Abstract
BackgroundThe complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. To inform the development of integrated care models, it is essential to map patients’ use of healthcare resources. In this nationwide registry-based cohort study, we describe and compare patient characteristics and healthcare utilisation between Danish patients with chronic conditions in general practice follow-up and in hospital outpatient follow-up.MethodsOn 1 January 2016, we identified 250,402 patients registered in 2006–2015 with a hospital diagnosis of atrial fibrillation/flutter, congestive heart failure, chronic liver disease, inflammatory bowel disease or chronic obstructive pulmonary disease. By linkage to national social and health registries, patient characteristics and 12-month healthcare utilisation were extracted. Incidence rates of health care utilisation were compared between patients with chronic conditions in general practice follow-up and patients in hospital outpatient follow-up using negative binomial regression.ResultsAcross all five conditions, the largest proportions of patients were in general practice follow-up (range = 59–87%). Patients in hospital outpatient follow-up had higher rates of exacerbation-related admissions (adjusted incidence rate ratio (IRR) range = 1.3 to 2.8) and total length of stay (IRR range = 1.2 to 2.2). For these five conditions, all-cause admissions and lengths of stay, general practice daytime and out-of-hours contacts, and municipal home nursing contacts were similar between follow-up groups or higher among patients in general practice follow-up. The exception was patients with chronic obstructive pulmonary disease, where patients in hospital outpatient follow-up had higher utilisation of healthcare resources.ConclusionsPatients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates. Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is also likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up.
Highlights
The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand
Patients in general practice follow-up accounted for the largest proportion of total healthcare utilisation, but patients in hospital outpatient follow-up were characterised by high exacerbation rates
Enhanced integration of chronic care may be of most benefit if patients in general practice follow-up are targeted, but it is likely to have an impact on exacerbation rates among patients in hospital outpatient follow-up
Summary
The complexity of caring for patients with chronic conditions necessitates new models of integrated care to accommodate an increasing demand. Overall quality of the Danish system is considered satisfactory [6], but fragmentation is a threat to chronic care due to a lack of continuity between sectors [7] This is further complicated by a high degree of specialisation in hospitals and a shortage of GPs [8]. Danish chronic care is intended to be guided by the principles of the Chronic Care Model (CCM) and risk stratification [6] This means that the majority of patients with chronic conditions have regular follow-up appointments in general practice, while a small proportion characterised by a moderate to high degree of complications have additional follow-up appointments in the specialised hospital outpatient setting. Formal criteria are lacking for other chronic conditions and the division of care has yet to be empirically investigated as a first step for improving chronic care delivery between general practice and hospitals
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