionsUtilization 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3246-z) contains supplementary material, which is available to authorized users.

Socioeconomic inequalities in out-of-hours primary care use: an electronic health records linkage study

“…33,34 Additionally, these patients may have difficulty obtaining other healthcare and social services and therefore may experience unmet needs. 2,35,36 The Jansen, T., Hek, K. Schellevis, F.G., Kunst, A.E., Verheij, R.A. Socioeconomic inequalities in out-ofhours primary care use: an electronic health records linkage study. European Journal of Public Health: 2020 __________________________________________________________________________________________________________________________________ This is a Nivel certified Post Print, more info at nivel.nl 7…”

“…1 Timely access to an OPCS is pivotal for adequate delivery of primary healthcare and prevention of unplanned hospital visits. 2,3 For patients with multiple health problems, the acute health problem focused approach of OPCSs could, however, be disadvantageous. Continuity of care is hampered by limited or lack of knowledge about the patient's medical history at the OPCS.…”

“…Socioeconomically vulnerable individuals thus would benefit from the continuity of care and familiarity with the patient's background in DGP. 2,11,12 However, there lies a paradox in the needs of low SEP patients, with their generally more complex health problems, and the generally limited resources available to them to put these needs into adequate action and benefit from healthcare. The complexity imposed by multimorbidity necessitates skills that low SEP individuals often lack.…”

“…10 Although the strong primary healthcare system of the Netherlands does not represent a strong market competition, and fosters equity in healthcare accessibility, 11 low SEP is related to more fragmented and inappropriate use of health and social services. 2 Suboptimal healthcare use may be reflected in higher rates of OPCS use by low SEP individuals. In a previous study, we found that OPCS use was higher in each lower level of neighbourhood socioeconomic status.…”

A Polish Pilot Programme of Coordinated Care: A Herald of Change or a Missed Opportunity? A Critical Debate

“…We feel that the pilot would greatly benefit from multi-sectoral collaboration, especially with an aim to address complex health needs of deprived populations. In various coordinated care models around the world, it has often been achieved through collaboration between health care and social care (56,57). Furthermore, POZ Plus also entails a degree of functional integration in the form of selected support functions (a uniform IT system, management model, and reporting system), whose use is simply required by the government as the programme initiator and leader.…”