Reorganising Dermatology Care: Predictors of the Substitution of Secondary Care with Primary Care

Overview

Journal BMC Health Serv Res

Publisher Biomed Central

Specialty Health Services

Date 2020 Jun 7

PMID 32503509

Citations 3

Authors

Esther H A van den Bogaart

Marielle E A L Kroese

Marieke D Spreeuwenberg

Herm Martens

Peter M Steijlen

Dirk Ruwaard

Affiliations

Soon will be listed here.

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.

Citing Articles

Skin diseases in a primary, secondary, and tertiary setting in Trinidad and Tobago, with an evaluation of service provision.

Hallai N, Macias V, Iswaravaka S, Ramroop S, Ramjit S, Laloo P Skin Health Dis. 2024; 4(1):e307.

PMID: 38312243 PMC: 10831545. DOI: 10.1002/ski2.307.

Assessment of Primary Care Physicians' Expertise of Common Dermatological Conditions in the Jouf Region, Saudi Arabia: A Mixed Methods Study.

Alotaibi H, Alruwaili Z, Dilli A, Altaleb A, Asiri M, Alwadani O Healthcare (Basel). 2023; 11(12).

PMID: 37372823 PMC: 10298479. DOI: 10.3390/healthcare11121705.

The spectrum of skin-related conditions in primary care during 2015-2019-A Finnish nationwide database study.

Salava A, Oker-Blom A, Remitz A Skin Health Dis. 2022; 1(3):e53.

PMID: 35663141 PMC: 9060089. DOI: 10.1002/ski2.53.

References

Starfield B, Shi L, Macinko J . Contribution of primary care to health systems and health. Milbank Q. 2005; 83(3):457-502. PMC: 2690145. DOI: 10.1111/j.1468-0009.2005.00409.x. View

Winpenny E, Miani C, Pitchforth E, King S, Roland M . Improving the effectiveness and efficiency of outpatient services: a scoping review of interventions at the primary-secondary care interface. J Health Serv Res Policy. 2016; 22(1):53-64. PMC: 5482389. DOI: 10.1177/1355819616648982. View

Courtenay M, Carey N . Nurse-led care in dermatology: a review of the literature. Br J Dermatol. 2006; 154(1):1-6. DOI: 10.1111/j.1365-2133.2005.06979.x. View

Delnoij D, Van Merode G, Paulus A, Groenewegen P . Does general practitioner gatekeeping curb health care expenditure?. J Health Serv Res Policy. 2000; 5(1):22-6. DOI: 10.1177/135581960000500107. View

ODonnell C . Variation in GP referral rates: what can we learn from the literature?. Fam Pract. 2000; 17(6):462-71. DOI: 10.1093/fampra/17.6.462. View

Sampson R, Barbour R, Wilson P . The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study. BMC Fam Pract. 2016; 17:45. PMC: 4831146. DOI: 10.1186/s12875-016-0442-y. View

van der Heijden J, de Keizer N, Bos J, Spuls P, Witkamp L . Teledermatology applied following patient selection by general practitioners in daily practice improves efficiency and quality of care at lower cost. Br J Dermatol. 2011; 165(5):1058-65. DOI: 10.1111/j.1365-2133.2011.10509.x. View

Schut F, Varkevisser M . Competition policy for health care provision in the Netherlands. Health Policy. 2016; 121(2):126-133. DOI: 10.1016/j.healthpol.2016.11.002. View

Roine R, Ohinmaa A, Hailey D . Assessing telemedicine: a systematic review of the literature. CMAJ. 2001; 165(6):765-71. PMC: 81454. View

10.

van Hoof S, Spreeuwenberg M, Kroese M, Steevens J, Meerlo R, Hanraets M . Substitution of outpatient care with primary care: a feasibility study on the experiences among general practitioners, medical specialists and patients. BMC Fam Pract. 2016; 17:108. PMC: 4979105. DOI: 10.1186/s12875-016-0498-8. View

11.

Knol A, van den Akker T, Damstra R, de Haan J . Teledermatology reduces the number of patient referrals to a dermatologist. J Telemed Telecare. 2006; 12(2):75-8. DOI: 10.1258/135763306776084365. View

12.

Federman D, Hogan D, Taylor J, Caralis P, Kirsner R . A comparison of diagnosis, evaluation, and treatment of patients with dermatologic disorders. J Am Acad Dermatol. 1995; 32(5 Pt 1):726-9. DOI: 10.1016/0190-9622(95)91449-8. View

13.

van Hoof S, Kroese M, Spreeuwenberg M, Elissen A, Meerlo R, Hanraets M . Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus. Int J Integr Care. 2016; 16(1):12. PMC: 5015530. DOI: 10.5334/ijic.2446. View

14.

Ringberg U, Fleten N, Forde O . Examining the variation in GPs' referral practice: a cross-sectional study of GPs' reasons for referral. Br J Gen Pract. 2014; 64(624):e426-33. PMC: 4073728. DOI: 10.3399/bjgp14X680521. View

15.

Awadalla F, Rosenbaum D, Camacho F, Fleischer Jr A, Feldman S . Dermatologic disease in family medicine. Fam Med. 2008; 40(7):507-11. View

16.

Davies P, Pool R, Smelt G . What do we actually know about the referral process?. Br J Gen Pract. 2011; 61(593):752-3. PMC: 3223771. DOI: 10.3399/bjgp11X613278. View

17.

van den Bogaart E, Spreeuwenberg M, Kroese M, van den Boogaart M, Boymans T, Ruwaard D . Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting. PLoS One. 2020; 15(1):e0227863. PMC: 6977750. DOI: 10.1371/journal.pone.0227863. View

18.

Coast J, Noble S, Noble A, Horrocks S, Asim O, Peters T . Economic evaluation of a general practitioner with special interests led dermatology service in primary care. BMJ. 2005; 331(7530):1444-9. PMC: 1315650. DOI: 10.1136/bmj.38676.446910.7C. View

19.

Berwick D, Nolan T, Whittington J . The triple aim: care, health, and cost. Health Aff (Millwood). 2008; 27(3):759-69. DOI: 10.1377/hlthaff.27.3.759. View

20.

Shea D, Stuart B, Vasey J, Nag S . Medicare physician referral patterns. Health Serv Res. 1999; 34(1 Pt 2):331-48. PMC: 1089005. View