Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus

Abstract

Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation.Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex consultations at general practitioner practices. Qualitative data were collected through interviews with general practitioners and medical specialists, focus groups and notes from meetings in the Netherlands between April 2013 and January 2014. Data were analysed using a conventional content analysis which resulted in categorised barriers, facilitators and policy adjustments, after which preconditions were formulated.Results: The most important preconditions were make arrangements on governmental level, arrange a collective integrated IT-system, determine the appropriate profile for medical specialists, design a referral protocol for eligible patients, arrange deliberation possibilities for general practitioners and medical specialists and formulate a diagnostic protocol.Conclusions: The barriers, facilitators and formulated preconditions provided relevant input to change the design of substituting hospital care with primary care.

Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting

“…The apparent influence of the possibility to request additional diagnostic tests on the referral decision is in accordance with the study by van Hoof et al [28]. In the present study, specialists indicated that they needed diagnostic imaging, such as an X-ray, to diagnose patients.…”

“…Development of patient profiles for PC+ appears relevant for further optimisation of the program. These profiles can give an indication of patient complaints that are suitable for PC+, which would support GPs in their PC+ referral behavior [28].…”

“…Orthopaedic care was one of the four specialties involved. Although the results of the feasibility study by van Hoof et al [28] showed that PC+ seemed to be a promising intervention, problems of inefficiency and competitive restraints were found. Therefore, two independent PC+ centres located in the city of Maastricht were established in 2014.…”

“…The region Maastricht-Heuvelland developed the PC+ intervention to substitute primary care for outpatient hospital care. The concept of PC+ started with a pilot in which four medical specialties performed consultations within GP practices [21,28]. Orthopaedic care was one of the four specialties involved.…”

Substitution of low-risk skin cancer hospital care towards primary care: A qualitative study on views of general practitioners and dermatologists

“…Rising health care expenditures places the potential for substitution of hospital care towards primary care high on the political agenda. [ 1 ] With the Dutch health care system being one of the most costly in Europe[ 2 ], the ultimate goal for the Dutch health care system to make it more sustainable for the future. [ 3 , 4 ] This may imply substituting tasks to primary care, and preventing unnecessary referrals to secondary care.…”