1. Substitution of outpatient hospital care with specialist care in the primary care setting: A systematic review on quality of care, health and costs.
- Author
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van Hoof SJM, Quanjel TCC, Kroese MEAL, Spreeuwenberg MD, and Ruwaard D
- Subjects
- Ambulatory Care economics, Ambulatory Care statistics & numerical data, Delivery of Health Care standards, Humans, Primary Health Care economics, Primary Health Care statistics & numerical data, Specialization economics, Ambulatory Care organization & administration, Cost-Benefit Analysis, Delivery of Health Care economics, Health Care Costs, Primary Health Care organization & administration, Quality of Health Care standards, Specialization statistics & numerical data
- Abstract
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., Method: 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., Results: 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., Conclusions: 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., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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