Abstract
BackgroundReinforcing the gatekeeping role of general practitioners (GPs) by embedding specialist knowledge into primary care is seen as a possibility for stimulating a more sustainable healthcare system and avoiding unnecessary referrals to outpatient care. An intervention called Primary Care Plus (PC+) was developed to achieve these goals. The objective of this study is to gain insight into: (1) the content and added value of PC+ consultations according to stakeholders, and (2) patient satisfaction with PC+ compared to outpatient care.MethodsA feasibility study was conducted in the southern part of the Netherlands between April 2013 and January 2014. Data was collected using GP, medical specialist and patient questionnaires. Patient characteristics and medical specialty data were collected through the data system of a GP referral department.ResultsGPs indicated that they would have referred 85.4 % of their PC+ patients to outpatient care in the hypothetical case that PC+ was not available. Medical specialists indicated that about one fifth of the patients needed follow-up in outpatient care and 75.9 % of the consultations were of added value to patient care. The patient satisfaction results appear to be in favour of PC+.ConclusionPC+ seems to be a feasible intervention to be implemented on a larger scale, because it has the potential to prevent unnecessary hospital referrals. PC+ will be evaluated on a larger scale regarding the effects on health outcomes, quality of care and costs (Triple Aim principle).
Highlights
Reinforcing the gatekeeping role of general practitioners (GPs) by embedding specialist knowledge into primary care is seen as a possibility for stimulating a more sustainable healthcare system and avoiding unnecessary referrals to outpatient care
During the PC+ feasibility study 17 GPs with 32,322 patients, working under the umbrella of primary care organisation ‘Care in Development’, were able to refer patients to PC+ in case they were uncertain of the diagnosis, treatment or necessity to refer a patient to outpatient care
For the remaining internal medicine patients, the complaint was taken care of after the consultation in PC+ (21.4 %), 47.6 % needed an extra consultation with the GP, and 29.8 % needed an extra consultation in PC+
Summary
Reinforcing the gatekeeping role of general practitioners (GPs) by embedding specialist knowledge into primary care is seen as a possibility for stimulating a more sustainable healthcare system and avoiding unnecessary referrals to outpatient care. Previous studies have shown van Hoof et al BMC Family Practice (2016) 17:108 that integrating outreach services of specialist care into primary care could lead to a higher satisfaction of GPs with working processes, with no increase of total costs and a decrease of referrals to outpatient departments and specialist centres [10,11,12,13,14,15]. Other research on joint consultation interventions where medical specialists together with GPs examined and diagnosed patients in a primary care setting showed a decrease in referrals to outpatient care [16, 17]. Other literature states that more medical specialist input could lead to immoderate medical consumption and over-diagnosis [19]
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