Reorganising dermatology care: predictors of the substitution of secondary care with primary care

Esther H A van den Bogaart; Mariëlle E A L Kroese; Marieke D Spreeuwenberg; Herm Martens; Peter M Steijlen; Dirk Ruwaard

doi:10.1186/s12913-020-05368-2

Reorganising dermatology care: predictors of the substitution of secondary care with primary care

Esther H A van den Bogaart^*, Mariëlle E A L Kroese, Marieke D Spreeuwenberg, Herm Martens, Peter M Steijlen, Dirk Ruwaard

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch 'Blue Care' pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision.

METHODS: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors.

RESULTS: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient's diagnosis independently influenced the referral decisions following PC+.

CONCLUSION: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.

Original language	English
Pages (from-to)	510
Number of pages	10
Journal	BMC Health Services Research
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12913-020-05368-2
Publication status	Published - 5 Jun 2020

Keywords

Dermatology
EFFICIENCY
GENERAL-PRACTITIONERS
HEALTH-CARE
INTERFACE
Outpatient care
PROVISION
Primary care
QUALITY
REFERRAL RATES
Referral decision
SERVICES
SPECIALIST CARE
Substitution
TELEMEDICINE
DISEASE

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Cite this

@article{e3bbb085c81b45e2969861b9b5eded18,

title = "Reorganising dermatology care: predictors of the substitution of secondary care with primary care",

abstract = "BACKGROUND: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch 'Blue Care' pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision.METHODS: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors.RESULTS: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient's diagnosis independently influenced the referral decisions following PC+.CONCLUSION: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.",

keywords = "Dermatology, EFFICIENCY, GENERAL-PRACTITIONERS, HEALTH-CARE, INTERFACE, Outpatient care, PROVISION, Primary care, QUALITY, REFERRAL RATES, Referral decision, SERVICES, SPECIALIST CARE, Substitution, TELEMEDICINE, DISEASE",

author = "{van den Bogaart}, {Esther H A} and Kroese, {Mari{\"e}lle E A L} and Spreeuwenberg, {Marieke D} and Herm Martens and Steijlen, {Peter M} and Dirk Ruwaard",

note = "Funding Information: We acknowledge financial support for the study from the insurers CZ and VGZ and the Province of Limburg. We would also like to acknowledge employees from the Maastricht UMC+ Patient and Care Department (in Dutch, Resultaat Verantwoordelijke Eenheid Pati{\"e}nt & Zorg) for their contributions in providing us with data. Finally, we acknowledge the participating GPs of Care In Development, the participating medical specialists of the Maastricht UMC+ and the other people involved in PC+ for their effort. An earlier version of this work was presented at the International Conference on Integrated Care in 2018 [56]. Publisher Copyright: {\textcopyright} 2020 The Author(s).",

year = "2020",

month = jun,

day = "5",

doi = "10.1186/s12913-020-05368-2",

language = "English",

volume = "20",

pages = "510",

journal = "BMC Health Services Research",

issn = "1472-6963",

publisher = "BioMed Central Ltd",

number = "1",

}

TY - JOUR

T1 - Reorganising dermatology care

T2 - predictors of the substitution of secondary care with primary care

AU - van den Bogaart, Esther H A

AU - Kroese, Mariëlle E A L

AU - Spreeuwenberg, Marieke D

AU - Martens, Herm

AU - Steijlen, Peter M

AU - Ruwaard, Dirk

N1 - Funding Information: We acknowledge financial support for the study from the insurers CZ and VGZ and the Province of Limburg. We would also like to acknowledge employees from the Maastricht UMC+ Patient and Care Department (in Dutch, Resultaat Verantwoordelijke Eenheid Patiënt & Zorg) for their contributions in providing us with data. Finally, we acknowledge the participating GPs of Care In Development, the participating medical specialists of the Maastricht UMC+ and the other people involved in PC+ for their effort. An earlier version of this work was presented at the International Conference on Integrated Care in 2018 [56]. Publisher Copyright: © 2020 The Author(s).

PY - 2020/6/5

Y1 - 2020/6/5

N2 - BACKGROUND: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch 'Blue Care' pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision.METHODS: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors.RESULTS: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient's diagnosis independently influenced the referral decisions following PC+.CONCLUSION: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.

AB - BACKGROUND: The substitution of healthcare is a way to control rising healthcare costs. The Primary Care Plus (PC+) intervention of the Dutch 'Blue Care' pioneer site aims to achieve this feat by facilitating consultations with medical specialists in the primary care setting. One of the specialties involved is dermatology. This study explores referral decisions following dermatology care in PC+ and the influence of predictive patient and consultation characteristics on this decision.METHODS: This retrospective study used clinical data of patients who received dermatology care in PC+ between January 2015 and March 2017. The referral decision following PC+, (i.e., referral back to the general practitioner (GP) or referral to outpatient hospital care) was the primary outcome. Stepwise logistic regression modelling was used to describe variations in the referral decisions following PC+, with patient age and gender, number of PC+ consultations, patient diagnosis and treatment specialist as the predicting factors.RESULTS: A total of 2952 patients visited PC+ for dermatology care. Of those patients with a registered referral, 80.2% (N = 2254) were referred back to the GP, and 19.8% (N = 558) were referred to outpatient hospital care. In the multivariable model, only the treating specialist and patient's diagnosis independently influenced the referral decisions following PC+.CONCLUSION: The aim of PC+ is to reduce the number of referrals to outpatient hospital care. According to the results, the treating specialist and patient diagnosis influence referral decisions. Therefore, the results of this study can be used to discuss and improve specialist and patient profiles for PC+ to further optimise the effectiveness of the initiative.

KW - Dermatology

KW - EFFICIENCY

KW - GENERAL-PRACTITIONERS

KW - HEALTH-CARE

KW - INTERFACE

KW - Outpatient care

KW - PROVISION

KW - Primary care

KW - QUALITY

KW - REFERRAL RATES

KW - Referral decision

KW - SERVICES

KW - SPECIALIST CARE

KW - Substitution

KW - TELEMEDICINE

KW - DISEASE

U2 - 10.1186/s12913-020-05368-2

DO - 10.1186/s12913-020-05368-2

M3 - Article

C2 - 32503509

SN - 1472-6963

VL - 20

SP - 510

JO - BMC Health Services Research

JF - BMC Health Services Research

IS - 1

ER -