Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands.
PLoS One. 2019 Aug 1;14(8):e0219957. doi: 10.1371/journal.pone.0219957. eCollection 2019.
RATIONALE, AIMS AND OBJECTIVE: Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting.
The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible.
A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers.
Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design.
背景、目的和目标：将门诊医院护理替代为初级保健被视为一种解决方案，可以减少不必要的门诊医院护理转诊，并降低不断上升的医疗保健成本。本系统评价旨在评估通过医疗专家在初级保健环境中进行面对面咨询来替代门诊医院护理的基于初级保健的干预措施对护理质量、健康和成本结果的影响。
系统评价使用 PICO 框架进行。合格的原始论文前提是通过在初级保健环境中涉及医疗专家来替代门诊医院护理。
共纳入 14 篇论文。11 篇论文描述了在全科医生 (GP) 实践中进行的替代干预措施，3 篇论文描述了联合咨询干预措施，其中全科医生与医疗专家一起为患者提供服务。这项研究表明，替代举措通常会产生比门诊医院护理更有利的结果。这些举措通常会导致较短的等候名单、较短的诊所等候时间和更高的患者满意度。在干预环境中，治疗额外患者的成本似乎更高。这主要是由于咨询时间规划效率低下和患者人数减少所致。
尽管国际上已经写了很多关于进行替代干预措施的重要性的文章，这些干预措施的目的是防止不必要的门诊医院护理转诊，但仅纳入了 14 篇论文。未来的系统评价应侧重于替代举措对三重目标的影响，其中除了医疗专家之外，还涉及其他医疗保健专业人员以及新技术，例如电子咨询。此外，为了更深入地了解在动态医疗保健环境中运作的替代举措的效果，重要的是要在纵向研究设计中不断评估干预措施。
