Strong primary care and patients\u2019 survival

Michel Wensing,Gunter Laux,Joachim Szecsenyi,Petra Kaufmann-Kolle

doi:10.1038/s41598-019-47344-9

Michel Wensing, Gunter Laux + Show 2 more

Open Access

https://doi.org/10.1038/s41598-019-47344-9

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Abstract

Primary healthcare is the cornerstone of any healthcare system. A major health system reform to strengthen primary care has been implemented in Germany since 2008. Key components include: voluntary participation, intensive management of patients with chronic diseases, coordination of access to medical specialists, continuous quality improvement, and capitation-based reimbursement. The objective of this study was to assess the effect of this reform on survival of enrolled patients. We conducted a comparative cohorts study with 5-year follow-up, starting in the year 2012 in Baden-Wuerttemberg, Germany. Participants were 1,003,336 enrolled patients and 725,310 control patients. A Cox proportional hazards regression model was applied to compare survival of enrolled patients with a composed control cohort of non-enrolled patients, adjusted for a range of patient and physician characteristics. Average age of enrolled patients was 57.3 years and 56.1% were women. Compared to control patients, they had lower mortality (Hazard Ratio: 0.978; 95% CI: 0.968; 0.989). Participation in chronic disease management programs had independent impact on survival rate (Hazard Ratio 0.744, 95% CI: 0.734; 0.753). We concluded that strong primary care is safe and potentially beneficial in terms of patients’ survival.

Highlights

Strong primary care is characterized by the provision first point of access to healthcare for most people and most health issues, high continuity over time and coordination across healthcare providers, and a strong patient-centered approach[1]
This study in routine healthcare found lower 5-year mortality in patients enrolled in strong primary care as compared to a comparable cohort of non-enrolled patients
The study shows that the strong primary care www.nature.com/scientificreports

Summary

Introduction

Strong primary care is characterized by the provision first point of access to healthcare for most people and most health issues, high continuity over time and coordination across healthcare providers, and a strong patient-centered approach[1]. Insight into the causal mechanisms is limited, epidemiological studies reported on better health outcomes and lower healthcare costs in healthcare systems with strong primary care[2,3] Despite these benefits, primary care is under pressure across the world, indicated by shortages of primary care capacity and signals of suboptimal performance. In Germany, health system reforms to strengthen primary care (‘Hausarztzentrierte Versorgung’) have been implemented in the law (Social Code Book V) in the previous decade These reforms were designed as voluntary contracts between healthcare insurers and primary care physicians, and voluntary enrollment by patients. These have effectively reformed the healthcare system as they scaled-up intensive management of chronically ill patients, coordination of access to medical specialist care, and participation of primary care physicians in continuous quality improvement activities. The aim of this study was to assess the effects of the strong primary care model on patient survival

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