Quality of After-Hours Primary Care in the Netherlands: A Narrative Review
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Quality of After-Hours Primary Care in the Netherlands: A Narrative Review. Ann Intern Med.2011;155:108-113. [Epub 19 July 2011]. doi:10.7326/0003-4819-155-2-201107190-00006
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Cost containment using Primary Care Cooperatives is unlikely in open access health systems
Giesen et al offer a thorough review of the system of after hours primary care services in the Netherlands using Primary Care Cooperatives (PCC).[1] This study demonstrates high quality, as indicated by low numbers of adverse events and high adherence to national guidelines. In the Netherlands, primary care physicians (PCP) function as cornerstone of the health care system. Patients hardly have any free access to secondary services during regular work hours. Therefore, the conclusions of this research should be interpreted with great caution for use in more competitive health systems.
Belgium, a neighbouring country to the Netherlands, recently developed alike services for PCP as well. However, the structure of the health care system is very different.[2] PCP have no gatekeepers function and Emergency Departments (EDs) compete with primary health care services for patients and income. While the Netherlands have a PCP-oriented health care system, Belgium has a health care system with free access to all levels of medical care.
We recently performed a prospective intervention study in a region of 180 000 inhabitants with two hospitals, their respective EDs and one large PPC. Before the intervention, primary care physicians were on call from their own premises. One year after the implementation of the PPC, the number of primary care contacts increased, while the number of contacts at the ED remained the same. We concluded that establishment of a PCC in an open access health care system, might redirect some patients with particular medical problems to primary care or even attract surplus work, but did not lower workload at the EDs.[3]
The literature emphasizes that redirecting a number of patients (e.g. inappropriate users, self-referrals, ...) from EDs to primary care services reduces costs and improves the quality of care. However, to achieve this in open access health system, a more rigorous approach is mandatory. A more explicit image of primary health care is needed, as stated in the latest WHO report.[4] This can only be assured by incentives at the level of payers of care who should best support concerted actions of EDs and PPCs. To change patient behavior, centrally-delivered information to patients about the tasks and skills of primary care physicians is necessary. Furthermore, PPCs should provide professional service from the first-time contact on as experience is the most critical factor in choice of after-hours medical care.[5]
Roy Remmen, MD, PhD, Hilde Philips, MD, PhD, Jonathan Van Bergen, MD, Department of Primary and Interdisciplinary care, University of Antwerp
References
[1.] Giesen, P., et al., Quality of After-Hours Primary Care in the Netherlands: A Narrative Review. Annals of Internal Medicine, 2011. 155(2): p. 108-113.
[2.] Huibers, L., et al., Out-of-hours care in western countries: assessment of different organizational models. BMC Health Services Research, 2009. 9(1): p. 105.
[3.] Philips, H., et al., What's the effect of the implementation of general practitioner cooperatives on caseload? Prospective intervention study on primary and secondary care. BMC Health Services Research, 2010. 10(1): p. 222.
[4.] WHO, The World Health Report: Primary Health Care: Now more than ever. 2008.
[5.] Philips, H., Experience: the most critical factor in choosing after- hours medical care. Qual Saf Health Care, 2010.
Conflict of Interest:
None declared