Hamburg Center for Health Economics (HCHE), University of Hamburg, Hamburg, Germany
Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany.
BMJ Open. 2022 Oct 21;12(10):e061964. doi: 10.1136/bmjopen-2022-061964.
To examine the effect of introducing a non-clinical community health advice and navigation service on the demand for primary care in a socially deprived area.
Observational panel study with difference-in-differences design. We conducted fixed-effects negative binomial regressions to compare changes in the number of visits to general practitioners (GPs) in individuals who visited the health advice and navigation service and a matched control group of individuals who did not visit the service. In addition, we analysed the effects of visiting the service multiple times.
Our empirical setting is a socially deprived urban area in Germany with a multicultural population of about 110 000 people. Our analyses are based on patient data (N=1044) from a non-clinical community health advice and navigation service and from two statutory health insurers.
Patient demand for primary care measured as the number of visits to GPs before and after the first visit to the health advice and navigation service.
Visiting the service for the first time significantly decreased the number of GP visits compared with the control group (β=-0.113, p<0.1). Each additional visit to the service, however, significantly decreased the effect of the first visit (β=0.037, p<0.05).
Our findings suggest that non-clinical community health advice and navigation services can serve as a low-threshold first point of contact. As first point contact, such services might possibly reduce the burden of primary care physicians in socially deprived areas. At the same time, such services might function as a gateway to accessing the health system, reducing unmet care needs and stimulate demand. Ongoing counselling in the service can identify medical needs that require a physician visit. Our findings may be useful for policymakers and healthcare leaders seeking to reduce the demand on the primary care workforce and can stimulate further research in this area.
研究在社会贫困地区引入非临床社区健康咨询和导航服务对初级保健需求的影响。
观察性面板研究，采用差异-差异设计。我们进行固定效应负二项回归分析，比较访问健康咨询和导航服务的个体与未访问该服务的匹配对照组个体的就诊次数变化。此外，我们还分析了多次访问该服务的效果。
我们的实证背景是德国一个社会贫困的城市地区，人口多元，约有 11 万人。我们的分析基于非临床社区健康咨询和导航服务以及两家法定健康保险公司的患者数据（N=1044）。
初级保健需求的患者需求，以首次访问健康咨询和导航服务前后的家庭医生就诊次数衡量。
与对照组相比，首次访问该服务显著减少了家庭医生就诊次数（β=-0.113，p<0.1）。然而，每次额外访问该服务都显著降低了首次访问的效果（β=0.037，p<0.05）。
我们的研究结果表明，非临床社区健康咨询和导航服务可以作为低门槛的第一个接触点。作为第一个接触点，此类服务可能有助于减轻社会贫困地区初级保健医生的负担。同时，此类服务可以作为进入医疗体系的门户，减少未满足的医疗需求并刺激需求。服务中的持续咨询可以确定需要医生就诊的医疗需求。我们的研究结果可能对寻求减少初级保健劳动力需求的政策制定者和医疗保健领导者有用，并可以促进该领域的进一步研究。
