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

Dionne S Kringos,Arnold P M Van Der Lee,Karien Stronks,Jennifer R Van Den Broeke,Thomas Plochg

doi:10.1186/s12889-016-3246-z

Dionne S Kringos, Arnold P M Van Der Lee + Show 3 more

Open Access

https://doi.org/10.1186/s12889-016-3246-z

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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.

Highlights

To 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
In control district 2 the number of actual versus expected total GP care decreased over time
If we relate the use of care from 2007 onwards to the index year 2006, it becomes clear that the total GP care increased more in the intervention district than in the control districts, compared to control district 2 (Fig. 1)

Summary

Introduction

To 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. People living in deprived neighbourhoods have higher morbidity and mortality rates [1, 2], and they become chronically ill twice as often compared to more advantaged populations [3]. The available evidence suggests that people in lower socioeconomic groups compared to higher groups receive more inappropriate care as regards their (often multiple) health and social care needs [6,7,8,9]. This mismatch results in unnecessary high health care consumption rates. Health problems remain unresolved leading to a high amount of frequent attenders in primary care [9], high referral rates from primary to specialized care, and inappropriate medication use [10,11,12]

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