PHP8 - THE ROLE OF GENERAL PRACTITIONERS IN TRAUMA CARE: VARIATION BY INJURY TYPE, REGION, PATIENT PROFILE, AND OVER TIME

Abstract

General practitioners (GPs) are essential within the Swiss healthcare system. In our study, we analyze the role of GPs in trauma care: to what extent and for what types of injury GPs act as initial point of care and whether they act as sole care providers or refer patients. We examine differences depending on injury type, region, patient age and citizenship, considering developments over time. Using a claims dataset from the largest Swiss accident insurer with N=2.2 million injury cases between 2008 and 2014, we construct individual treatment trajectories, i.e., when and from which provider they received care. We estimate conditional probabilities for different trajectories, adjusting for injury and patient characteristics using multinomial regression models. Overall, GPs acted as initial point of care in 55% of injury cases with substantial differences between injury types (e.g. 66% of knee contusions; 37% of wrist fractures). GPs played a role in follow-up care in 15%, and were not involved in 30% of cases. In 42% of cases, GPs were sole care providers. GPs referred patients to medical specialists in 4% or to hospitals in 9% of cases. GPs’ involvement is higher in rural regions, among elderly patients, and among Swiss citizens than noncitizens. From 2008 to 2014, there was a steady decline from 58% to 52% of injury cases where GPs acted as first point of care, and a decline from 44% to 39% where GPs acted as exclusive care provider. Our findings show that GPs play a key role in trauma care, but there is considerable variation depending on region, patient profile, and injury type. The general decline in GP involvement in trauma care may be an indication that their role in Swiss healthcare is changing, which may have implications for their continuous education and training.