Primary Care+ in pioneer site MyCare
Background information: In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, the former Dutch Ministry of Health in 2014 appointed nine Dutch regional initiatives as ‘pioneer sites’. They all aim to restructure health services based on the concept of population management (PM). PM initiatives focus on addressing health needs at all points along the continuum of health and well-being for a specified population by integrating services across health care, prevention, social care and welfare. A considerable number of the interventions implemented in the pioneer site regions are focusing on substitution of care. Substitution of care is defined as the continual regrouping of resources across and within care settings to exploit the best and least costly solution in the face of changing needs and demands.
Aim and relevance of the initiative: This application concerns the implementation of a cardiology primary care plus (PC+) centre which is implemented in the pioneersite ‘MyCare’. The cardiologists, supported by other health-care professionals, provide specialist consultations in a primary care setting. Diagnostic tests are carried out by multiple health-care professionals, such as nurses, laboratory technicians and physicians, all specialized in cardiology. After the tests, the patient meets the cardiologist, who sends a comprehensive description of the results of the tests, the diagnosis and his recommendation regarding further treatment (if needed) to the GP. The PC+ intervention aims to improve patient value and the Triple aim dimensions (the health of the population, patients’ experience of care and health-care costs growth).
Patient description and involvement: All GPs in the region participate in the PC+ intervention and are able to refer non-acute and low-complexity patients with cardiology-related complaints to the PC+ centre. The GP discusses the cardiologist’s recommendation with the patient and based on the principles of shared decision-making the GP and the patient discuss the options for further treatment. Moreover, the GP remains clinically in charge of the patient. The further treatment will depend on the results of the tests and the recommendation of the cardiologist; the three overall options are: 1) the patient needs no care, 2) the patient will remain in the primary care setting or 3) the patient will be referred to secondary care.
Method: This initiative is scientifically evaluated by Maastricht University by performing a quantitative study with a longitudinal observational design with 661 patients (PC+ centre (intervention group, n=370) or hospital-based outpatient care (control group; care-as-usual, n=291).
Size and scope: The implementation started in October 2014 with the medical specialty cardiology and involved 2253 referrals in 1419 patients in 2015. It is currently up scaled to 7 other medical specialties and applicable for a wide range of healthcare issues.
Results: The patient-perceived quality of care was significantly higher within the intervention group for 26 out of 27 items. At baseline and also at three, six and nine months’ follow-up the healthcare costs per patient were significantly lower for patients in the intervention group (P<0.001).
Formation of IPU/ collaboration/ Partnerships: Pioneer site ‘My Care’ is a partnership between the care group called ‘General Practitioners Eastern South-Limburg’, which is a legal entity of all GPs in the region (in Dutch: Huisartsen Oostelijk Zuid-Limburg), the regional hospital Zuyderland Medical Centre, the patient representative foundation called ‘House for Care’ (in Dutch: Huis voor de Zorg, recently renamed into Burgerkracht Limburg) and the dominant health insurance company in the region (named: CZ).