Department of Primary and Long-term Care, University of Groningen, University Medical Center Groningen, PO Box 196, 9700 AD, Groningen, the Netherlands.
Project Group Care Substitution Service Regiopoli Sunenz Drachten, Drachten, the Netherlands.
BMC Prim Care. 2023 Sep 1;24(1):171. doi: 10.1186/s12875-023-02137-y.
In care substitution services, medical specialists offer brief consultations to provide general practitioners (GPs) with advice on diagnosis, treatment, or hospital referral. When GPs serve as gatekeepers to secondary care, these regional services could reduce pressures on healthcare systems. The aim is to determine the impact of implementing a care substitution service for dermatology, orthopaedics, and cardiology on the hospital referral rate, health care costs, and patient satisfaction.
A before-after study was used to evaluate hospital referral rates and health care costs during a follow-up period of 1 year. The study population comprised patients with eligible International Classification of Primary Care codes for referral to the care substitution service (only dermatology, orthopaedic, cardiology indications), as pre-defined by GPs and medical specialists. We compared referral rates before and after implementation by χ tests and evaluated patient preference by qualitative analysis.
In total, 4,930 patients were included, 2,408 before and 2,522 after implementation. The care substitution service decreased hospital referrals during the follow-up period from 15 to 11%. The referral rate decreased most for dermatology (from 15 to 9%), resulting in a cost reduction of €10.59 per patient, while the other two specialisms experienced smaller reductions in referral rates. Patients reported being satisfied, mainly because of the null cost, improved organisation, improved care, and positive experience of the consultation.
The care substitution service showed promise for specialisms that require fewer hospital facilities, as exemplified by dermatology.
在医疗替代服务中，医学专家提供简短的咨询，为全科医生提供诊断、治疗或医院转诊建议。当全科医生担任二级保健的把关人时，这些区域服务可以减轻医疗保健系统的压力。其目的是确定实施皮肤科、骨科和心脏病学替代护理服务对转诊率、医疗保健成本和患者满意度的影响。
采用前后对照研究，在 1 年的随访期间评估转诊率和医疗保健成本。研究人群包括符合转诊至替代护理服务的国际初级保健分类（仅皮肤科、骨科、心脏病学适应证）的患者，由全科医生和医学专家预先定义。我们通过 χ 检验比较实施前后的转诊率，并通过定性分析评估患者的偏好。
共有 4930 名患者入组，实施前 2408 名，实施后 2522 名。在随访期间，替代护理服务使医院转诊减少了 15%至 11%。皮肤科的转诊率降幅最大（从 15%降至 9%），导致每位患者的成本降低了 10.59 欧元，而其他两个专科的转诊率降幅较小。患者报告满意，主要是因为零成本、更好的组织、更好的护理以及对咨询的积极体验。
对于需要较少医院设施的专业，如皮肤科，替代护理服务显示出了潜力。
